For the last few years I have been developing a deeper interest in the vagus nerve. Part of this interest comes from my training in the Toyohari system and its gentle naso techniques in the greater neck-supraclavicular fossa complex (in this region of the body we are working right over the vagus nerve as it runs over the SCM), and part comes from my study of the polyvagal theory of Stephen Porges, MD, a psychiatrist-researcher who has developed a ground-breaking new understanding of the autonomic nervous system (ANS). In this blog I’d like to describe why this topic is so fascinating for me, and why I continue to be drawn ever deeper in this direction. Although this work is new and developing, we Chinese Medicine practitioners with our ancient medicine have a lot to contribute. That’s what excites me.
Let’s look at the basics of the vagus trajectory and function. The word vagus is related to vagabond and vagrant, which is to say it wanders over quite a large part of the human body. It is a long, meandering bundle of motor and sensory nerves that links our brain stem to most of our organs. It is the key to healthy parasympathetic nervous system function.
As Porges explains, the vagus has two branches: The dorsal branch is an unmyelinated, more primitive part of the nerve that we share with all other vertebrates, and the higher functioning, ventral myelinated vagus. The dorsal vagus links organs below the diaphragm with the dorsal brain stem and is connected with the primitive freeze response we find in animals such as opossum that is engaged when threatened. The ventral vagus on the other hand can engage or inhibit the limbic system. Porges refers to it as a function of social engagement. There is much more to his work, but let’s limit ourselves for now to this basic view.
As I understand the history of the development of Toyohari’s gentle naso techniques, they originally started with an interest in ST-12 and some classical passages about its role in adjusting the pulse, i.e., improving the quality of the pulse. Toyohari is a largely pulse-drive system (though not exclusively), and so there was real interest in using this point regularly with many patients because it did indeed seem to help improve the pulse picture. Over time practitioners of this style became interested in the entire supraclavicular fossa around ST-12, and they expanded their work beyond that one point. I believe that, from a scientific perspective, the wonderful, gentle work they do in this area improves what is called “vagal tone.” This term “vagal tone” refers in general to a healthy functioning of the parasympathetic nervous system (“rest and digest”). This is reflected in a slowed heart rate and increased heart variability (desirable).
Beyond the gentle needling of this area, we also have manual techniques we can include in our treatments of the neck-shoulder complex. Many US acupuncturists have studied cranial-sacral techniques to at least a beginner level, and these techniques are very helpful, but there are techniques from within our own East Asian tradition that do a great job here as well. Qigong tuina, an ancient Taoist system, (look for an online CE seminar on this amazing system soon at Blue Poppy) is an approach that uses a yin and yang rhythm that can be identified and worked with in different layers of the body’s tissues. Taken into this SCM-scalenes area, qigong tuina is amazing how much change can be won in just a few minutes of subtle work.
Sotai is another manual system that has a lot to offer in the neck. In Sotai we use comfortable movements in the direction of ease. We instruct the patients to exhale while they do these slow, gentle movements. At some point in the movement we offer them resistance, thus stopping the motion. After holding the resistance for 3-5 seconds we give the command to relax. Once the patient has relaxed, we then passively complete the movement. In the neck this can bring blessed relief in just a few minutes, whether using rotation, lateral flexion, or extension-flexion. Jeffrey Dann, Ph.D., has developed a “micro-Sotai” that is specific to the neck. It is a brilliant addition to the style and is a boon for patients.
Using a teishin instead of our hands or insertive needling gives yet more options in the neck. I have written in previous blogs about one of my teachers, Mr. Iwashina (aka Dr. Bear). He does all of his treatments with a teishin, (a teishin looks a bit like a metal toothpick and is one of the nine classical needles mentioned in the Ling Shu) including work in this area. His “sanshin” technique is one I now use with all of my patients. I continue to be amazed how so minimal a technique can generate so much positive change.
In 2009 I spent a year flying to San Jose for many modules studying the Zhu Scalp Acupuncture system (ZSA) with Dr. Zhu Ming-Qing. I remember well one day when Dr. Zhu said that he always inserted needles in the ZSA neck zone (a bit posterior to GV-20) of elderly patients, even when they insisted their necks were fine. His point was that modern life always will have an impact in this region, that no one in this culture escapes neck tension. I take the implication of this to be that over time this chronic neck tension will lead to reduced vagal tone. Why do we carry this chronic tension? Too much driving, too much TV viewing while sitting in poorly designed chairs, too little movement…
As it turns out, much of the work Porges has developed on the vagus plays a direct role in cases of trauma. In his theory people can get locked into the primitive freeze response when confronted with real danger. By being locked into that response, they lose access to the social engagement function of a healthy parasympathetic nervous system. In this scenario the organs connected to the ANS suffer and start to exhibit diminished function. His work has shown that our facial expressions, safe eye contact, and voice quality (and I think the quality of our touch is also absolutely key, though Porges has not researched this to my knowledge) can go a long way to establishing to the patient that s/he is safe with us, that s/he can emerge from the frozenness in which they have been trapped.
I am inviting everyone to begin to assess this supraclavicular fossa pre- and post-treatment. Check the feel of the tissues and check the range of motion. That is a start. If your treatment has not resulted in greater ease in these tissues and in better range of motion, then I think you likely missed something. We want our treatments to lead to a generalized whole-body response, no matter what the chief complaint. From this starting point we can go on to investigate acupuncture styles that more specifically target the neck in novel ways.
I look forward to hearing from others who share my interest in this part of the body. Please take the time to look Stephen Porges up on youtube and other websites. The implications of his research and theories for our work are significant.
Best wishes all around,
Bob Quinn