When Lyme Disease Doesn't End with Antibiotics: How Acupuncture Supports Nervous System Recovery
Most people expect Lyme disease to have a clear finish line: you get bitten, you get treated, you recover. For a significant number of patients, that's not what happens. Months (sometimes years) after completing antibiotics, symptoms persist: crushing fatigue, brain fog so thick you can't follow a conversation, heart palpitations, dizziness when you stand up, poor sleep, and pain that moves around without explanation.
For a long time, these patients were told their tests were normal and their problems were psychological. That is changing fast. Research from Johns Hopkins published in 2024 identified nervous system dysregulation as a likely core driver of these lingering symptoms. Not psychological distress, not residual infection, but a measurable disruption of the system that governs your heart rate, digestion, blood pressure, body temperature, and immune responses.
At Golden Mean Acupuncture, this is terrain we work in regularly. Here is what the current evidence shows, and why acupuncture has a legitimate, well-researched role in addressing it.
Key Takeaways
Post-Treatment Lyme Disease Syndrome (PTLDS) affects an estimated 10–20% of patients after standard antibiotic treatment
A 2024 Johns Hopkins review identified autonomic nervous system dysfunction (dysautonomia) as a key, previously underrecognized component of PTLDS
A 2025 Johns Hopkins study of 210 PTLD patients found significantly elevated autonomic symptom scores compared to healthy controls, with a subgroup developing measurable orthostatic tachycardia (POTS)
Acupuncture at the ST36 acupoint has been shown in animal studies to reduce Lyme-specific inflammation through the vagus nerve without reducing bacterial load, meaning the effect is purely anti-inflammatory
Electroacupuncture suppresses pro-inflammatory cytokines (TNF-α, IL-4, IL-13) while upregulating anti-inflammatory signals, addressing the immune dysregulation that drives many chronic Lyme symptoms
A 2025 meta-analysis of randomized controlled trials confirmed acupuncture's ability to shift measurable autonomic function markers including heart rate variability
What Is PTLDS, and Why Does It Happen?
Post-Treatment Lyme Disease Syndrome (PTLDS) is the term researchers use to describe symptoms that persist after a completed, guideline-based antibiotic course for confirmed Lyme disease. Common symptoms include:
Severe, unexplained fatigue
Cognitive difficulties: memory problems, difficulty concentrating, mental fog
Musculoskeletal pain
Sleep disturbances
Headaches
Heart palpitations or racing heart, particularly when standing
Lightheadedness and dizziness
The CDC estimates that between 10 and 20 percent of people treated for Lyme disease develop PTLDS. For a disease affecting an estimated 476,000 Americans annually, that represents a significant patient population.
The honest answer about why PTLDS happens is that researchers are still working it out. Leading explanations include residual damage to tissues and the immune system, an autoimmune response triggered by the infection, persistent neuroinflammation, and, increasingly supported by new data, disruption of the autonomic nervous system.
The Autonomic Nervous System: The Missing Piece
The autonomic nervous system (ANS) is the part of your nervous system that runs in the background, managing the things you don't consciously control: your heart rate, blood pressure, digestion, temperature regulation, sweating, and immune activity. It has two branches, the sympathetic ("fight-or-flight") and the parasympathetic ("rest-and-digest"), and in a healthy body, these two branches work in balance.
When that balance breaks down, the consequences spread across every organ system the ANS governs. That is exactly the symptom picture seen in PTLDS: a wide-ranging collection of problems that don't obviously belong to any single organ or system.
A 2024 review published in Frontiers in Neurology by a multidisciplinary team at Johns Hopkins University School of Medicine made a compelling case that dysautonomia, the clinical term for this kind of ANS dysfunction, may explain much of what PTLDS patients experience. The researchers reviewed case reports, autopsy data, and primate studies and found a sound biological basis for Borrelia burgdorferi (the bacterium that causes Lyme disease) disrupting autonomic nerve pathways.
POTS: The Most Recognized Manifestation
One of the most common and diagnosable forms of dysautonomia is Postural Orthostatic Tachycardia Syndrome, or POTS. It is characterized by an abnormal surge in heart rate when you move from lying down or sitting to standing, often accompanied by lightheadedness, fatigue, brain fog, and weakness. Over half of POTS patients report that their symptoms began after an infection, and Lyme disease is increasingly recognized as one of those triggers.
What Johns Hopkins Found in 2025
In a November 2025 study, Johns Hopkins researchers assessed 210 PTLD patients using an active stand test and a validated symptom questionnaire called the COMPASS-31. The results were striking: PTLD patients scored significantly higher on autonomic symptom measures than healthy controls, with a symptom profile that closely resembled patients with formally diagnosed POTS. A subset showed objectively abnormal heart rate increases on standing.
The researchers called for routine autonomic screening in Lyme disease patients with persistent symptoms, acknowledging that this mechanism has been underdiagnosed and undertreated.
How This Connects to Long COVID and ME/CFS
PTLDS shares substantial clinical overlap with two other post-infectious conditions: Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). All three involve:
Autonomic dysfunction
Post-exertional symptom worsening
Neuroinflammation
Immune dysregulation
The similarities are not coincidental. Researchers at Johns Hopkins have described a likely shared mechanism of post-infectious dysautonomia that cuts across conditions triggered by different pathogens. This convergence matters for patients: treatments showing promise in Long COVID dysautonomia research are likely relevant to PTLDS, and vice versa.
The TCM Perspective: Kidney, Heart, and Defensive Qi
Traditional Chinese Medicine understood centuries ago what modern research is now confirming in molecular terms: that severe illness can leave the body's regulatory systems fundamentally depleted, with cascading effects that outlast the original infection.
In TCM, PTLDS maps closely to patterns of Kidney Jing depletion (deep constitutional exhaustion), Heart Qi or Yin deficiency (explaining palpitations, sleep disruption, and emotional dysregulation), and Wei Qi insufficiency (the body's defensive energy, responsible for immune function and adaptation to external stressors). The Kidney and Heart systems in TCM have a specifically described regulatory relationship, one governing foundational energy and the other governing circulation and the spirit, that aligns remarkably well with the autonomic balance problems modern research is identifying.
This is not metaphor. It is a different language for the same observation: that Lyme disease can knock the body's self-regulating systems off axis in ways that are real, measurable, and treatable.
Acupuncture and the Autonomic Nervous System: What the Research Shows
The mechanistic evidence for acupuncture's ability to modulate the autonomic nervous system is now well-documented. A 2013 review in Evidence-Based Complementary and Alternative Medicine established that acupuncture can measurably influence blood pressure, heart rate variability, skin temperature, muscle sympathetic nerve activity, and heart rate, all direct markers of ANS function.
A 2025 meta-analysis in Frontiers in Neuroscience, analyzing data from randomized controlled trials drawn from PubMed, Embase, and other databases, confirmed acupuncture's ability to bidirectionally shift ANS balance. In practical terms, it can calm an overactive sympathetic response while restoring parasympathetic tone. The primary outcome measure was SDNN, a heart rate variability marker considered the most reliable indicator of overall autonomic regulation.
The Vagus Nerve: Acupuncture's Main Pathway
The vagus nerve is the largest nerve in the parasympathetic system. It connects the brainstem to the heart, lungs, digestive system, and immune organs. It also runs what researchers at the Feinstein Institutes have called the "inflammatory reflex," a circuit through which the nervous system actively damps down systemic inflammation.
Acupuncture at the ST36 point (located just below the outside of the knee) has been studied more than almost any other intervention for its vagal effects. In a foundational study published in PLOS ONE, manual acupuncture at ST36 significantly reduced TNF-alpha, one of the primary drivers of inflammation, in animal models. When the vagus nerve was severed, the effect disappeared entirely. The anti-inflammatory benefit depended entirely on an intact vagal pathway.
Research published in Nature identified the precise cellular mechanism: a specific population of sensory neurons, activated by low-intensity electroacupuncture at ST36, carries signals up the spinal cord to the brainstem, which then activates vagal nerve fibers that signal the adrenal glands to release anti-inflammatory compounds. High-intensity stimulation activates a different, sympathetic pathway, which is one reason treatment parameters matter in clinical practice.
Directly Tested in Lyme Disease
In 2022, researchers at Rowan University School of Osteopathic Medicine and Duke University published a study in Frontiers in Immunology testing electroacupuncture in mice infected with Borrelia burgdorferi. The findings were notable: EA-treated mice showed a significant and lasting reduction in joint inflammation and systemic inflammatory cytokines at four weeks, two weeks after treatment had ended.
Crucially, the bacterial burden was identical in treated and untreated animals. The electroacupuncture was not killing the bacteria; it was modulating the inflammatory and immune response to the infection. For patients with PTLDS, where ongoing infection is not believed to drive symptoms in most cases, this is precisely the kind of effect that would be clinically useful.
The mechanism: electroacupuncture at ST36 activated the sciatic-vagal nerve network, modulating dopamine production in a way that suppressed systemic inflammatory activity. The durability of the effect, persisting beyond the treatment period, suggests genuine recalibration of immune signaling rather than temporary suppression.
Neuroinflammation and the Brain
A 2025 review in ScienceDirect examined how electroacupuncture modulates neuroinflammation specifically. Findings included suppression of NF-κB signaling (a central driver of inflammatory activity in the brain and nervous system), inhibition of the NLRP3 inflammasome (involved in chronic inflammatory states), and promotion of a neuroprotective microglial state. These are mechanisms directly relevant to the brain fog, cognitive difficulties, and fatigue seen in PTLDS.
Herbal Support for PTLDS
Important: Herbal medicines can interact with prescription and over-the-counter medications. Always discuss any herbal protocol with your prescribing physician before beginning, particularly if you take immunosuppressants, blood thinners, antihistamines, or antibiotics.
At Golden Mean Acupuncture, acupuncture treatment is often combined with herbal support targeted to the specific presentation, not a one-size-fits-all protocol.
Reishi (Ganoderma lucidum)
Reishi has the strongest evidence base among medicinal mushrooms for immune modulation. Its two main active constituent groups work through different mechanisms:
Triterpenes (ganoderic acids): Structurally similar to steroid hormones, these fat-soluble compounds can influence inflammatory responses at the molecular level.
Beta-glucans: These polysaccharides influence mast cell and macrophage activity and have been studied for their effects on immune balance in chronic conditions.
I use a dual-extracted tincture (hot water and ethanol extraction) to capture both constituent classes. For patients with the fatigue, immune dysregulation, and sleep disruption typical of PTLDS, reishi is often a foundational element of herbal support.
Adaptogens for ANS Support
For the exhaustion, stress-intolerance, and dysautonomia picture of PTLDS, adaptogenic herbs that support adrenal and ANS resilience are often indicated. These are selected and dosed individually based on clinical assessment; which herbs are appropriate depends on the full picture of a patient's presentation, not just their diagnosis.
Practical Strategies While in Treatment
Managing PTLDS requires more than in-office care. These strategies support the work done in treatment:
Pacing activity. Post-exertional symptom worsening, where even moderate activity triggers a significant symptom flare, is common in PTLDS, as it is in ME/CFS and Long COVID. Working within your actual current capacity rather than your pre-illness capacity is not a concession; it is a therapeutic strategy.
Sleep hygiene. ANS dysregulation interferes directly with sleep regulation. Consistent sleep and wake times, a cool and dark sleep environment, and avoiding screens for 60 minutes before bed all support the parasympathetic shift needed for restorative sleep.
Hydration and salt intake. For patients with POTS or orthostatic symptoms, maintaining blood volume through adequate fluid and sodium intake is often recommended by dysautonomia specialists. This can meaningfully reduce dizziness and fatigue on standing.
Anti-inflammatory nutrition. A diet rich in vegetables, fiber, and omega-3 fatty acids and low in refined sugar and ultra-processed foods supports the immune rebalancing work being done through acupuncture, herbs, and nutritional guidance.
Stress management. Chronic stress maintains sympathetic dominance, the opposite of what a dysautonomia patient needs. Gentle breathwork, meditation, and restorative movement (within tolerance) all support parasympathetic recovery.
When to Seek Professional Support
Consider working with a practitioner who understands the intersection of Lyme disease and nervous system function if:
You have completed antibiotic treatment but significant symptoms persist beyond four weeks
You experience dizziness, racing heart, or weakness when standing
Fatigue and brain fog are interfering with work, relationships, or daily functioning
You've been told your tests are normal but you don't feel normal
You're interested in addressing the underlying immune and nervous system dysregulation rather than only managing individual symptoms
PTLDS and Acupuncture at Golden Mean
For patients in Echo Park, Silver Lake, and the surrounding Los Angeles area navigating the long aftermath of Lyme disease, the clinical picture is rarely simple. At Golden Mean Acupuncture, located at 1292 West Sunset Boulevard, treatment integrates classical TCM assessment with the current evidence on post-infectious dysautonomia and neuroimmune dysfunction. Initial evaluation includes a detailed intake covering symptom patterns, autonomic indicators, and constitutional presentation, because a protocol that works for one PTLDS patient may not address what another patient needs.
If you're still searching for answers, you don't have to start over. We'll work from where you are.
FAQ
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Lyme fatigue is an acute symptom of the active infection. PTLDS is defined by symptoms that persist six months or more after completing antibiotics in patients with a confirmed diagnosis. The driver shifts from the bacteria itself to how the immune and nervous systems were altered by it.
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No, and we don't claim that. What the research supports is acupuncture's ability to modulate the inflammation and autonomic dysregulation driving PTLDS symptoms. In the key 2022 animal study, bacterial levels were identical in treated and untreated animals, but inflammatory damage was significantly reduced in the treated group.
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Most patients notice initial changes within two to four sessions. Meaningful autonomic and immune shifts typically require eight to twelve weeks of consistent treatment, after which many patients transition to seasonal maintenance care.
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Yes, always. Acupuncture for PTLDS is integrative support alongside conventional care, not a replacement for it. If your physician has referred you for dysautonomia evaluation, that workup is important and complementary to what we do here.
References
Adler BL, Chung T, Rowe PC, Aucott J. Dysautonomia following Lyme disease: a key component of post-treatment Lyme disease syndrome? Front Neurol. 2024;15:1344862. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1344862/full
Adler BL, Rebman AW, Chung T, et al. Autonomic Symptoms in Post-Treatment Lyme Disease: Insights From the COMPASS-31 and the 10-Minute Active Stand Test. Mayo Clin Proc Innov Qual Outcomes. November 2025. https://www.sciencedirect.com/science/article/pii/S2542454825000852
Akoolo L, Djokic V, Rocha SC, Ulloa L, Parveen N. Sciatic-Vagal Nerve Stimulation by Electroacupuncture Alleviates Inflammatory Arthritis in Lyme Disease-Susceptible C3H Mice. Front Immunol. 2022;13:930287. https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.930287/full
Lim HD, Kim MH, Lee CY, Namgung U. Anti-Inflammatory Effects of Acupuncture Stimulation via the Vagus Nerve. PLOS ONE. 2016;11(3):e0151882. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0151882
Li QQ, Shi GX, Xu Q, Wang J, Liu CZ, Wang LP. Acupuncture Effect and Central Autonomic Regulation. Evid Based Complement Alternat Med. 2013;2013:267959. https://pmc.ncbi.nlm.nih.gov/articles/PMC3677642/
Ma Y, et al. Clinical efficacy and safety of acupuncture in modulating autonomic nervous function: a meta-analysis of randomized controlled trials. Front Neurosci. 2025;19:1694110. https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2025.1694110/full
Liu S, et al. Electroacupuncture activates neurons to switch off inflammation. Nature commentary. PMC9628694. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9628694/
Pavlov VA, Tracey KJ. Control of inflammation using non-invasive neuromodulation. Int Immunol. 2022;34(2):119–128. https://academic.oup.com/intimm/article/34/2/119/6374856
Zhang Q, et al. Modulating neuroinflammation through electroacupuncture: Mechanistic insights and pharmacological synergies. J Neuroinflammation. 2025. https://www.sciencedirect.com/science/article/abs/pii/S1471489225000608
Johns Hopkins Lyme Disease Research Center. Autonomic Nervous System Symptoms and POTS in Post-Treatment Lyme Disease. November 2025. https://www.hopkinslyme.org/research/autonomic-nervous-system-symptoms-and-postural-orthostatic-tachycardia-syndrome-pots-in-post-treatment-lyme-disease/
Content medically reviewed and updated February 2026 by Shaun Menashe, LAc, MTOM
This information is for educational purposes and does not replace medical advice from your primary care physician.