Primitive Reflexes and Their Role in Nervous System Development

Primitive reflexes form the foundation of the human nervous system, acting as building blocks for complex motor and cognitive functions. These automatic, involuntary movements present at birth gradually integrate as the child matures. Controlled by cranial nerves in the brainstem, these reflexes establish a balance between the parasympathetic and sympathetic nervous systems, supporting motor movement, decision-making, and emotional regulation. Cranial nerves reside in the brainstem, a more primitive part of the brain, and are resource-intensive, demanding oxygen, glucose, and yin. When reactive, they block vagal nerve signals, leaving the body in a heightened state of arousal that flood the brain with stress hormones along the HPA axis.

Proper integration of primitive reflexes supports higher-order skills like decision-making, emotional regulation, and balance within the autonomic nervous system. Incomplete integration can lead to poor coordination, orthopedic issues, learning difficulties, and behavioral problems. It is now understood that trauma—whether emotional or physical, such as emotional shock, head injuries, car accidents, or neurogenic disease—can reactivate these reflexes in both children and adults, indicating states of high sympathetic arousal. This may or may not be felt by the patient as emotional stress.

The HPA Axis: The Biochemistry of Phlegm Misting the Mind

The HPA axis (hypothalamus-pituitary-adrenal) is a complex network of interactions among the hypothalamus, pituitary, and adrenal glands. This system is crucial for stress response and regulating digestion, immune function, mood, and energy balance. Here’s how the HPA axis functions:

1.    Hypothalamus: Perceiving stress, the hypothalamus releases corticotropin-releasing hormone (CRH).

2.    Pituitary: CRH prompts the pituitary to secrete adrenocorticotropic hormone (ACTH).

3.    Adrenals: ACTH stimulates the adrenal glands to produce and release cortisol.

Cortisol manages stress by raising blood sugar, enhancing glucose use, and increasing the availability of repair substances. It curbs non-essential functions during fight-or-flight, inhibiting immune responses and suppressing digestion, reproduction, and growth. After the stress passes, parasympathetic cushioning (yin) lowers cortisol levels, signaling the hypothalamus and pituitary to reduce CRH and ACTH production, thus turning off the stress response and returning the body to homeostasis. This feedback loop maintains balance and prevents the negative effects of chronic stress, such as inflammation and other long-term issues.

 TCM and the Autonomic Nervous System: Insights from the Eight Extraordinary Vessels

Although TCM predates modern understanding of the ANS and fight-flight-freeze responses, it qualitatively reflects these concepts through the Eight Extraordinary Vessels (8 EV), particularly the channels of second ancestry, the Qiaos and the Weis. The first-order channels (Chong, Dai, Ren, Du) coordinate our development in utero. The Qiaos and Weis channels extend the energy of the first-order channels above the diaphragm.  They are dominant after birth and reflect post-natal experience. As such, they develop with the ANS, rely on myelin and begin with rotation from the trunk (Dai Mai). The Qiaos link top-bottom (heaven-earth), and the Weis connect left-right, to coordinate spatial awareness in the developing vestibular system.

Initial movement toward an object is driven by desire and sense impressions. As a child develops muscle strength to hold the head, sit, and move with intention, these movements originate through trunk rotation, with avoidant movement triggered by pain or overwhelm. All sensory input is sympathetic (yang) in nature, mediated externally by the "6 External Pathogenic Factors" and internally by the "7 Emotions." The 6 factors and 7 emotions directly influence the sympathetic charge in the autonomic nervous system in real time and create the parasympathetic (yin) cushion in the developing nervous system.

Socialization and emotional maturity are regulated by the parasympathetically supported limbic system (yin), transitioning from primitive survival reactions to nuanced emotions and volitional responses. A socially mature adult self-soothes, regulates in the face of opposition, knows when to persevere, refrain from retaliation, or choose a new course.

While used in TCM to address various physical and emotional conditions, their applications often lack consistent rationale, leading to overlapping indications. Both the Yang Qiao Mai and Yin Qiao Mai, for example, can be used for symptoms like overactivity, insomnia, and emotional trauma. This overlap complicates clinical decision-making and often leads to a trial-and-error approach.

This issue mirrors the challenges in modern mental health, where emotional symptoms, such as anxiety, are inherently subjective without clinical markers. During my TCM psyche rotations, Professor Greg Bantick shared an insight that still guides my practice: "If you have depression in the mind, you will find depression in the body. Look to the fascia, pulse, tongue, hara, and other physiological processes for confirmation." His observation emphasized the importance of objective criteria in confirming emotional diagnoses.

Yin Qiao Mai (Yin Heel Vessel)	Yang Qiao Mai (Yang Heel Vessel)
Insomnia (difficulty staying asleep)	Insomnia (difficulty falling asleep)
Lower abdominal pain	Lower abdominal pain
Pain in the lumbar region	Pain in the lumbar region
Inner thigh pain	Tightness along the lateral leg
Genital pain	Hip pain
Eye disorders (difficulty closing eyes, hypersensitivity to light)	Dizziness or vertigo, photophobia
Foot inversion issues	Epilepsy or convulsions
Emotional disturbances	Psychological issues (mania, restlessness)
Headaches, Brain Fog	Headaches (especially occipital)

 

Bridging Qualitative Experience with Objective TCM Practices

Modern insights from Polyvagal Theory (PVT) and myofascial theory highlight the role of the autonomic nervous system (ANS) and the limbic system in the body's fascia and emotional regulation. In TCM, the channels of second ancestry describe qualitative post-natal development under the influence of the ANS, reflecting our emotional landscape. Both systems, while profound, have offered limited clinical success, due, in part, to the subjective nature of language and symptoms.  Additionally, the prohibition of mental health providers to physically assess patients has led to an erroneous conclusion that vagal tone is invisible.

Revitalizing our use of the sinew channels (Jing Jin) through a neuro-informed approach bridges the qualitative nature of both traditions by integrating neurological understanding integral to both. With TCM, the return of vagal tone through the fascia serves as real-time confirmation of treatment efficacy.  While this is a palpation-based style of treatment, the visible nature of the sinew channels leaves far less room for subjective error, and fostering neuroplasticity is how we can help our patients effectively recover from neurogenic disease and trauma. 

There are notable changes in methodology required to observe the parasympathetic effects described:

• The subjective nature of the autonomic nervous system and its triggers makes a one-size-fits-all point prescription ineffective.  Master and couple points don’t work in PR demonstration, and point functions are disregarded in favor of addressing channel patency. 
• Pain is an involuntary reflex that is never integrated, so painless needle technique must be observed.  Eliciting a strong de qi sensation is contraindicated in PR demonstration with spasticity. 
• From an ANS perspective, the use of e-stim may be contraindicated, and used sparingly.  Estim floods the body with exogenous energy which contributes to sympathetic dominance.
• Practitioners who favor scalp acupuncture without first resolving spasticity through the brainstem and carotid may inadvertently exacerbate conditions, particularly in patients with demyelinating diseases.  Once cranial nerves become reactive, spasticity through the neck prevents the body from receive the descending efferents from the vagus, and diminishes O2 through the carotid artery.  This prevents the neuroplastic effects needed for effective scalp work.
• TJM and meridian therapists who favor very light needling like Toyohari will find that when working with the sinews, resolving PR demonstration often requires needling proximal and deeper than the Jue Yin to free up rotation. 
• Acu-sport practitioners may find that in cases including PR demonstration,  manually triggering a motor point may aggravate pain in patients because propagation can only continue to the next flexion point, along the same myofascial level at which the original signal was generated. But practitioners of this style will find it effortless to incorporate this understanding since they are adept at palpation.  Many of the classic trigger points tie directly to the primitive reflexes.
• Community style practitioners may have limited time available to manually work tissue, but as we begin introduce treatment and cases, community providers can use different techniques to maximize treatment effect even in spasticity cases.  If you don’t have a non-complete, it is a great opportunity to invite patients in for deeper work, or to work collaboratively with a masseuse or PT

Regardless of your preferred treatment style, an understanding of the patterns included in a retained fight-flight-freeze response or sympathetic allows us to expand our medicine for the current era.  By bringing these insights to all forms of TCM can help patients understand neuroplasticity to enhance outcomes for everyone.