Abstract Polyvagal Nerve Research

American College of Traditional Chinese Medicine @ CIIS, DACM Program

Pauline Torrey-Magret

Date: March 28, 2020

Spring Semester 2020

Clinical Case Analysis II

Literature Review: Can The Autonomic Nervous System Respond To TCM Post Trauma and Down Regulate Inflammatory Responses?

Abstract

Objective: The objective of this literature review is to evaluate the current publications about the Autonomic Nervous System reactions from chronic stress; its symptoms and the efficacy of methods used by Traditional Chinese Medicine (TCM) to treat and down regulate inflammatory responses. 

Design: Review of lectures and material printed by respected authors in the field of research and practice of TCM. 

The vagus nerve is composed of very complex pathways which can be linked to social behavior such as isolation as a consequence of its malfunction. The biological response linked the Brain-Guts connection, and its biological transcendence at a cellular level affecting the proper function of the immune system, and the regulation of the heart rhythm. Specific exercises, breath work, postural practice, and nutritional attention all are contributing factors to the recovery of the down regulations from chronic stress.

Keywords: Vagus nerve, Polyvagal theory, chronic stress, somatic manifestations,  autonomous nervous system, depression, anxiety, mental disorder, stress-related illness, posture, sound therapy, vocalization, breath, breath work, nutrition, meditations, visualization, TCM, 

Introduction

The vagus nerve brings sensory information from and distributes motor fibers to both the visceral and somatic structures. Coupled with the glossopharyngeal and accessory nerve, the vagus nerve makes up a unique system with mostly parasympathetic activity. The biological process of vagal nerve compression demonstrates the cascade of biological activities leading to the comprehension of the effect of the vagal pathway manifestations. The symptoms associated with this pathology can be restored through a series of physiological responses from breath, postural work, vocalization, nutrition, meditation, and guided visualizations. 

Anatomy

The first recording of the vagus nerve came from the Greek physician Claudius Galen (130-200 AD), who lived during the Roman Empire and studied anatomy in gladiator injuries. Galen performed dissections on pig and apes as well, and noted dysfunction related to damage to the vagus nerves. (Rosenberg, 2016) 

The vagus nerve (X), also known as the polyvagal nerve based on the theory proposed by Dr. Steven Porges, Ph.D., is a mixed motor and sensory nerve. The longest of the twelve cranial nerves, with the most distribution and functional abilities, it is named from the Latin word vagus meaning “wanderer”. 

These three nerves have in common the sharing of the pathway of the dorsal vagal nucleus, the solitary tract nucleus, and the nucleus ambiguous. The vagus has a functional connection with the trigeminal spinal nucleus. The somatic portion of the valgus innervated the ear canal and the skin of the posterior external ear. The visceral sensory portion receives input from the larynx, pharynx, bronchi, lungs, heart, esophagus, stomach, large and small intestines, and bile duct system. Its somatic motor division supplies the larynx, pharynx, and palate. A portion of the voluntary innervation is shared with the accessory nerve which is variable from individual to individual.

The valgus exits the posterior lateral medulla bilaterally by eight to twelve rootlets, in series with the rootlets of the glossopharyngeal nerve above, and the accessory nerve below. All of these rootlets unite to form the vagus nerve. 

The central nuclei of the valgus system are located in the medulla, which is located directly above the foramen magnum. It connects the spinal cord (below) to the pons of the cerebral diencephalon (above), and to the cerebellum (posteriorly). (Upledger, 1987)

The effects of activity on the ventral valgus pathway:

The ventral branch of the vagus nerve connected with its associated four cranial nerves functions properly by feeling in a desirable state of social engagement. Feeling safe and secure, feeling physically healthy, invites to engage in social activities promoting a state of being with a sense of creativity, positive thoughts, productivity, and happiness. This allows the physiological prerequisite for optimal physical, and emotional health, friendship, cooperation, mutual support, parent-child bonding, and a loving relationship. On the other hand, when we are threatened, or in danger, our autonomic central system shuts down the activities of the ventral branch of the vagus nerves and regresses to a primal state, a primitive evolutionary response of either spinal sympathetic activity (flight-or-fight) or depressive behavior (withdrawal). This primary evolutionary response can degenerate to a more extreme state of withdrawal by shutting down completely or dissociating. Extreme fear can generate the inability to stay in the realm of rational thought and conscious choice and as a survival mechanism intuitively isolate.

Autonomic nervous system and degenerative disease

Dr.Thomas Cowan, MD defines any accurate theory of the cause of myocardial infarction to account for the risk factors such as chronic psychological/emotional stress. The real revolution in the prevention and treatment of heart disease has to do with the autonomic nervous system. The central Nervous system (CNS) controls conscious functions such as muscles and nerves. The autonomic nervous system, (ANS) controls the function of our internal organs. (Cowan, T. (2016).

The ANS has two branches which in health are always balanced but in a ready state. The sympathetic known as the fight-or-flight system is centered in our adrenal medulla and uses the chemical adrenaline to send messages about the danger to our bodies. The mechanism of action is a series of biochemical responses primarily, activating the glycolytic pathways, cascading the breakdown of glucose to be used as quick energy in order to possibly run fast. The parasympathetic system in contrast is centered in the adrenal cortex and uses the neurotransmitters acetylcholine, nitric oxide, and cyclic guanosine monophosphate as its chemical mediator. It is the rest and digest arm of the autonomic nervous system. (Cowan, T. (2016). The specific nerve of the parasympathetic nervous chain that innervates the heart is the vagus nerve. It slows the heart and relaxes it, the sympathetic branch synergistically constricts the heart. “It is the imbalance of these two branches that is responsible for most heart disease.” 80% of ischemic events are preceded by chronic reductions in parasympathetic activity, such as smoking, emotional stress, inactivity, poor diet, hypertension, or-often-a combination of these, followed by a significant, often drastic increase in sympathetic activity such as an acute traumatic event or physical exertion. (B.Takase et Al).

Effects of activities in the dorsal valgus pathway:

The dorsal valgus regulates metabolic functions. It allows animals to reduce the activity level of their organ functions, conserving energy. The polyvagal theory describes how a surge in the activities of the dorsal branch of the vagus nerve is a defensive strategy causing a physiological state of shock and shutdown to help us cope with traumatic events, extreme danger, or imminent destruction, whether real or imagined, by suddenly collapsing and shutting down. When dorsal vagal activity is less extreme but chronic, its emotional correlation is characterized by depressive feelings. Once the danger is passed, people are expected to move out of the state of feeling depressed and back to social engagement; however, many people get stuck at some level of this state of immobilization with fear. In this case, the dorsal vagal pathway is most likely downregulated. 

Symptoms of a dorsal vagal state

When facing adverse conditions and social distancing, one response is the state of mobilization of the spinal sympathetic chain induced by a fight-or-flight reaction. Symptoms such as feeling helpless, apathetic, and hopeless occur. The heartbeat deregulates at a slower rate, blood pressure drops, and the blood withdraws from the periphery of the body and gathers in the center. Most of the blood full of oxygen is retracted to the thorax and abdomen to maintain a level of basic visceral functions. Our hands and feet feel cold and clammy. Symptoms such as moving pain syndrome are observed, often diagnosed as fibromyalgia. A state of shock or shutdown can be observed, the face looks pale and complexion is white, and the eyes appear dull and lifeless. The feeling of unexplained dizziness or fainting can occur. On the contrary, a well-functioning dorsal vagal nerve combined with social engagement allows the physiological response for rest and restitution, and proper intimacy. (Rosenberg, S. (2016)

The biological process of the vagal nerve 

Connecting biology to social behavior is a way to understand symptoms patients describe to their physicians and are being told they could not find anything ‘wrong’ with them, and are being sent away. Not only does the human genome have its own behavior, but the expression of white blood cells in epidemiology studies demonstrate variations of the gene's expression in reaction to a virus or the invasion of a pathogen with the Immunoglobulin G production, with type1 interferon antiviral response increasing production. A risk factor is translating in the expression based on the isolation factor. The remarkable behavior change in the genes transcription from the isolation is actually observed in several situations such as social loss, post-traumatic stress, cancer diagnosis, loneliness, social instability, chronic stress, low social rank, caregiving for serious illness, depression or early life adversity. (Cole lecture).

The mutation in the gene's expression is mediated by a signal sent to the brain by the myeloid embedded immune cells. 

The messages sent to the brain when we feel unsafe, threatened or in doubt create the fight-or-flight response which releases norepinephrine from the sympathetic nervous system terminal throughout the body including where the immune cells congregate. Those signals get picked up by receptors on the surface of white blood cells. It is as if evolution had programmed us when the signal get sent by that particular receptor; which according to Dr Cole research implies, there is a molecular wiring in diagram within the cell that activates the gene involved in inflammatory responses, in protecting us against cell injuries and bacterial infections; while simultaneously suppressing the activity of the genes involved in defending the body against a viral infection. Furthermore, psychology reveals to be a key to this kind of molecular reflex response. 

For example, when a person has had an experience of the world generating a feeling of being profoundly overwhelmed, and defeated instead of feeling threatened and doubt full, this person would have what biologists call a “defeated withdrawal response”, which is the mechanism created by the strong activation of the hypothalamus-pituitary-adrenal neural axis of releasing cortisol from the adrenal gland. This mechanism engages receptors that execute a fundamentally different program, actively repressing the activity of these antiviral interferon genes but also repressing the activity of these pro-inflammatory genes. (Breit, 2018).

Different ways of experiencing everyday life and the world in which we live, in particular, connected to a sense of safety, and security, embedded within a community transcend in gene expression. Dr. Steve W Cole, Ph.D., describes the phenomena as “a fundamental evolved regulatory architecture in our bodies. It’s called "force for different responsiveness for the menu of our opportunities that are embedded into 20,000 genes in the genome.”

The dynamics leading to the manifestation of these processes are regulated by reshaping the cellular composition of our bodies. This reshaping of the cellular composition is due to the dynamics mediated by a particular group of cells called monocytes, dendritic cells, collectively known as “myeloid lineage immune cells.”

What has been demonstrated is that in people confronting adverse environments for a long period of time, the brain basically activated the sympathetic nervous system, mediating fight-or-flight stress response, over and over but enough to actually resolve in the release of norepinephrine from these nerve terminal and in the bone marrow. (Cole lecture). The bone marrow, the seat of our immunity, produces new white blood cells industrially all the time due to the short lifespan of these cells. We constantly have to regenerate the cells that are essentially our immune system. When breached by the invasion of pathogens such as viruses; our genes' expressions fail and the multiplication of sick cells develops causing a feeling of constant exhaustion which can take a while to reach the diagnosis of cancer for example, or immune disorder. The cellular regeneration process is mediated by hematopoietic stem cells which, when they “hear” a signal from the parasympathetic nervous system, activate receptors in their environment to then send the signal. This activates a program that causes them to lighten up on the production of lymphoid lineage immune T-cells and B cells, and to invest more deeply into the production of these first lines of defense the myeloid lineage cells. 

The granulocytes and monocytes initially born in the bone marrow circulate in our blood throughout our body. The function of these cells is to ward off bacterial infection or tissue injuries, or the feeling of being threatened. When these cells get into the systemic circulation, without necessarily tissue injuries, the cells react according to what they cross paths with. In the event of an initiated cancer, for example, the cells will start to squash their neighbors’ myeloid lineage cells by invading the tissue and in some misguided attempt, limit the growth of tissue injury or bacterial infections by secreting growth factor, growth of blood vessels into the environment, and vastly promoting metastasis in an incidental way.

They also will get into damaging blood vessel lining and start to build a little plaque to protect the injured tissue, which ends up creating arteriosclerosis and heart diseases. With more damaged neurons, the more neuro-degenerative disease develops due to prime myeloid lineage cells circulating in your body. This is the actual accidental equation for the development of very major chronic illness that shapes contemporary morbidity and mortality which is the epidemiology of modern life. 

The question birthing from these observations is: How to not live lonely but integrated? As isolation remains the key factor of these cells' production activated by the feeling of uncertainty, threat, or unsafe, it is known now that it is essential to alleviate these feelings to see more favorable biology at the molecular level in immune cells. Many theories have been developed about how to cultivate positive leukocytes. There are ways to activate the parasympathetic nervous system including doing good for people you care for and cultivating many of the same kinds of biological responses through contemplative practices and meditation. Our biology intrinsically binds people around us, our relationship to them shapes the way we function at a physiological level. Physiology is an intervening variable. Training compassion or any kind of manipulation vary greatly based on the state of the individual. Physiological state leads to emersion properties such as compassion and empathy.(Porges lecture)

According to Dr. Stephen Porges, Ph.D., a researcher at the University of North Carolina, US, the physiological state that enables these emerging properties is the state of parasympathetic nervous system control, mediated by a unique vagal pathway that is unique to mammals. 

Activating A Vagal Response

The Vagal pathways can be accessed through certain types of behaviors, through spontaneous social interactions with the emerging properties of down-regulating stress responses and facilitating health. We know this from ancient religious practice. 

At its root, the manipulation of the vagal pathways is embedded in religious and spiritual practices as well as the manipulations of vocalizations, breath, posture, and exercises. There is a specific vagal pathway that leads to compassion and health. Each of these manipulations triggers a specific vagal pathway that is linked to down-regulating defensiveness. Being in a state of unconditional presence and total mindfulness allows our defenses to be turned off. When we are not in a defensive state, we are really connected. In addition, connectedness is a biological imperative for mammals, like us humans, we cannot survive by ourselves. We cannot regulate our physiology as an individual. We need other individuals and some of us can get along with another mammal like a dog. Postural awareness, exercise, vocalization, and breathing exercises, are neuro exercises. They activate specific vagal pathways that are promoting portals thru compassion but they are also portals to health, growth, and restoration. 

Methods for Vagal Activation

The first neural exercise is vocalization:

Vocalization has been practiced in every religion since the beginning of time. When a baby cries, the voice or song of a mother’s lullaby has a profound calming effect, while the voice of a father with a deeper tone can trigger a predator- like of predator due to its lower frequency of sounds. (Porges lecture). 

Many fathers are distanced from their children due to these frequencies, often time confirmed in autistic children who are frightened by their father’s voice. The fix for that is to speak in a soft tone. A melodic voice is a feature detector that activates neuroreceptors triggering safety. The neuro-regulation of the face, the mouth, the oral area, and the eyes, controlling the muscle of the middle ear enable us to hear human voices and dampen background sounds. All are regulated to the vagal regulation of our heart. When we sing, we are embracing the regulation of the heart through the vagal pathways. It crosses religions.

The second neural exercise is breath:

The metaphor that we breathe in the suffering, and exhale with love influences the vagal response in the heart. This exercise affects the heart by accentuating its beat during exhalation and turning it off during inhalation. 

When we sing, we are always controlling the duration of the exhalation. When we play wind instruments, we control the diaphragm. 

Long before we had syntax or words, we had vocalizations. Vocalizations like baby’s sounds, serve a functional adaptive purpose in the survival of mammals. (Porges). A melodic prosaic vocalization conveys to another person a feeling of safety and calmness like a mother’s lullaby or the sound of a wind instrument tuned at the 432 Hz frequencies, which is closer to the vibration of nature, and more harmonious to the human heart. Vibrations are a subtle form of communication. Before light, there are sounds. A mild and soft tone project peace and harmony while a slight inflection of tone can create tension. (notes 1). This is a reflection of neuro-regulation thru laryngeal nerves and vagal nerves monitoring and manifesting the physiological state of the person vocalizing. We now live in a world dominated by syntax and words, the articulation of those words create sounds and vibration that shape our physiology and our bodies because it is our biology. As we increase in the duration of exhalation with vocalizations, we enhance the vagal brake on the heart, we calm our bodies down to regulate the sympathetic defensiveness. Voluntary breathing practice is a manipulation of the vagus nerve which can turn on and off the “vagal brake”. Posture is another critical element as it changes the position of our blood pressure receptors, primarily the one in our neck. In the action of bowing, we trigger physiological responses thru the bowing receptor reflex which change the vagal activity. (Porges).

This is also embedded in Pranayama breathing in Yoga. Master Mantak Chia from Thailand, a Taoist Master, over the last several decades, has been teaching knowledge and practical applications of breath work in the Universal Tao. This is an ancient centuries-old Taoist practice of a self-help system for curing and preventing illness and stress. The key concept focuses on the increase of vital energy or chi, through easy techniques and physical exercises. In a book published by Master Mantak Chia: “The Six Healing Sounds”, he explains how each organ of our body vibrates at a particular frequency. Their meditations reveal six sounds with the correct frequencies to keep the organs in optimal condition to prevent and alleviate illness. Over time, six postures were developed to complement the Six Healing Sounds to activate the acupuncture meridians or energy channels of the organs. According to Master Chia, malfunction of the organs can be from urban society life which he calls “urban jungle”. Urban and suburban environments are full of physical and emotional stresses from overcrowded areas, pollution and radiation exposures, junk food and chemical additives nutrients, anxiety and loneliness feelings, bad posture, and sudden or overly achieving exercises. Many stimuli lead our bodies to hyperactivity. When we lack the protection provided by nature such as trees, green spaces, and natural running water, which provide a cooling purifying energy, the body becomes out of balance. In other words, overstimulation leads to false heating of our organs as well as obstruction of the flow of energy within them. The accumulation of negative energy overloads the internal organs, creating a contraction and hardening of the organ which result in illness. He mentioned that “stress cooked your brain”. 

In order to cool the system of the organs, TCM teaches that each organ is surrounded by a tissue called fascia, a membrane with the function to regulate its temperature. The heat is meant to be releasing excess heat throughout the skin, when it is not, the toxins block the free flow of exchange of cooling and heating energy, with the heat being reflected back into the organs, causing pressure and overheating to a malfunction of the organs. 

The Six Healing Sounds facilitate heat exchange through the digestive system and the mouth, helping to release heat from the fascia by cooling and cleansing the organs and skin. In order to correct the temperature of the organs toward an optimal state, six sounds, and postures allow the proper distribution by the intestinal tract. 

The practice is focused on 5 organs, the lungs, kidneys, liver, heart, spleen, and the San Jiao and their pair organs. The sounds are associated with postures and guided meditations and visualizations which change the perception of the feeling body. He developed this fabulous technique to smile at our inner organs. The practice of breathing, postural and meditative movements transcend the physical boundaries by developing the soul and the spirits within the human. The fact that sounds heal and restore calmness and good health including greater sexual pleasure, improved digestion, stronger immunity as well as the ability to consciously overcome the long-standing dependence on sleeping pills, tranquilizers, antacids, and chemical substances has been well documented and taught among mental health workers. Heart attack victims have prevented further attacks. Psychologists have reported the relief of depression. Anxiety and anger from patients who practice this method of breathing. (Chia).

This work reflects the polyvagal theory of Dr. Porges who defined the address of the Vagus nerve to be capable of healing by the practice of vocalizations, which are sounds, movements to address posture and breath work. 

According to Dr. Steven Porges, PhDDuring the experimental workshop, patients were asked to practice long inhalation and short exhalations, repeatedly without hyperventilation, then reversing the practice with rapid inhalation and longer slow exhalations. The outcome from the practices about how they perceived their exercise partner, and how that person perceived them resulted in 80% of the people perceiving a loving person across them. In contrast, the practice of long inhalation and short exhalation exercises resulted in a confused state of being. This is an example of a manipulated state of breathing. Like Master Mantak Chia demonstrates the alteration of a state of being with the exercises of the Six Healing Sounds, Dr. Porges concluded the same outcomes. 

The third neural exercise is posture: 

In the major religions, postures are also practiced, such as bowing as a Muslim practice, kneeling for Christians, and bending and bowing in Judaism. Master Mantak Chia exercises require postural positions specific to the pair of organs being cleansed and toned. 

Long before we had syntax or words, we had vocalizations. Vocalizations like baby’s sounds, serve a functional adaptive purpose in the survival of mammals. (Porges). A melodic prosaic vocalization conveys to another person a feeling of safety and calmness like a mother’s lullaby or the sound of a wind instrument tuned at the 432 Hz frequencies, which is closer to the vibration of nature, and more harmonious to the human heart. Vibrations are a subtle form of communication. Before light, there are sounds. A mild and soft tone project peace and harmony while a slight inflection of tone can create tension. (notes 1). This is a reflection of neuro-regulation thru laryngeal nerves and vagal nerves monitoring and manifesting the physiological state of the person vocalizing. We now live in a world dominated by syntax and words, the articulation of those words create sounds and vibration that shape our physiology and our bodies because it is our biology. As we increase the duration of exhalation with vocalizations, we enhance the vagal brake on the heart, we calm our bodies down to regulate the sympathetic defensiveness. Voluntary breathing practice is a manipulation of the vagus nerve which can turn on and off the “vagal brake”. Posture is another critical element as it changes the position of our blood pressure receptors, primarily the one in our neck. In the action of bowing, we trigger physiological responses thru the bowing receptor reflex which change the vagal activity. (Porges).

Conclusion

Based on the literature published and the many studies published in regard to the autonomic nervous system response to TCM post-trauma, it is encouraging to say the downregulation of the inflammatory response is affected by positive outcomes. 

Not only TCM offers a unique combination of tools to down-regulate inflammatory response with breathing exercises, postural awareness, physical exercises, vocalization, meditation, guided visualizations, nutrition, and herbal treatments but there is more to this search with many studies demonstrating the positive effect of acupuncture as well. This is a fascinating subject that is initiating a bridge between emotions, behavior, biology, and energy. A promising outcome for our understanding of our humanity. 

REFERENCES

• Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Frontiers in Psychiatry, 9, 44. https://doi-org.ciis.idm.oclc.org/10.3389/fpsyt.2018.00044

• Chia, M. (2009). The six healing sounds: Taoist techniques for balancing chi. Rochester, VT: Destiny Books.

• Cowan, T. (2016). Human heart, cosmic heart: a doctor's quest to understand, treat, and prevent cardiovascular disease. White River Junction, VT: Chelsea Green Publishing.

• Kim, H.-bae. (2015). Handbook of Oriental medicine. Anaheim, CA: AcupunctureMedia.com.

• Pitchford, P. (2009). Healing with whole foods: Asian traditions and modern nutrition. Berkeley, CA: North Atlantic Books.

• Rosenberg, S. (2016). Accessing the healing power of the vagus nerve: self-help exercises for anxiety, depression, trauma, and autism. Berkeley, CA: North Atlantic Books.

• Scheid, V., & Bensky, D. (2015). Chinese herbal medicine. Seattle, WA, USA: Eastland Press.

• Stone, R. (2009). Health building: the conscious art of living well. Summertown, TN: Book Publishing.

• Twicken, D. (2013). Eight extraordinary channels: qi jing ba mai: a handbook for clinical practice and nei dan inner meditation. London: Singing Dragon.

• Upledger, J. E. (n.d.). Craniosacral therapy Ii: beyond the dura.

• Upledger, J. E., & Vredevoogd, J. D. (2003). Craniosacral therapy. Seattle: Eastland Press.

NOTES

1.(http://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=BPC&division=2.&title=&part=&chapter=12.&article=2)

2.(www.highspirit.com).

3. https://youtu.be/VAL-MMYptQc, Stephen Porges

4. https://youtu.be/9FtePgF1f28, Steve Cole