Bridging Polyvagal Theory and TCM: Understanding the Fight-Flight-Freeze Response

In TCM, we can view mobilization of the fight-flight response through the lens of the Yang sinew channels, which activate the body's defensive (Wei Qi) and muscular responses, highlighting a direct correlation to the sympathetic activation described in PVT. This perspective allows us to see the cascade of physiological and energetic responses—from Qi stagnation and Blood stasis to the impairment of the enteric system—as a comprehensive response system that aligns with the neurobiological pathways outlined by Porges. By understanding these parallels, the cascade of reactions set off by the fight or flight response becomes evident, providing a clear pathway for addressing these responses holistically and restoring balance to the body and mind.

Perception of Threat

Western Medicine

TCM Equivalent

The brain identifies a threat through sensory input (sight, sound, smell, etc.). The eyes and other sensory organs send information to the thalamus, which relays this to the amygdala. The amygdala (part of the limbic system) is activated and assesses the threat level based on past associations.

The Heart (Xin) communicates the sense of danger to the Kidneys (Shen) via the via the Shao yin relationship, so mobilize kidney yang initiating the fight-or-flight response. 80% of sensory input to the ANS is mediated via the eyes. “The eyes have it.” The Liver, as the general of our defenses perceives the threat particularly visual stimuli. This threat is communicated via the jue yin to affect the Parasympathetic activity mediated by the Pericardium.

 

Activation of the HPA Axis

 

Western Medicine	TCM Equivalent
The hypothalamus activates the hypothalamic-pituitary-adrenal (HPA) axis. The hypothalamus releases corticotropin-releasing hormone (CRH). CRH signals the pituitary gland to release adrenocorticotropic hormone (ACTH). ACTH prompts the adrenal cortex to release cortisol.	The Heart-Kidney axis is activated, with the Heart (Fire) and Kidneys (Water) working in harmony to manage the stress response.

 

Signal to the Hypothalamus

Western Medicine	TCM Equivalent
The amygdala sends a distress signal to the hypothalamus. The hypothalamus activates the sympathetic nervous system by sending signals through the autonomic nerves to the adrenal glands.	The Heart (Xin) communicates the sense of danger to the Kidneys (Shen) via the Shaoyin relationship, mobilizing kidney yang and initiating the fight-or-flight response.

 

Release of Adrenaline

Western Medicine	TCM Equivalent
The adrenal medulla releases adrenaline (epinephrine) into the bloodstream, causing various immediate physiological changes.	The Kidney Yang is mobilized (adrenaline induced), initiating a rapid increase in Qi (energy) and Blood circulation to prepare the body for immediate action. Kidney Yang is sympathetic/(+) charge/yang and as part of the fight-flight cascade circulates via the San Jiao (wei qi activation).

 

Release of Cortisol

Western Medicine	TCM Equivalent
Cortisol helps maintain fluid balance and blood pressure. It also regulates non-essential parasympathetic functions to focus energy on  dealing with the threat.	This is a direct example of kidney insulting spleen, or water overacting on earth. Kidney yang (in the form of adrenaline-cortisol) insults or diminishes the role of the spleen in the active fight-flight cascade. Since survival is key, the skeletal muscles below the waist take precedent.

 

Physiological Changes and their TCM Counterparts

 

Physiological Change	Western Medicine	TCM Equivalent
Increased Heart Rate	The heart beats faster to pump more blood to the muscles and vital organs.	The Heart yang flares, increasing both contractile strength and stroke volume to increase circulation of Blood and Qi throughout the body.
Increased Blood Pressure	Blood vessels constrict to increase blood pressure and ensure adequate blood flow.	Wei qi (defensive) is yang in nature and circulates via the San Jiao in the sinew channels, as wei qi is mobilized outwardly in the sinews. This directly affects the pericardium's function of conducting blood through the vessels by increasing smooth muscle contraction in the vasculature to mobilize vital resources for large skeletal muscle.
Rapid Breathing	Breathing rate increases to supply more oxygen to the blood.	The Lungs (Fei) in conjunction with the heart, work harder to regulate the Qi and ensure an adequate supply of air to support the heightened state.
Dilated Pupils	Pupils dilate to allow a wider peripheral vision to scan for oncoming threats, mediated by sympathetic activity.	The Liver, as the general, governs the eyes. Understanding that 80% of the sensory data mediated by the ANS comes from visual input, we can see a direct link between sensory input triggering the fight-flight cascade. Since the primitive reflex activity is mediated by Jue Yin internal rotators for contraction, this conceptualizes the TCM understanding of the liver governing the eyes.
Reduced Digestive Activity	Digestive processes slow down to divert energy to more critical functions.	The Spleen (Pi) and Stomach (Wei) functions are suppressed as parasympathetic activity is reduced to the middle jiao.
Glucose Release	The liver releases stored glucose to provide a quick energy source for muscles.	The Spleen mobilizes stored energy (postnatal Qi) to provide immediate resources for physical action.  Insulin activity is increased to allow cells to take in more cellular fuel.
Muscle Tension	Muscles tense up, preparing for quick action.	The Sinew Channels (Jing Jin) are engaged via the wei qi which is circulated via the San Jiao, preparing the muscles for rapid contraction and movement. The Dai Mai (Belt Vessel) is activated via flexion synergies through the rectus and abdomen, coordinating the mobilization of muscles and Qi below the trunk, ensuring large skeletal muscles are primed for action.

 

 

Return to Homeostasis

Western Medicine	TCM Equivalent
Once the threat is gone, the parasympathetic nervous system is activated. The body gradually returns to its normal, balanced state. Heart rate, blood pressure, and other physiological responses normalize.	The Pericardium serves as the parasympathetic equivalent in TCM. This can be intuited by its yin-yang pairing with the San Jiao as the circulator of sympathetic-wei-yang qi. This is communicated to the Liver via the Jue Yin relationship, informing the general to tell the troops to stand down; the threat is over.