Chronic Sympathetic Dominance and Fascia: Vagal Tone is Visible!

Contributions from mental health and trauma professionals like Peter Levine, PhD, Dr. Stephen Porges, PhD, and Svetlana Masgutova, PhD, illustrate the role of the nervous system and the biochemical processes involved in trauma. However, their profound insights have not yet translated into effective treatment solutions for many. Several factors contribute to this challenge: a persistent mind-body split in mental health, prohibitions against mental health providers physically interacting with patients, inadequate insurance coverage for counseling, and an over-reliance on medication. These issues highlight the complex landscape of mental health care, where pharmaceutical approaches often fail to provide comprehensive solutions.

Mental health symptoms remain subjective and often lack clear clinical markers for conditions like anxiety or emotional lability. For many patients, the layering of emotional disharmony presents so much complexity that they can only express it in phrases like "Agitated." "On." "I can't turn off my brain." Many clients only have physical symptoms—pain, insomnia, and so forth. The subjective nature of these pathologies is reflected in the wide range of psychiatric medications currently available. The mind-body split grew more pronounced in the late 1990s when HMOs entered the healthcare marketplace. They limited counseling to psychologists and family counselors (who cannot prescribe medication and must avoid physically touching clients).  Talented psychiatrists found themselves restricted to managing medication without the opportunity to counsel patients thoroughly, a source of deep grief for many. Consequently, insights from Polyvagal and other trauma theories were often applied only to the mind, leading to the erroneous conclusion that vagal tone is invisible. This is similar to the challenges we face in legitimizing Traditional Chinese Medicine (TCM), and both fields struggle with integrating subjective symptoms into cogent pathomechanisms for treatment.

Pattern Differentiation in TCM

One of the core principles of Traditional Chinese Medicine (TCM) is pattern differentiation, which identifies and treats underlying patterns rather than relying solely on Western diagnoses. This approach benefits patients by recognizing that conditions like the flu manifest in various subtypes—such as heat or cold. Pattern differentiation stands as one of the most elegant aspects of TCM, integrating the patient's subjective symptoms into the diagnosis and allowing for a wide diversity of applications. TCM practitioners have applied this approach to understanding and treating the patterns associated with COVID-19, for example. They allow tailoring treatments to address specific manifestations of the virus.

• Damp-Heat in the Lung: Characterized by fever, cough with sticky yellow sputum, and shortness of breath.
• Cold-Dampness in the Lung: Symptoms include cough with white phlegm, fatigue, and a sensation of heaviness.
• Toxic Heat: Severe cases with high fever, restlessness, and rapid breathing.

In a similar fashion, the patterns in my own condition were remarkably similar to patients with MS, Parkinson’s, SFN, and PTSD. Spasticity and primitive reflex (PR) demonstration were consistent in all cases, regardless of the diagnosis and regardless of how long ago a traumatic event occurred. After a while, even patients presenting with basic orthopedic injuries showed spasticity issues with PR demonstration. Classical TCM language predates modern neuroscience and uses qualitative descriptions, so I relied on modern neuroscience and PVT to understand the specific conditions and incorporated TCM and functional chemistry to effect treatment.

The Role of the Sinew Channels (Jing-Jin)

Recent advancements in osteopathic medicine and PVT reveal the role of the autonomic nervous system (ANS) in maintaining health, particularly the influence of the vagus nerve in effecting 'rest digest and repair.'   But understanding the fascia's role is only part of the equation.

To fully grasp the body’s response to chronic stress, we must include the relationship between muscle tone, emotions (the limbic system), and the ANS. Strength manifests in the muscles, but tone, particularly vagal tone, stems from the brain and spinal cord, specifically within the brainstem’s primitive regions. Due to the conflicting flexion and extension synergies involved in PR demonstration, spasticity, high tone, indicates a body in chronic high arousal mode. Sympathetic dominance inhibits neuroplasticity and diminishes the patency of the vagus nerve, leading to inflammation, stiffness and rigidity, inhibition of digestion and stress hormones that target the HPA axis (the basis of phlegm misting the mind). By contrast, low tone usually appears in parasympathetic states and manifests as flaccidity and weakness.

Integrating this information into our understanding of the sinew channels (jing jin) is like the ultimate neuro-hack: we use TCM to restore parasympathetic balance to the autonomic nervous system (ANS) by visibly restoring the patency of vagal tone in the fascia. Ultimately, both high and low tone in the sinews reflect imbalance in the ANS, and primitive reflex (PR) demonstration indicates cranial nerve involvement in the cervical spine.  Recognizing these visible patterns allows practitioners to address issues that were poorly understood with the modern iteration of oriental medicine.  A neuro-informed approach within TCM allows us to modify these techniques with painless methods that avoid reactivating primitive states of defense and revitalizes our understanding of the jing-jin which has fallen out of favor with the use of needles.  

How Chronic Fight-Flight-Freeze Affects the Cellular Environment

Dr. Carla Stecco's book, Functional Atlas of the Human Fascial System, provides a detailed understanding of the physiology of our living fascia web. Her work includes the role of the autonomic nervous system (ANS) in supporting the health of fascia and illustrates how sympathetic dominance significantly affects its repair and maintenance.

Our body tissues and bones form a living network of collagen, chondroitin, and elastin, which gives the body its ability to stretch and support various activities. Bones have the least amount of elastic tissue, while tendons and similar tissues develop stiffer, more supportive qualities to facilitate load-bearing. In contrast, tissues requiring fine movement or rotation have more elastic properties for incremental movement. The activity of white blood cells called microfibroblasts (MFB) and microfibroclasts (MFC) dictate the relative percentages of chondroitin and elastin in these tissues. (For students, the mnemonic: -Blast (B for birth) indicates creating new tissue, while -Clast indicates cleanup of tissue.)

The ECM's optimal condition supports tissue growth and repair, maintaining a balance of elastin crucial for tissue elasticity and resilience. However, under sympathetic dominance or chronic fight-flight (marked by a lower pH and high (+) concentration), Qi, blood, and body fluids are shunted into the large skeletal muscles below the waist, occurring at the level of the Dai Mai, where it intersects with the Chong Mai in the trunk. With sympathetic dominance, the environment of the ECM shifts toward fibroblast differentiation that increases collagen production over elastin (Stecco, 2015). This leads to less pliable tissues that have a higher bone quality. Additionally, in such states, the body’s ability to conduct an electric or nerve potential through the myofascial lines is diminished as the muscle tissue with a sympathetic charge is already in a semi-contracted state, limiting its ability to perform or take on new load bearing. In the fascia, this creates a resistance that springs back under the fingers like a trampoline, reflective of the less elastic nature of the fascia in a high-stress environment. This tension in the fascial system manifests as spasticity, preventing the body’s structures from moving freely and fluidly.

Thomas Myers, in his profound work on Anatomy Trains, describes the entire fascial system as a "living web" that possesses contractile strength across three planes. This dynamic web not only maintains structural integrity but also has the ability to respond to external stimuli, including an electrical charge. Myers' analogy likens the fascial web to the structure of an orange, where the interconnected fibers hold muscles and organs in place, providing both stability and flexibility. This living matrix can contract and transmit force, playing a crucial role in maintaining posture and movement, and the full body flexion-extension apthwys are illustrated by the primitive reflexes'

The transmission of neurological action potentials along the fascial layers adds another layer of complexity to this system. When initiated, action potentials propagate along a continuous fascial network, following the path of the originating impulse. This is due to the integrated nature of the fascia with the muscle and nervous systems, where fascia not only provides structural support but also facilitates communication between different parts of the body. The cell walls within this matrix exhibit contractile properties, contributing to the overall tensile strength of the body. Sympathetic dominance interferes with these cellular responses by altering the normal contractile and adaptive functions of the fascial system, leading to decreased tissue elasticity and increased rigidity. This shift in the ECM's properties can disrupt the balance and coordination necessary for optimal physiological function, highlighting the importance of addressing autonomic imbalances in therapeutic interventions.

In the realms of myofascial therapy, such as Anatomy Trains theory and various trigger point modalities employed in osteopathy and chiropractic care, there is often debate about the relationship of trigger points to traditional Chinese medicine (TCM) meridians. Critics (the authors) argue that these points do not correlate with TCM and represent a unique system; however, an 85 to 95% correspondence between these myofascial trigger points and TCM sinew channels (Jing Jin) is more than statistically significant. For the purposes of treating spasticity, which is particularly relevant in addressing conditions such as MS, stroke, and Parkinson’s disease, this correlation cannot be overlooked.  For our purposes, the 6 divisions are synonymous with the myofascial planes as illustrated in modern osteopathy.

By bridging Eastern and Western modalities, this integration offers a comprehensive, visible, objective framework for treating chronic sympathetic dominance and trauma, and begins to shed light on a neurological pathomechanism in TCM that has remained elusive.

Dedication:  For Ernie W. MD.  With great Love.

References:

   Barral, J.-P. (2007). Visceral Manipulation (2nd ed.). Eastland Press. ISBN: 978-0939616421.

  Barral, J.-P., & Croibier, A. (2005). Manual Therapy for the Cranial Nerves. Churchill Livingstone. ISBN: 978-0444519251.

  Barral, J.-P., & Croibier, A. (2009). Manual Therapy for the Peripheral Nerves. Churchill Livingstone. ISBN: 978-0443103079.

  Keleman, S. (1989). Emotional Anatomy: The Structure of Experience. Center Press. ISBN: 978-0934320156.

  Keleman, S. (2012). Your Body Speaks Its Mind. Center Press. ISBN: 978-0934320170.

  Myers, T. W. (2020). Anatomy Trains: Myofascial Meridians for Manual Therapists and Movement Professionals (4th ed.). Elsevier. ISBN: 978-0702078132. Anatomy Trains 4th Edition.

  Stecco, C. (2014). Functional Atlas of the Human Fascial System. Elsevier. ISBN: 978-0702044304.

  Stecco, L. (2018). Fascial Manipulation - Practical Part (2nd ed.). Piccin Nuova Libraria. ISBN: 978-8829928215.