Journal of Chinese Medicine | Issue126 | June 2021

Polyvagal Theory through the Lens of Chinese Medicine

Polyvagal Theory through the Lens

of Chinese Medicine
Vanda Huang

Abstract

According to polyvagal theory, the parasympathetic nervous system has

two distinct branches: the ventral and dorsal branches of the vagus nerve.
The dorsal vagal circuit triggers a shutdown defense system in response to
trauma or chronic stress. This self-preservation mechanism can result in chronic
symptoms of feeling isolated, hopeless and disconnected. From a Chinese
medicine perspective, this cold, desolate emotional landscape closely
correlates with signs of an imbalanced water element, or Kidney deficiency.
This article explains polyvagal theory and how acupuncture and other
Chinese medicine modalities can be utilised to treat a nervous system that has
become stuck in survival mode.
Keywords
Polyvagal theory, nervous system, dorsal vagal, vagus nerve, stress, trauma, water element, Kidney, acupuncture

After periods of acute trauma or prolonged stress, Polyvagal theory

patients frequently describe feeling disconnected,
overwhelmed or lost. They may complain of feeling numb Polyvagal theory was first presented by Dr. Stephen Porges
or apathetic - incapable of being present for family and in 1994.2 He described three branches of the autonomic
friends. According to Dr. Stephen Porges' polyvagal theory, nervous system: the sympathetic branch and the ventral
those emotional states are the result of an autonomic vagal and dorsal vagal branches of the parasympathetic
nervous system that has shifted from sympathetic nervous system. Most of us are familiar with the sympathetic
dominance to shutdown mode under the influence of the versus parasympathetic aspects of the nervous system. Dr.
dorsal vagal pathway.1 This theory states that when fight or Porges delineates two types of vagus circuit within the
flight becomes ineffective (such as being unable to deal with parasympathetic nervous system: the myelinated ventral
a pandemic or flee from wildfire smoke), an ancient mammalian vagus and the more primitive unmyelinated
neurological circuit is triggered that generates an dorsal reptilian vagus.3 The myelinated (ventral) vagus
immobilisation or shutdown response. For these patients, is engaged when we feel safe, so that we easily connect
hopelessness and exhaustion set in. It becomes very difficult with others and feel open, grounded and relaxed. With
for them to muster energy to care about anything, leaving increased stress, our sympathetic nervous system takes
them feeling isolated or depressed. There are various over, triggering a ‘fight or flight’ response and leading us
interventions that can pull patients out of this state. This to feel hypervigilant, restless, frantic or angry. When our
article discusses the Chinese medicine understanding of sympathetic response is ineffective at making us safe, the
polyvagal theory, and suggests acupuncture and other unmyelinated (dorsal) vagal circuit turns on as a protective
Chinese medicine treatment options for addressing this last resort by immobilising or shutting down the system. In
type of nervous system dysfunction. situations where fleeing is not possible and fighting would be

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 Journal of Chinese Medicine | Issue126 | June 2021
Polyvagal Theory through the Lens of Chinese Medicine

Stress
level Nervous system Characteristics Strategies for balance

LOW VENTRAL VAGAL Present, connected, social, settled, N/A

Calm, safe and grounded, curious, open, compassionate;
engaged joy, motivation, relaxation

| SYMPATHETIC Angry, frustrated, anxious, frantic, restless, Move the body: dance, yoga, tai chi/qi gong, hike or stroll
| Activation, tense, reactive, irritable, impulsive, uptight, through the forest
| mobilisation hypervigilant, unable to focus; racing Grounding: squish toes in the sand, walk barefoot in the grass,
| (fight or flight) thoughts, racing heart, rapid breathing, no forest bathing
| patience to make conversation Let it out: expressive writing, communicate (email and text if that
| is the only option, but it is even more effective for the nervous
| system to see and hear a real person)
|
| DORSAL VAGAL Disconnected, numb, sad, exhausted, Deep breathing: alternate nostril breathing, meditation
| Shutdown, frozen, heavy, hopeless, foggy, Cold water: splash cold water on the face or do a cold rinse at
immobilisation abandoned, isolated, depressed, lifeless, the end of a shower
overwhelmed, sluggish, lost, shutdown, Activate the throat/breath: gargle, chant/sing/hum, play a
withdrawn; shame, avoidance, wanting to wind instrument
HIGH curl up and hide

Table 1: Summary of Porges’ polyvagal theory

life-threatening, complete
shutdown may represent
In situations where fleeing is not anger. People with a wood
element constitutional
the best chance at survival. possible and fighting would be life- type often gravitate
This response can result in
disassociation, or even loss
threatening, complete shutdown towards impact sports,
such as boxing or hockey,
of consciousness, as a way may represent the best chance at to keep their Liver energy
to raise pain thresholds.
For example, laboratory
survival. moving. This can be
seen as ‘self-medicating’
studies have shown that the impulse to ‘fight’ if
mice without a normal fear response are uncontrollably they find themselves in a chronic state of ‘fight or flight’
aggressive and will fight to the death.4 A nervous system by giving the impulse a channel of expression. When the
in a healthy mouse, on the other hand, will allow a fight to dorsal vagal circuit is activated, the effects are evocative of
continue only up to a certain point before immobilisation an imbalanced water element: feeling withdrawn, isolated,
is triggered in order to prioritise survival. In reptiles the rigid and exhausted. If the trigger is extreme enough to the
response of freezing - i.e. feigning death - can be an effective nervous system, the person may feel paralysed or even lose
survival mechanism, but not so much for humans if they consciousness. The Chinese character for fear, kŏng 恐,
become stuck in this state. contains within it the character gŏng 巩, which means ‘to
make firm’ or ‘consolidate’.5 With fear there is rigidity, a
Merging Chinese medicine with polyvagal theory lack of the flexibility that is inherent to the water element.
With panic attacks and phobias we become frozen and
If polyvagal theory is looked at through the lens of Chinese immobilised by fear.
medicine we can see many parallels. The ventral vagal One noteworthy predilection that patients in the dorsal
pathway is associated with emotions such as joy, compassion vagal state express is a desire to curl up and hide. The status
and social engagement, and therefore correlates with the fire of their nervous system does not allow them to feel safe
element and the Heart. When the fire element is in balance, being exposed out in the world and around other people.
there is lightness, cheer, warmth and a natural desire for Chinese medicine has an explanation for this distinctive
social connection. Interestingly, the myelinated branch of the symptom. Arnaud Versluys translated Zhang Jingyue’s
vagus nerve mainly innervates the heart (and bronchi), while description of the Kidney in Chapter 13 of the Category
the unmyelinated dorsal vagus innervates the gut. A hyper- on Disease in the Leijing as follows:
aroused sympathetic nervous system provokes emotions
very similar to those associated with Liver qi stagnation and All cold, retraction and contraction belong to the kidney.
a constrained wood element: frustration, irritability and Retraction means astringeing, contraction means urgent

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Polyvagal Theory through the Lens of Chinese Medicine

Nervous system Organ/element Emotion Nervous system characteristics

Ventral vagal Heart/fire joy xĭù 喜 Social engagement, compassion, connection

Sympathetic Liver/wood anger nù 怒 Irritability, frustration, tension, impatience

Dorsal vagal Kidney/water fear kŏng 恐 Withdrawal, numbness, exhaustion, hopelessness

Table 2: Characteristics of the different aspects of the nervous system

tightness. The kidneys belong to water and engender cold; it Treatment strategies
indicates a weakness of the yang energy causing the nutritive
and protective to congeal and the body to curl up, which all There are a variety of Chinese medicine treatment
belong to the concept of retraction and contraction.6 strategies that can be applied to help patients shift from a
dorsal vagal state of shutdown to a calm, socially engaged
In another classical reference, Peter Deadman notes in A state, as follows:
Manual of Acupuncture that according to the Ling Shu the • If the Kidney qi becomes injured due to sudden or
acupuncture point Dazhong KID-4 can be used in cases prolonged fear, the water element can be strengthened
where Kidney qi deficiency so severely weakens the will via its mother, metal. Fuliu KID-7 (aptly translated by
that one ‘withdraws and is unwilling or unable to leave the Cleaver [1994] as ’Recover Flow’) is the metal point on
safety of their home.’7 the water channel, and combining it with the water point
According to Dr. Porges, for patients with post- on the water channel - Yingu KID-10 - can help reinforce
traumatic stress disorder (PTSD) or other psychiatric this flow of qi. Needle gently and in the direction of the
conditions, there is frequently auditory dysfunction channel.
where they have difficulty distinguishing human voices • Another option would be to use the yuan-source point,
from loud background noises. This is because when Taixi KID-3, in combination with the luo-connecting
one is hypervigilant, the nervous system is incapable of point, Feiyang BL-58.
listening to human voices because it is on high alert for the • Kidney points near the heart region appear to be an
low-frequency sound of predators - it has shifted from social excellent choice to treat a state of shutdown, as they
engagement to surveillance mode.8 Distinguishing human strengthen the Kidney-Heart connection. Lingshu
voices from background noises is also highly dependent on KID-24, which translates as ‘Spirit Burial Ground’,12 is
the muscles of the middle ear, the neuroregulation of which one option for those feeling lost.
is linked to our facial muscles.9 When we are interested • As mentioned earlier, Dazhong KID-4 is indicated for
in what someone is saying, we naturally use lively facial patients who wish to close their front door and remain at
expressions. Contracting facial muscles to expressively home. A Manual of Acupuncture also lists a combination
widen the eyes will simultaneously tense the middle ear from Sun Simiao’s Qianjing Yaofang (Prescriptions Worth
muscles, making it easier to hear in a noisy environment.10 a Thousand Gold) that pairs Dazhong KID-4 with Ximen
In Chinese medicine, because the Kidney opens into the P-4 for ‘fear of people’. A 1997 study showed that P-4
ears, damage to the Kidney essence will diminish the power increases cardiac vagal activity.13 This combination would
of hearing. Michael Tierra elucidates this relationship work well for patients with social anxiety and elevated
between the Kidneys and hearing by describing two heart rate.
mechanisms. First, the Kidney is involved with regulating • Kiiko Matsumoto’s method to fortify the Kidney uses
the autonomic nervous system and, if harmonious, its Yishe BL-49, Weicang BL-50, Huangmen BL-51 and
‘capacity to differentiate between pitch, intensity and Zhishi BL-52, all needled superficially and threaded
loudness is optimized’.11 He also explains how the Kidney horizontally towards the spine.14 The needles in these
relates to the ossicular system of the middle ear and plays a outer back-shu points should be inserted in such a way
role in calcium metabolism. Any imbalance in this calcium that when viewed from above, their layout naturally
metabolism will cause the ossicles of the middle ear to curves outward, outlining the lateral curved shape of
fibrose, which then adversely affects one’s hearing. As Dr. the kidney organs.
Porges has established, without a responsive middle ear, • The internal dragon points popularised by J. R. Worsley
people will have great difficulty communicating in public can also be considered to help pull people out of the
places as their nervous system will not allow them to hear cold, reptilian dorsal vagal state. The internal dragon
what their companions are saying. points are: the point halfway between Juque REN-14

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Polyvagal Theory through the Lens of Chinese Medicine

Acupuncture Metal/Water on the Kidney channel: Fuliu KID-7, Yingu KID-10

Yuan/Source point combination: Taixi KID-3 , Feiyang BL-58
Kidney points over the heart: Lingshu KID-24, or Shenfeng KID-23 and Shencang KID-25
For the desire to curl up and hide: Dazhong KID-4 can be combined with Ximen P-4 to improve cardiac vagal tone
Kiiko style Kidney-support points: Yishe BL-49, Weicang BL-50, Huangmen BL-51 and Zhishi BL-52 needled
superficially and threaded horizontally towards the spine
J. R. Worsley’s internal dragon points: point halfway between Juque REN-14 and Jiuwei REN-15, Tianshu ST-25,
Futu ST-32 and Jiexi ST-41
Sa’am four needle technique for chronic stress induced depression: Yingu KID-10, Ququan LIV-8, Jingqu LU-8
and Xingjian LIV-2 (according to one study Yinggu KID-10 and Ququan LIV-8 may be sufficient)
Fortify essence and nourish Kidney via the lower dantian: Guanyuan REN-4
Cupping Tonification cupping: warming, gentle flash cupping over Shenshu BL-23

Qigong Any styles that incorporate bringing qi/breath to the lower dantian and/or mingmen

Moxa Guanyuan REN-4, Qihai REN-6

Sound therapy Singing bowls, tuning forks, playlists without low frequency sounds

Table 3: Summary of treatment methods for the dorsal vagal state

and Jiuwei REN-15 plus description of LIV-8, A

bilateral Tianshu ST-25, These patients respond best to a Manual of Acupuncture
Futu ST-32 and Jiexi ‘less is more’ approach; aggressive states: ‘As the water point
ST-41. These points are on the Liver channel,
indicated for a state of treatment will only cause their Ququan LIV-8 links the
‘possession’ in which a nervous system to retreat even Liver with its ‘mother’ the
person is unable to make Kidney.’17 This connection
eye contact or connect further as a protective mechanism. between the water
with other human element and the Kidney
beings.15 These are typical post-traumatic behaviours that may be why these two particular points were especially
manifest when a patient’s nervous system shuts down. effective for the chronically stressed mice.
• Frontiers in Psychology published a study that suggests • Tonification cupping over Shenshu BL-23 to gently coax
acupuncture can be an effective treatment for chronic qi into the Kidney region would also be a nourishing
stress-induced depressive behaviour.16 The study option. This method of cupping, as described by Bruce
needled stressed mice using a traditional Korean Bentley, is not the typical vigorous type of cupping with
acupuncture method (Sa’am). The mice received one strong suction used for tight muscles or other excess
of four sets of acupuncture points: 1. Yingu KID-10, conditions.18 Instead, the method requires ensuring the
Ququan LIV-8, Jingqu LU-8 and Xingjian LIV-2 (Sa’am cups are warm and very lightly applied a total of nine
protocol); 2. Yingu KID-10 and Ququan LIV-8 only; times. The cup is removed at the peak of the patient’s
3. Jingqu LU-8, Zhongfeng LIV-4, Shaofu HE-8 and inhalation; since the suction is so light, the cup should lift
Xingjian LIV-2 (control points); and 4. non acu-points off easily without any sound. Upon the last round of this
around the hips/coccyx. After the acupuncture extremely gentle flash cupping, the cups are left in place
treatment, mice from the first two groups were willing for 10 minutes, covered with a sheet or towel to keep the
to explore the furthest, similar to the way they had patient warm.
prior to the induced stress. The researchers concluded • An adverse effect of injured Kidney qi is that the breath
that the Sa’am protocol, especially Yingu KID-10 and becomes stuck above the diaphragm and can no longer
Ququan LIV-8, were effective for treating depressive- sink into the lower dantian. Qigong that focuses on
like symptoms induced by chronic stress. In the the dantian and deep abdominal breathing can help to

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Journal of Chinese Medicine | Issue126 | June 2021
Polyvagal Theory through the Lens of Chinese Medicine

reset the nervous system to remedy this problem. As Vanda Huang, ND, LAc has had an interest in the
mentioned earlier, the unmyelinated branch of the vagus influence of the psyche on chronic pain since working on
nerve runs below the diaphragm to innervate the gut. her thesis at the National University of Natural Medicine
If we correlate the gut in this context with the lower in 2006. Since then she has been in private practice in
dantian, needling or moxa at Guanyuan REN-4 to warm New York, and currently Seattle. If readers feel inclined to
and nourish the dantian will be beneficial for patients share experiences of treating patients from the polyvagal
who are stuck in chest breathing. perspective she can be reached at office@flowinghealth.org.
• Sound therapy can play a significant role in addressing
the dorsal vagal state. Dr. Porges has developed an Endnotes
auditory playlist protocol (the ‘Safe and Sound Protocol’) 1. Buczynski, R. & Porges, S. (n.d). The Polyvagal Theory for Treating
that regulates the middle ear muscles to trigger specific Trauma, available at <https://static1.squarespace.com/
static/5c1d025fb27e390a78569537/t/5cce03089b747a35
neural circuits.19 Acupuncture practitioners might 98c57947/1557005065155/porges_nicabm_treating_trauma.
consider incorporating tuning forks or singing bowls pdf> p. 10 [accessed 15.05.21]
into treatments as a way to nourish the water element 2. Buczynski, R. & Porges, S. (n.d). Body, Brain, Behavior: How Polyvagal
Theory Expands Our Healing Paradigm, available at <https://static1.
through the ears.20 squarespace.com/static/5c1d025fb27e390a78569537/t/5c
• Another important approach to support these patients d366238c5c890001a39cf9/1557358164261/NICABM-
would be to harmonise the earth element in the treatment StephenPorges-Brain2013.pdf> p.29 [accessed 15.05.21]
3. Ibid., p. 6
space. In the controlling sequence of the five phases, earth 4. Grandin, T. (2005). Animals in Translation. Scribner: New York City,
can over-control water. Practitioners should minimise p. 125
any startling noises, harsh lighting or chaotic crowded 5. Larre, C & and Rochat de la Vallee, E. (2005). The Seven Emotions:
Psychology and Health in Ancient China. Monkey Press: London, p. 88
areas in the clinic so as not to further trigger any defense 6. From pathology lecture notes by Arnaud Verslus at the National
mechanisms. Providing a nurturing, stable environment University of Natural Medicine.
and using a gentle melodic tone of voice with empathetic 7. Deadman,P., Al-Khafaji,M. & Baker, K. (1998), A Manual of
Acupuncture. Journal of Chinese Medicine Publications: Hove
facial expressions will signify to the patient’s nervous 8. Buczynski, R. & Porges, S. (n.d). The Polyvagal Theory for Treating
system that they are safe. Face-to-face social interaction Trauma, available at <https://static1.squarespace.com/
with someone they trust can in itself help to bring the static/5c1d025fb27e390a78569537/t/5cce03089b747a35
98c57947/1557005065155/porges_nicabm_treating_trauma.
person back to a calm, connected state. pdf>, p.15-16.
9. Porges, S. (2003). The Polyvagal Theory: phylogenetic contributions
Conclusion to social behavior, Physiology & Behavior, 79, pp. 503–513.
10. Dykema, R. (2006). “Don’t talk to me now, I’m scanning for danger”,
Nexus, March/April, pp. 30-35
Viewing polyvagal theory through the lens of Chinese 11. Tierra, M. (2006). Integrating the Traditional Chinese Understanding of
medicine provides many treatment options that can be the Kidneys into Western Herbalism, available at <http://acupuncture.
com/herbs/tcmkidney.htm> [accessed 15.05.21]
applied for patients exhibiting shutdown behaviour who 12. Jarrett, L. (2006). Clinical Practice of Chinese Medicine. Spirit Path
are struggling in a contracted state of immobilisation. Press: Stockbridge, MA
One of the key components of effective treatment for 13. Nishijo, K., Mori, H., Yosikawa, K. et al. (1997). Decreased heart
rate by acupuncture stimulation in humans via facilitation of cardiac
these patients is to remind their nervous system that they vagal activity and suppression of cardiac sympathetic nerve, Neurosci
are safe - the calm, understanding presence of the Lett, 227, 3, pp. 165-8
practitioner is vital in this regard. These patients respond 14. Matsumoto, K. (2019). Kidney Detox Treatment. Seminar notes
15. Jarrett, L. (2014). Treating Trauma with Chinese Medicine. Seminar
best to a ‘less is more’ approach; aggressive treatment notes.
will only cause their nervous system to retreat even 16. Lee Min-Ju, Ryu Jae-Sang, Won Seul-Ki et al. (2019). Effects of
further as a protective mechanism. A quote by Ye Tianshi Acupuncture on Chronic Stress-Induced Depression-Like Behavior
and Its Central Neural Mechanism, Front. Psychol., available at
is befitting here: ‘A light intervention can eliminate a <https://doi.org/10.3389/fpsyg.2019.01353> [accessed
deep seated problem.’21 Chinese medicine, with its varied 15.05.21]
treatment options and flexibility, with which we can 17. Deadman,P., Al-Khafaji,M. & Baker, K. (1998), A Manual of
Acupuncture. Journal of Chinese Medicine Publications: Hove
easily customise the intensity of therapy, makes it a 18. Bentley, B. (2011). Cupping Deficiency, The Lantern, 8, 2, pp. 15-27
uniquely apt modality for addressing the dorsal vagal 19. See <https://integratedlistening.com/ssp-safe-sound-protocol/>
state. By supporting the water element, patients can [accessed 15.05.21]
20. Wong, A. & New, A. (2020). Sound Therapy: from Polyvagal
recover from trauma and replenish their inner resources. Theory to Practice. The Hong Kong Medical Diary, available at
With their inner strength restored, they can overcome <https://sha-journal-articles.s3-us-west-2.amazonaws.com/
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21. Cited in Bentley, B. (2011). Cupping Deficiency, The Lantern, 8(2),
pp. 15-27

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