Why understanding autonomic reflexes can change the way we approach acupuncture, dysautonomia, and concussion rehabilitation.
Most of us learn about the autonomic nervous system (ANS) through a relatively simple framework: the sympathetic nervous system controls our fight-or-flight response, while the parasympathetic nervous system promotes rest, digestion, and recovery.
This distinction is useful as an introduction to autonomic physiology, but it represents only a small part of what the autonomic nervous system actually does.
The ANS is a sophisticated network of sensory receptors, neural circuits, and regulatory mechanisms that continuously monitors our internal environment and adjusts physiological activity to meet the body's changing demands. It regulates blood pressure, heart rate, digestion, thermoregulation, respiration, and immune function, often without our conscious awareness.
More importantly, much of this regulation occurs through autonomic reflexes.
For practitioners of acupuncture and Chinese medicine, understanding these reflexes provides an entirely different perspective on how the nervous system maintains homeostasis, how neurological injuries can disrupt physiological regulation, and how peripheral sensory stimulation may influence central nervous system activity.
The Autonomic Nervous System Is Not Simply an On-Off Switch
We frequently describe sympathetic and parasympathetic activity as opposing forces. When sympathetic activity increases, parasympathetic activity decreases, and vice versa.
However, autonomic physiology is considerably more complex.
Different organs receive different patterns of autonomic innervation. Sympathetic and parasympathetic activity can change independently, and some physiological responses involve simultaneous activity in both divisions.
For example, standing up from a seated position requires coordinated cardiovascular adjustments. Blood shifts toward the lower extremities, temporarily reducing venous return to the heart. Without an appropriate compensatory response, blood pressure could fall, and compromising cerebral perfusion. The nervous system must rapidly detect this change and adjust heart rate, vascular resistance, and cardiac function.
This is accomplished through an autonomic reflex.
The body does not need to perceive danger or enter a fight-or-flight state to activate sympathetic cardiovascular pathways. These adjustments are part of ordinary physiological regulation.
This distinction becomes especially important when evaluating patients with orthostatic intolerance, POTS, and other forms of dysautonomia.
Understanding the Anatomy of an Autonomic Reflex
An autonomic reflex involves several fundamental components:
- Sensory receptors detect a physiological change.
- Afferent pathways carry that information toward the central nervous system.
- Central neural circuits integrate the incoming information and coordinate an appropriate response.
- Efferent autonomic pathways transmit signals to target organs.
- Effector organs respond by adjusting their physiological activity.
Consider the arterial baroreflex, one of the most important mechanisms for maintaining cardiovascular stability.
Specialized mechanoreceptors in the carotid sinus and aortic arch detect changes in arterial wall stretch associated with blood pressure. Sensory information travels through cranial nerves IX and X to the nucleus tractus solitarius (NTS) in the medulla. The NTS communicates with additional brainstem circuits that regulate sympathetic vasomotor activity and cardiac parasympathetic output.
When arterial pressure increases, the reflex generally reduces sympathetic vasoconstrictor activity and increases cardiac vagal activity, helping restore blood pressure toward its regulated range. When arterial pressure decreases, the opposite pattern of cardiovascular adjustments helps maintain circulation. This process occurs continuously throughout the day.
The baroreflex illustrates an essential principle: autonomic function depends on the integrity of an entire reflex circuit, not simply the activity of the sympathetic or parasympathetic nervous system.
A disturbance in sensory detection, central integration, or autonomic output can interfere with the body's ability to respond appropriately.
Why Autonomic Reflexes Matter in Concussion Rehabilitation
The importance of reflex regulation extends beyond cardiovascular physiology.
The brainstem contains neural circuits involved in vestibular reflexes, eye movements, postural regulation, respiration, and autonomic function. These systems are extensively interconnected and continuously exchange information with the cerebellum, thalamus, and cerebral cortex.
Following a concussion, disturbances within these networks may contribute to symptoms that initially appear unrelated.
A patient may experience dizziness when standing, nausea during head movements, difficulty tolerating exercise, visual disturbances, and cognitive fatigue.
Rather than assuming that each symptom represents an independent disorder, clinicians can consider whether disrupted sensory integration and reflex regulation may be contributing to several symptoms simultaneously.
This systems-level perspective is particularly relevant to an interesting theoretical framework recently proposed by Dr. Matthew Antonucci and Dr. Kenneth Jay.
The NERD Model: When Reflex Dysfunction Disrupts Brain Networks
In January 2026, Antonucci and Jay published a paper in Frontiers in Systems Neuroscience introducing the Network Entrapment by Reflex Dysfunction (NERD) model.
The model proposes that persistent post-concussion symptoms may arise, in part, from disruptions in reflex circuits and their interactions with larger neural networks.
Rather than viewing persistent symptoms exclusively as consequences of cortical injury, the authors describe a dynamic system involving five interconnected functional components:
sensory inputs
brainstem reflex circuits
cerebellar processing
basal ganglia–thalamic modulation, and
cortical networks.
When reflex circuits become dysregulated, their outputs may generate inaccurate or maladaptive sensory feedback. This information is then processed by other neural networks, potentially reinforcing dysfunctional patterns of activity.
Over time, these feedback loops may contribute to reduced neurological adaptability and persistent symptoms, providing a possible reason for why some people appear to remain “stuck” in their symptoms for long periods of time after the initial injury.
The NERD model is particularly interesting because it places reflex physiology at the center of neurological rehabilitation.
It also introduces an important distinction between treating an individual symptom and identifying the neural circuits contributing to that symptom.
Although the NERD model remains a theoretical framework requiring experimental validation, it provides a useful perspective for considering how disruptions in relatively fundamental neurological processes could influence complex brain functions.
What Does This Mean for Acupuncture and Chinese Medicine?
As acupuncturists, we routinely stimulate peripheral sensory nerves through the insertion and manipulation of our needles. Those sensory signals travel through spinal and cranial nerve pathways and can influence neural circuits involved in pain modulation, autonomic regulation, and other physiological functions. From a neuroscience perspective, acupuncture is a form of somatosensory stimulation with the potential to influence reflex pathways.
This raises an interesting question: Could understanding the organization of autonomic reflex circuits help practitioners better understand why acupuncture produces different physiological responses in different patients?
Research has already demonstrated that electroacupuncture can recruit specific somato-autonomic reflex pathways, with the resulting response depending on factors such as stimulation location, intensity, and the nerve fibers activated.
Traditional Chinese medicine describes health in terms of dynamic regulation and the relationships between physiological systems. Modern autonomic neuroscience offers a different explanatory framework, grounded in anatomical pathways, sensory feedback, and neural circuit physiology. At first glance, these may seem unrelated, but there are parallels that highlight the utility of understanding both.
In 2018 at the Great River Symposium, and later in my book The Concussion Breakthrough, I presented an example of this in the form of Ying-Wei Disharmony. When looking at the list of representative symptoms of Ying-Wei Disharmony, it is hard to see a connection. What does diarrhea have to do with insomnia? And how do these relate to alternating fever and chills and numbness and tingling? However, when you look at the totality of symptoms making up a Ying-Wei Disharmony, it becomes evident that all of these symptoms are associated with bodily functions that fall under the category of autonomic regulation.
The more I started working with people with dysautonomia, the more the pattern stood out to me. This is not to say that every case of dysautonomia is the equivalent of a Ying-Wei Disharmony, because it isn’t. I lay out many possible TCM patterns in my continuing education course on Dysautonomia (link below). What strikes me as highly relevant, is that for thousands of years, traditional East Asian medicine had a reference frame for understanding dysautonomia in its complexity. Modern neuroscience is just getting started.
Continue Exploring:
Concussion Treatment Series Course 5: Autonomic Nervous System Dysregulation
This course was designed as a stand-alone course. You do not need to take Courses 1-4 prior to taking 5.
Explore Concussion Course 5Dysautonomia — A Clinical Guide for AcupuncturistsThe NERD Model and Concussion Rehabilitation
I recently explored the NERD model in greater depth with Dr. Matthew Antonucci on Episode 61 of Life After Impact: The Concussion Recovery Podcast.
Our conversation examines how disrupted reflex circuits, maladaptive feedback loops, and changes in neural network regulation may contribute to persistent post-concussion symptoms.
Listen to Episode 61: Functional Neurology Explains Why Concussion Symptoms Spiral
You can also read the original research paper:
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