Trauma refers to an overwhelming experience that exceeds the parasympathetic buffering capacity of the autonomic nervous system (ANS). It can arise from physical injuries such as traumatic brain injuries (TBI), natural disasters, or a life-altering medical diagnosis. Trauma also includes emotional experiences such as death, divorce, migration, or the loss of a home. These events place tremendous demands on the ANS, resulting in observable shifts in blood flow, oxygen delivery, body fluids, and vital resources as the body prioritizes survival.
When trauma exceeds the body's buffering capacity, parasympathetic activity remains suppressed, leaving the body in a prolonged state of high arousal, a retained fight-or-flight state known as sympathetic dysregulation. This sustained activation disrupts the body's natural recovery processes and locks it into maladaptive response patterns. It elevates cortisol, impairs emotional regulation, and interferes with the brain's ability to adapt and recover from perceived threat. When chronic, these states reshape neural pathways and leave the body unable to return to a state of calm and homeostasis.
Trauma and
the Alteration of Perception
Sensory inputs
are distorted under threat to prioritize signals from the hippocampus and
amygdala that increase the perception of danger. Ideally, in non-threatening
situations, the ANS determines threat level to facilitate a quick return to
normal parasympathetic function. This process relies on vagal tone, which
supports the body's preference to maintain a parasympathetically neutral state
for rest, digestion, and repair.
Cortisol plays
a central role in maintaining states of heightened arousal. The hormones of
activation from the FF response from the hypothalamus-pituitary-adrenal axis
can make neutral stimuli difficult to interpret as safe, a state known as hypervigilance.
In Traditional Chinese Medicine (TCM), we refer to this imbalance qualitatively
as 'phlegm misting the mind,' which reflects the distortion of mental
and neural clarity experienced in states of high arousal.
Prolonged
autonomic dysregulation alters sensory integration across all the systems mediated
by the vagus nerve, including the vestibular, enteric, neural and fascial
networks. A retained fight-or-flight response reduces range of motion, inhibits
neuroplasticity, and disrupts learning and memory. Persistent activation prevents
the body from returning to homeostasis, damages immune function and repair, and
impairs the enteric and reproductive systems.
To better
understand these patterns in TCM, trauma responses can be organized into three
main autonomic subtypes: sympathetic dominance (yang style), parasympathetic
dominance or dorsal freeze (yin style), and a mixed autonomic type, which has
been the most common presentation among my clients over the past 20 years.
Oriental
medicine, in its current form, predates a modern understanding of neurology and
endocrinology. The dysautonomia patterns seen today did not exist en masse 85
years ago when TCM was being medicalized. Our nervous systems have become
inundated with sympathetic charge from technology, noise, overwork, processed
food, and a disconnection from natural circadian cycles—an epigenetic insult
unprecedented in human history. These rapid lifestyle changes have overwhelmed
the ANS, creating patterns of chronic dysregulation. To
address this effectively in ancillary care, our methodology and understanding
must evolve.
The integrated development
of the systems mediated by the ANS during the childhood are why we can use the sinew channels through myofascial
work and acupuncture to help restore proper autonomic balance across multiple
systems. Autonomic dysregulation is a
common symptom that underlies trauma and PTSD, neurogenic diseases, long COVID,
and cognitive decline, including Alzheimer’s. Recognizing patterns of dysautonomia helps ancillary
and TCM providers address these conditions.
Understanding Sympathetic Dysregulation and Trauma Patterns
Disasters of this magnitude affect all of us, and my goal is to provide insights that support both patients and practitioners impacted by the tragedy. A basic understanding of trauma patterns also helps providers and first responders process their own experience in the moment, reducing the risk of post-traumatic stress disorder or burnout.
General
Support for Sympathetic Dysregulation
Certain
interventions provide universal benefits for all forms of sympathetic
dysregulation, as they address shared lifestyle and environmental factors that
contribute to autonomic imbalance. In all three subtypes, e-stim should
be avoided to avoid adding more sympathetic charge to an overwrought
system. It can exacerbate dissociation in the freeze states or
sympathetic dominance.
- Reduce Screen Use and Blue Light
Exposure:
Technology use, especially at night, disrupts natural circadian rhythms by
suppressing pineal melatonin production, a critical component of autonomic
recovery. Blue light exposure exacerbates this suppression, reducing
melatonin by up to 70–80%, particularly in children. Consider powering OFF
the router at least an hour before bed. Non-screen activities such as
reading or meditative practices are recommended after 9 PM, and devices
should remain on night shift mode at all times.
- Address Circadian Rhythm Disruption: Individuals in shock or with
irregular schedules face significant melatonin suppression that dysregulates
metabolic function at night, particularly lipid metabolism. This contributes to dyslipidemia,
insulin resistance, and oxidative stress in the brain and spinal
cord. These individuals may benefit
from liposomal melatonin spray at night to support gut-based pineal melatonin
function.
- Limit Overstimulation: Prolonged exposure to
stress-inducing stimuli such as media, social conflicts, and technology
keeps the ANS in a heightened state of arousal. Encouraging periods of
quiet, mindfulness, and reduced sensory input helps calm the system.
- Incorporate Breath Work: Diaphragmatic breathing re-activates
the ventral vagal complex and supports parasympathetic recovery. Mindful
breathing is a simple, effective tool that both benefit providers and
patients. I incorporate mindful breathwork in my sessions so that patients
can continue this at home.
These systemic
and lifestyle changes provide the foundation for recovery across all three
patterns of dysregulation, creating a platform for the subtype-specific care
detailed in the following sections.
______________________________________
Sympathetic Dominance
(Yang): Physiological and Behavioral Impacts
Sympathetic
dominance represents the yang form of autonomic dysregulation. Most Americans
live in this state already, especially after the pandemic. They are
in constant motion, with busy schedules, kids, late nights and high levels of
input from technology and media. Following the fires, many
individuals will display reactive emotions that include anger, assigning blame,
or a desire for vengeance.
Part of what makes catastrophic events so devastating are their ongoing nature- the impact does not end when the fires are out. Recovery takes months. The loss of homes, jobs, and community, along with disrupted schools and delays in insurance payouts, compound the challenges for these individuals. There is a "new normal" for those affected. Early recognition of these states allows providers in affected areas to intervene and reduce the potential long-term impact on health. The chronic release of cortisol is incredibly disruptive to normal metabolism and the nervous system. Alcohol can be problematic with this subtype.
Common clinical symptoms:
- Elevated heart rate, hypertension, and cardiovascular instability.
- Irregular breathing patterns, including shallow or rapid breathing.
- Insomnia and difficulty relaxing.
- Heightened emotional reactivity, anger, irritability, and volatility.
- Impulsive or aggressive behaviors, including a desire for revenge or assigning blame.
- Increased muscle tension, jaw clenching, or grinding teeth.
- Hypervigilance, feeling on edge including an exaggerated startle response.
Patients in this state respond well to longer, non-intrusive treatments that
reduce excess energy.
- Use painless acupuncture
with longer retention to facilitate calm. While NADA can facilitate some
symptom relief, these folks exhibit full body tissue tension and spasticity
through the cervical spine, which block motor efferents mediated by the
vagus. Many will show the reactivation of primitive reflexes
like Core Tendon Guard, Moro and Fear Paralysis. Go direct- needling the du mai (include the C-spine) or the
huatos all the way down the spine is helpful. UB 23 or UB 28 can be life
changing here. Chinetsukyu on the heel points is helpful.
- Strong physical exercise is VERY
effective for this type.
- Extended massage is extremely helpful here, and many in the beginning may prefer deep tissue. That will provide release in the short term, but will not reintegrate the ANS. Swedish or very light tissue styles work well on extremely defended patients.
Many individuals in Los Angeles will shift into parasympathetically dominant, dorsal freeze state for the next several months, which reflects the autonomic system’s response to overwhelming shock. Physiologically, their systems are immobilized, with inhibited metabolic and parasympathetic function. While the body may eventually move beyond the immediate response, the residual charge from this state can remain embedded in the nervous system for years.
This is a more serious patterns as dorsal states cannot connect to the ventral vagus (and the autonomic nervous system). it is, in essence, a more severe separation of yin and yang. Patients in these states often exhibit dissociation,
emotional numbness, emotional lability or difficulty processing events. Many of these patients will show marked insomnia, and a morbid fear of wind or cold. Coffee
or stronger stimulants are often the choice for this subtype until evenings at
which point they may switch to depressants like Xanax, wine or cannabis.
Common
clinical symptoms:
- Gastroparesis, nausea, or other symptoms of slowed digestion.
- Constipation due to inhibited gut motility – or - dumping syndrome from heart block (Worsley Pattern). Both patterns can be present and alternate.
- Insomnia or, conversely, excessive sleepiness (somnolence).
- Spasticity or stiffness in muscle tissue.
- Profound immobility and muscle rigidity.
- Emotional numbness, dissociation, or difficulty connecting with others.
- Extreme emotional liability is also possible with trauma survivors in decompensation.
- Reduced oxygenation and shallow breathing patterns.
Supportive
Care for Dorsal (Parasympathetic) States
Care for these individuals must address their immobilized state with gentle and
restorative interventions:
- Tissue work and light touch therapies such as craniosacral therapy or lymphatic drainage provide support without triggering overwhelm.
- Painless needle style is needed for this subtype, as pain is a reflex that we never integrate.
- Avoid invasive techniques such as deep needling or e-stim, which can exacerbate dissociation and discomfort.
- Patients may require digestive support such as digestive enzymes, NAD+ for digestive support for gastroparesis or digestive upset.
- This subtype can experience extreme emotional lability. Short-term use of antidepressants may be extremely helpful in dorsal states until they can re-access the vagus. Know when to refer to a competent mental health provider.
Mixed
Presentation: SANS-PANS Dysregulation
This pattern
reflects the cumulative strain on the autonomic nervous system caused by the
coexistence of fight-or-flight and freeze responses. Sympathetic overactivation
pairs with parasympathetic underactivity, creating cycles of short-term dorsal
freeze states, often lasting 2–6 months, followed by a return to
sympathetic-dominant patterns. These fluctuations show the body’s attempt to
adapt to prolonged stress but perpetuate dysregulation.
Chronic autonomic imbalance impairs normal function, while elevated cortisol drives oxidative stress, particularly in the brain. When the body cannot neutralize free radicals, cellular damage accelerates neurodegeneration and cognitive decline. Mixed presentations alternate between hyperactivity and crashes, reflecting deep imbalances that take months to resolve. Treatment aims to calm sympathetic overactivation and restore parasympathetic function to stabilize the nervous system. Many first responders and medical providers fall into this subtype.
Common clinical symptoms:
- Periods of profound fatigue alternating with hyperactivity or restlessness.
- Cognitive difficulties, including poor concentration, memory issues, and brain fog.
- Orthopedic issues such as frozen shoulder, carpal tunnel syndrome, and recurring injuries.
- Metabolic imbalances, including aggravation of Type 2 diabetes and weight fluctuations. Gallstones are common here.
- Cardiovascular issues, including irregular blood pressure and arrhythmias.
- Gastrointestinal symptoms such as constipation, bloating, or alternating bowel patterns.
- Emotional dysregulation, including mood swings, irritability, and episodes of numbness or emotional detachment.
- Sleep disturbances, including difficulty falling asleep or waking up unrefreshed.
- Primitive reflex demonstration, such as exaggerated startle reflex or Moro reflex, may remain apparent for 6–12 months.
Care for these individuals must address their immobilized state with gentle and restorative interventions, and include aspects of both subtypes as it presents. Patterns may change from session to session.
- Tissue work and light touch therapies such as craniosacral therapy or lymphatic drainage provide support without triggering overwhelm.
- Avoid invasive techniques such as deep needling or e-stim, which can exacerbate dissociation and discomfort.
- FOR NIGHT SHIFT WORKERS. Night shift work disrupts the pineal melatonin, which peaks during nighttime hours. Supplementing with liposomal melatonin or an oral liposomal spray on off-duty days supports the pineal gland and reduces oxidative stress caused by disrupted circadian rhythms. These supplements provide essential antioxidant protection for the brain during recovery periods.
Support for Healthcare Providers and First Responders
The fires in LA
signal a long-term challenge for Southern California and highlight patterns of
disruption common in areas affected by natural disasters, environmental crises,
and war. These events introduce chronic stress into the collective, reshape communities,
and create a new normal that requires ongoing adaptation. As providers, we must
address the impact not only in our patients but also in ourselves and our
families.
In service
professions, resilience depends on the ability to identify and tend to our personal
experiences of loss in addition to those we serve. The chronic nature of these events means that
as providers and first responders, we also must be mindful to prevent trauma from taking root in our
own nervous system. Compassionate self-care involves rest, time with loved
ones, playing an instrument or art, connecting with friends or a spiritual
community. It may include restorative
practices such as bodywork, meditation or breathwork.
The awareness
of the three primary patterns of autonomic dysregulation—sympathetic dominance,
parasympathetic freeze (dorsal), and mixed patterns—helps us manage our own
grief and that of our communities more effectively. Sympathetic dysregulation reminds us that with
any trauma, perception can distort, and fear-based patterns of defense are
common. It helps us cultivate compassion
so that we can extend grace to those in pain and to ourselves.
Bibliography
Andersen, L. P. H., Gögenur, I., Rosenberg, J., & Reiter, R. J. (2016). The safety of melatonin in humans. Clinical Drug Investigation, 36(3), 169–175. https://doi.org/10.1007/s40261-015-0368-5
Brzezinski, A. (1997). Melatonin in humans. New England Journal of Medicine, 336(3), 186–195. https://doi.org/10.1056/NEJM199701163360306Deadman, P. (2007).
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