Introduction: Understanding Autonomic Dysregulation (3) - Yang Patterns

 Yang-Type Sympathetic Dominance and Adrenal Fatigue

The ANS can become dysregulated in various ways, with two primary Yang-type subtypes: 

• Yang-Type Sympathetic Dominance and 
• Adrenal Fatigue. 

Both represent different stages of yang overactivation within the sympathetic system, but their effects and characteristics differ. Understanding these two subtypes provides insight into how prolonged sympathetic activation influences physical and emotional balance.
As we explore these patterns, it is important to note that the classics in TCM reference the more extreme emotional examples of autonomic imbalance, a condition of "phlegm misting the mind." The widespread phenomenon of sympathetic dominance did not exist culturally until the 1970s. Cultural changes that include the rapid growth of electronics and communication technologies has intensified sympathetic (yang) overactivation. Constant stimuli from smartphones, screens, and digital media overwhelm the brain’s sensory capacity, leaving individuals in prolonged states of arousal.   These conditions were not understood by the creators of early medical models, as neuroscience was still in its infancy, and sympathetic dominance was not a chronic global issue. 

Chronic Fear and Uncertainty: A Continuous Stressor

The prolonged nature of the pandemic, extending over two years contributed greatly to a pattern of global autonomic dysregulation. Initially, secondary trauma was prevalent among medical providers, first responders and essential personnel. People were in a constant state of uncertainty, reminiscent of the "terror alerts" post-9/11. These daily updates often communicated fear rather than useful information, and created an atmosphere of chronic stress and anxiety. However, as the pandemic persisted, the continuous state of fight, flight, or freeze responses began to have more insidious consequences (hello, cortisol). An extended stress response leads to the shutdown of the enteric nervous system, impairs digestion and diminishes afferent sensory pathways, resulting in  reduced sensory perception. Stress hormones that are highly inflammatory target the HPA axis, and the nervous system attempts to protect itself by limiting the influx of overwhelming information, ultimately by ignoring these sensory inputs.

Yang-Type Sympathetic Dominance

·        Characterized by heightened sympathetic activation, often experienced as a retained or chronic fight-or-flight response.

·        Clinical Symptoms: Increased heart rate, elevated blood pressure, muscle tension, hypervigilance, anxiety, tremors, and restlessness.

·        Clinical Lab Data:

o   Elevated cortisol and catecholamine levels (e.g., adrenaline, noradrenaline).

o   Increased heart rate, blood pressure, and respiratory rate.

o   Hypertonic muscles, often experienced as rigidity or spasticity in the sinew channels.

o   Persistent sympathetic arousal, presenting as hypervigilance, restlessness, and instability and insomnia

o   Heat sensations or sweating

o   Decreased insulin sensitivity, leading to insulin resistance and higher blood glucose.

o   Increased vascular resistance, resulting in hypertension and reduced heart rate variability (HRV).

o   Low GABA and serotonin levels, which commonly appear in anxiety and depression.

·        Physiological Effects: The body stays in a state of readiness, struggling to shift into recovery mode. Prolonged activation depletes energy, destabilizes emotions, and makes it difficult to relax.

·        Common TCM Patterns:

It is important to not that these are systemic patterns of high arousal, and single focused zang-fu patterns only provide symptom relief in patterns to sympathetic dominance until parasympathetic (yin balance is restored via the sinew channels.

o   Liver Qi Stagnation: Often leads to irritability, anxiety, and restlessness, associated with poor liver function and blocked Qi flow.

o   Heart Fire: Seen in anxiety, agitation, and insomnia, representing heat and inflammation in the Heart channel.

o   Fire-Water (Heart-Kidney) not communicating. 

o   Spleen Qi Deficiency: Commonly linked to digestive issues like bloating, fatigue, and low energy, typically in people with chronic stress or insufficient recovery.

Yang Type Adrenal Fatigue (Yang-Type Sympathetic Exhaustion)

Occurs after prolonged activation of the sympathetic system, when the body’s resources deplete.

·        Clinical Symptoms: Fatigue, emotional burnout, weakness, difficulty recovering from stress, reduced physical stamina.

·        Clinical Lab Data:

o   Elevated cortisol levels initially, followed by adrenal fatigue and reduced cortisol output over time.

o   Thyroid imbalances, often leading to hypothyroidism with symptoms like fatigue, cold extremities, and weight gain.

o   Gastrointestinal issues, including gastroparesis, constipation, and digestive distress due to slowed motility.

o   Elevated pro-inflammatory cytokines linked to chronic inflammation.

Physiological Effects: The body depletes its reserves, and the ability to maintain activation wanes. Individuals may appear drained and unable to cope with further stress.

·    Common TCM Patterns:

o   Kidney Yang Deficiency: Characterized by low energy, fatigue, and cold extremities, reflecting weakness in the kidneys and adrenal glands.

o   Qi and Blood Deficiency: Leads to exhaustion, dizziness, poor concentration, and pale complexion, associated with depleted Qi and blood flow.

o   Spleen Yang Deficiency: Results in digestive issues, fatigue, and bloating, commonly seen in individuals with long-term stress.

Physiological Features:

• Increased heart rate, blood pressure, and respiratory rate.
• Hypertonic muscles, often experienced as rigidity or spasticity in the sinew channels.
• Persistent sympathetic arousal, presenting as hypervigilance, restlessness, and instability and insomnia
• Heat sensations or sweating

Mechanisms and Pathophysiology:

• Chronic cortisol release disrupts hippocampal function, impairing memory and emotional regulation.
• Over time, this depletion of deeper reserves can create a dual state of yang exhaustion, where energy appears abundant but is unsustainably taxed.

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