Integrative Neurology: Autonomic Dysregulation for TCM (1)

Introduction: Understanding Autonomic Dysregulation

Autonomic dysregulation, often referred to as dysautonomia, reflects an imbalance within the autonomic nervous system (ANS) that disrupts its ability to fluidly transition between activation (defense) and rest (return to homeostasis). This imbalance manifests with a range of clinical symptoms, including heightened vigilance, muscular tension, withdrawal (flight), emotional dysregulation and the suppression of physiological functions (freeze).
Polyvagal Theory (PVT), developed by Stephen Porges, has significantly advanced our understanding of states of stress or relaxation, particularly in terms of the vagus nerve’s role in mediating safety and threat responses. PVT explores this role through a hierarchy of autonomic states—ventral vagal engagement, sympathetic activation (fight-flight), and dorsal vagal immobilization (freeze). While a useful framework, PVT often isolates the vagus nerve’s function from the broader networks and developmental processes that influence autonomic regulation.

A key concept within PVT, "neuroception," refers to the body’s unconscious detection of safety or danger. This process involves the autonomic nervous system that interpret environmental cues, such as body sensations, facial expressions, and tone of voice to determine threat levels and the appropriate response. Critics argue that neuroception lacks clear clinical criteria, which limits its application in therapy and diagnosis. Without measurable parameters, it can be difficult to integrate into practice. Traditional Chinese Medicine (TCM) faces a similar challenge, as it relies on subjective descriptions developed before modern neuroscience. Both PVT and TCM struggle to connect abstract concepts with clinical treatment.

PVT's limitations do not diminish its value with regards to our understanding of social engagement as a regulatory mechanism. However, the theory views bonding and safety primarily as behavioral phenomena, and does not address the role of physiological mediators such as oxytocin, GABA, serotonin, and glutathione. These mediators help regulate stress and recovery by influencing autonomic functions like heart rate, digestion, and breathing. PVT also bypasses the foundational role of early childhood experiences in establishing the parasympathetic (vagal) baseline for the autonomic nervous system (ANS). This omission highlights the need to explore how primitive reflexes (PRs) shape the trajectory of the vagus nerve, and how its patency, also known as vagal tone, influences sensory-motor coordination from the earliest stages of development.

The Role of Autonomic Dysregulation in Neurogenic Diseases and Trauma

Dysautonomia patterns appear in conditions such as neurogenic diseases, mental health disorders, traumatic brain injury, stroke and orthopedics. They represent an imbalance in the nervous system that disrupts both physiological and emotional function. To date, no treatment restores balance to the dysregulated nervous system outside of mindfulness-based practices and symptom management with pharmaceuticals. In neurogenic diseases like Parkinson’s, MS, and Alzheimer’s, symptoms attributed to disease progression such as poor coordination, spasticity, sensory and motor dysfunction go unrecognized as contributing to the decline. In trauma and PTSD patients, these patterns contribute to states of high arousal and emotional dysregulation in the limbic system. In chronic orthopedic cases, spasticity and ROM limits are attributed to poor conditioning or compensation, rather than being recognized as the result of autonomic imbalance.

Many mental health approaches, including PVT, rely on ‘mindfulness’ as a therapeutic solution without defining clinically why it is helpful. Widely promoted concepts like "vagal tone" lack clear definitions to patients and providers, and often remain disconnected from clinical practice. While mindfulness is a useful behavioral tool, it is essential to address the physiological mechanisms that underlie autonomic dysregulation, including the role of primitive reflexes (PRs) and neurochemical balance, to create a more comprehensive and effective therapeutic approach.

Among the significant advancements in neuroscience, the discovery of neuroplasticity is arguably the most groundbreaking. For over a century, medical training suggested that the nervous system could not regenerate. However, emerging research in neuroplasticity demonstrates its capacity for recovery and adaptation. Autonomic dysregulation reflects a state of chronic high arousal, which impedes the brain's neuroplastic abilities. This not only disrupts the brain's ability to rewire itself but also accelerates degeneration in the case of neurogenic decline, and prevents trauma survivors from harnessing the benefits of mindful based practices.

These discoveries create new pathways to restore balance to the nervous system to leverage the brains neuroplastic capabilities. Dysautonomia patterns require an integrative approach that combines Western allopathic care with modalities in mental health, neurology, rehabilitation, and complementary medicine. Given that the current iteration of TCM predates an understanding of both the nervous system and neuroplasticity, our methods require adaptation to meet modern clinical needs. Autonomic imbalances affect multiple systems. As such, they require an approach that combines a sinew-based palpation approach favored by meridian therapists, the gentle methods used in Toyohari, along with the gut-focused patterns in Zang-Fu. Functional medicine and lab work also play an important role. It also introduces a trauma-informed approach that has been missing in our current curricula, which allows patients to benefit more effectively from mindful-based practices. The goal is to help practitioners of every style apply techniques that improve neuroplasticity and autonomic balance, to address both the physiological and neurobiological dimensions of dysregulation.

Key Pathways in Autonomic Dysregulation

Understanding the deeper neurophysiological pathways involved in autonomic dysregulation requires exploring the relationship between delicate systems that include the thalamus, amygdala, hippocampus, hypothalamus, and pituitary. All sensory data, except for smell, is routed through the thalamus. The amygdala communicates “perceived” threat levels to the hypothalamus, and when threatened, initiates the fight-or-flight response. These cascades can overwhelm the nervous system, clouding judgment and perception—a phenomenon described in TCM as 'phlegm misting the mind.' This term, long mis-translated in TCM as physical mucus, is not a type of phlegm that can be alleviated by Er Chen Tang. It refers to disruptions in neural clarity and coherence, reflecting the interdependence between the limbic system, sensory integration, and autonomic function.

Primitive reflexes (PRs) are defensive automatic movements that present at birth to facilitate survival and neural development. PRs, innervated by the cranial nerves, lay the foundation for parasympathetic tone (e.g. vagal) in childhood. Qualitatively, “vagal tone" reflects both the strength and flexibility of the parasympathetic response necessary for autonomic balance. PRs influence the development of essential regulatory systems, including the autonomic nervous system (ANS), enteric nervous system (ENS), vestibular, limbic, and immune system, and the developing facia via the sinew channels.

Positive early experiences promote the proper integration of PRs, and allow for healthy sensory-motor processing and autonomic balance. However, trauma or stressful experiences—whether emotional, physical, or medical—can disrupt these pathways, leading to maladaptive patterns of dysregulation. Adult survivors of early trauma often exhibit retained reflexes or cranial nerve involvement that manifest as spasticity, sensory processing challenges, impaired proprioception, and emotional dysregulation.

In freeze states (e.g. dorsal), these disrupted pathways are even more distorted, as the body cannot access vagus states under extreme threat. These suppress motor function, metabolic processes, and even respiratory patterns. Delayed or shallow breathing mechanics further destabilize the nervous system by reducing oxygen exchange and increasing systemic inflammation. Disruptions in these systems often appear as spasticity (particularly through the cervical spine and pelvis), pain, gastroparesis, autoimmunity, mood disorders, anxiety, issues with cognition and neurogenic decline. This is the pattern most observed in adult survivors of abuse, and in our service men and women with PTSD. This has also been the most common pattern I have observed in patients with long COVID.

Key Pathways in Autonomic Dysregulation

Understanding the deeper neurophysiological pathways involved in autonomic dysregulation requires exploring the relationship between delicate systems that include the thalamus, amygdala, hippocampus, hypothalamus, and pituitary. All sensory data, except for smell, is routed through the thalamus. The amygdala communicates “perceived” threat levels to the hypothalamus, and when threatened, initiates the fight-or-flight response. These cascades can overwhelm the nervous system, clouding judgment and perception—a phenomenon described in TCM as 'phlegm misting the mind.' This term, long mis-translated in TCM as physical mucus, is not a type of phlegm that can be alleviated by Er Chen Tang. It refers to disruptions in neural clarity and coherence, reflecting the interdependence between the limbic system, sensory integration, and autonomic function.

Primitive reflexes (PRs) are defensive automatic movements that present at birth that facilitate survival and neural development. Prs, innervated by the cranial nerves, lay the foundation for parasympathetic tone (e.g. vagal) in childhood. Qualitatively, “vagal tone" reflects both the strength and flexibility of the parasympathetic response necessary for autonomic balance. PRs influence the development of essential regulatory systems, including the autonomic nervous system (ANS), enteric nervous system (ENS), vestibular, limbic, and immune system, and the developing facia via the sinew channels.

Positive early experiences promote proper integration of PRs, and allow for healthy sensory-motor processing and autonomic balance. However, trauma or stressful experiences—whether emotional, physical, or medical—can disrupt these pathways, leading to maladaptive patterns of dysregulation. Adult survivors of early trauma often exhibit retained reflexes or cranial nerve involvement that manifest as spasticity, sensory processing challenges, impaired proprioception, and emotional dysregulation.

In freeze states (e.g. dorsal), these disrupted pathways are even more distorted, as the body cannot access vagus states under extreme threat. These suppress motor function, metabolic processes, and even respiratory patterns. Delayed or shallow breathing mechanics further destabilize the nervous system by reducing oxygen exchange and increasing systemic inflammation. Disruptions in these systems often appear as spasticity (particularly through the cervical spine and pelvis), pain, gastroparesis, autoimmunity, mood disorders, anxiety, issues with cognition and neurogenic decline. This is the pattern most observed in adult survivors of abuse, and in our service men and women with PTSD.

Conclusion

Autonomic dysregulation represents a spectrum of sympathetic and parasympathetic imbalances that disrupt sensory, motor, and biochemical processes. While behavioral approaches such as mindfulness are often emphasized, emerging research suggests that the physiology of mindfulness extends far beyond behavior, functioning as a neurological reset. This process involves re-engaging the ventral vagal pathway through intentional breathing, sensory reintegration, and fostering states of safety within the body. These mechanisms not only calm the autonomic nervous system but also repair fragmented neural connections, enhancing the body's capacity for regulation and recovery.

By integrating insights from neurology, the biochemistry of mindfulness, and Traditional Chinese Medicine, practitioners can offer precise and effective interventions. The sinew channels, in particular, provide a powerful framework for restoring balance, addressing both tension and stagnation, and guiding patients toward dynamic regulation.

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