Bioadaptive Systems Therapeutics™ (BST): Engineering Remission Through Terrain Logic

Author: Cynthia Adinig

About the Author

Cynthia Adinig served on the U.S. Department of Health and Human Services Long COVID Advisory Committee and as a merit reviewer for the Patient-Centered Outcomes Research Institute (PCORI), assessing national research priorities. She has provided sworn testimony to Congress on Long COVID policy gaps and co-authored peer-reviewed research with Yale immunologist Akiko Iwasaki, PhD, and cardiologist Harlan Krumholz, MD, on symptom differentiation in Long COVID. As a board member of Solve M.E. and an advisor to major medical institutions, she has translated patient-generated insights into implementable clinical and policy frameworks.

Abstract

Bioadaptive Systems Therapeutics™ (BST) is a new discipline of medicine that engineers remission by recalibrating fragile biological systems across immune, autonomic, mitochondrial, connective, hormonal, and environmental domains. Unlike traditional medicine, which classifies disease onset and treats within rigid silos, BST is phase-aware, terrain-first, and subtype-specific. It treats conditions not by label, but by system condition: immune condition, mitochondrial condition, autonomic condition, endocrine condition, and environmental condition.

BST emerged from necessity.

In only five months of solo publishing, CYNAERA has generated the most complete systems map for infection-associated chronic conditions (IACCs) ever assembled, integrating immune, environmental, and socio-epidemiological layers into a unified framework. These publications — IACC Terrain™, SymCas™, Pathos™, VitalGuard™, and others, have been recognized by external AI models as sufficient to design FDA-approvable therapies if applied with permission. BST formalizes this map as a medical discipline, providing a replicable logic for stabilization, remission, and long-term resilience.

I. Introduction: From Survival to a Field

The COVID-19 pandemic revealed a truth long recognized by patients: chronic illness does not respect silos. Millions developed overlapping syndromes, including ME/CFS, POTS, MCAS, and autoimmune conditions, often triggered by a single viral or environmental insult (Proal & VanElzakker, 2021).

Medicine was unprepared because it remained locked in classification paradigms: Long COVID separate from ME/CFS, ME/CFS separate from MCAS, MCAS separate from dysautonomia. Patients fell between cracks.

CYNAERA’s approach is different. Instead of mapping disease onset, it mapped recovery. In five months of white paper publishing, CYNAERA demonstrated that remission becomes predictable once we read terrain patterns, stage by branch dominance, and stabilize hypersensitivity as a biomarker rather than dismissing it as “noise.” This is the foundation of Bioadaptive Systems Therapeutics™.

II. Why a New Discipline Was Needed

The Failure of Siloed Medicine

Patients with overlapping IACCs are often excluded from trials as “too complex” (Rowe et al., 2014). Yet complexity is the rule, not the exception. Estimates show over 60% of Long COVID patients meet criteria for MCAS (Afrin et al., 2020), while dysautonomia affects up to 70% (Raj et al., 2020). By treating each syndrome separately, medicine leaves these patients without guidance. Worse, failed clinical trials perpetuate the myth that stabilization is impossible.

The “Invisible Majority” Problem

Disability data underestimate true prevalence because individuals with overlapping syndromes are coded under separate diagnoses (Solve M.E., 2022). Policy frameworks, insurance systems, and public health models underestimate economic burden by hundreds of billions annually (Cutler, 2022).

Why BST Emerged

BST arose because no existing paradigm could serve the medically complex, hypersensitive patients left behind. It provides a systems-first framework that acknowledges the true heterogeneity of patient terrain and offers phase-aware strategies for remission.

III. Core Domains of BST

BST organizes care into nine interlocking subsystems. Each is both a therapeutic target and a terrain signal.

Subsystem	Therapeutic Focus	Case-Style Example
Immune Terrain	Mast cell modulation, cytokine phasing, antigen reactivity control	Long COVID patient with EBV reactivation stabilized by mast cell blockade and antiviral layering (Gold et al., 2021).
Autonomic Stability	Baroreflex retraining, vagal tone stimulation, HRV optimization	POTS patient post-H1N1 gains stability via low-dose beta blockers and tilt pacing (Raj et al., 2020).
Mitochondrial Resilience	Flare-aware pacing, metabolic buffering, PEM delay modulation	ME/CFS patient stabilized through NAD+ precursors and pacing (Tomas et al., 2017).
Hormone-Immune Alignment	Estrogen/cortisol phasing, flare timing, H3 axis stability	Perimenopausal MCAS patient improves with hormone-aware antihistamine scheduling (Theoharides, 2019).
Neuroplastic Repair	Cognitive pacing, tVNS-informed cognitive load	Long COVID patient with brain fog regains function via pacing + vagus nerve stimulation (Putrino et al., 2023).
Environmental Interfacing	Mold, air quality, pollution-trigger flare suppression	Patient in flood-prone housing achieves remission with HEPA + mold remediation (Brewer et al., 2013).
Viral Terrain & Persistence	Shedding delay modeling, immune recalibration	EBV reactivation in Long COVID resolved with antivirals + immune pacing (Su et al., 2022).
Flare Intelligence	Subthreshold flare tracking, sequence mapping	PANS patient prevents relapse by tracking pre-flare HRV shifts (Swedo et al., 2012).
Remission Engineering	Multi-phase recovery pathways, dynamic escalation logic	Patient with ME/CFS + MCAS moves from unstable to remission-ready terrain via stepwise stabilization.

IV. Case Examples

Case A: Mast Cell Dominant Terrain

• Profile: Long COVID + MCAS flares (hives, flushing, food reactivity).

• BST Approach: H1/H2 blockers, cromolyn, leukotriene inhibitors; low-histamine diet; environmental control (VitalGuard™ overlays).

• Outcome: Stabilization of hypersensitivity within 6 months, enabling reintroduction of activity.

  
  

Case B: Mitochondrial Fragility

• Profile: ME/CFS post-EBV with severe PEM.

• BST Approach: NAD+ boosters, CoQ10, pacing informed by SymCas™ flare sequencing.

• Outcome: Increased exertional threshold; 40% improvement in daily function over 1 year.

  
  

Case C: Connective Tissue Overlap

• Profile: hEDS + POTS + MCAS.

• BST Approach: Bracing, physiotherapy, mast cell stabilization, autonomic pacing.

• Outcome: Reduced syncope, joint instability, and hospitalization.

  
  

Section V: The Core Domains of BST

Bioadaptive Systems Therapeutics™ (BST) defines health not as the absence of disease but as the balance of interacting terrains. Each terrain branch represents a subsystem that can collapse after a Primary Chronic Trigger (PCT). Unlike traditional medicine, which isolates dysfunction into specialties, BST restores coherence by engineering remission across all domains simultaneously.

Terrains

1. Immune Terrain

The immune system is both sentinel and saboteur. In terrain collapse, mast cells misfire, cytokines enter maladaptive loops, and antigen tolerance disintegrates. Patients are told they are “allergic to everything,” but in truth they are witnessing immune instability as a biomarker of fragility.

• Therapeutic focus: mast cell modulation, cytokine phasing, and antigen reactivity control.

• Case example: A post-COVID patient with unrelenting urticaria and gastrointestinal flares was cycled through allergists, dermatologists, and gastroenterologists without stabilization. Only when mast-cell–targeted therapy (H1/H2 blockade plus cromolyn) was paired with environmental trigger reduction did symptoms stabilize (Afrin, Weinstock, & Molderings, 2020).

• Integration: SymCas™ models flare timing; Pathos™ assigns severity weighting to immune loops; VitalGuard™ flags environmental risk factors such as mold or PM2.5 that amplify mast-cell load.

  
  

2. Autonomic Stability

The autonomic nervous system (ANS) is terrain command-and-control. When destabilized, baroreflex sensitivity collapses, vagal tone decreases, and heart rate variability (HRV) becomes erratic. Patients faint, flush, and lose temperature regulation, but are too often dismissed as “anxious.”

• Therapeutic focus: baroreflex retraining, vagal stimulation, HRV optimization.

• Case example: An adolescent initially diagnosed with anxiety was later found to have severe orthostatic intolerance. BST logic emphasized autonomic dominance, leading to targeted pyridostigmine, fluid/salt loading, and HRV biofeedback. Function improved by 60% within 6 months (Raj et al., 2020; Rowe et al., 2014).

• Integration: NeuroVerse™ maps autonomic-immune interactions; SymCas™ sequences autonomic crashes relative to immune triggers.

  
  

3. Mitochondrial Resilience

Mitochondria govern the energy economy of terrain. Post-exertional malaise (PEM) is not deconditioning; it is the visible signature of metabolic collapse. Traditional trials (e.g., graded exercise therapy) failed because they ignored this biology.

• Therapeutic focus: flare-aware pacing, metabolic buffering (e.g., carnitine, CoQ10, NAD+), and PEM delay modulation.

• Case example: A patient labeled “non-compliant” in a rehabilitation trial regained stability only after pacing was reframed as metabolic therapy. Within a BST framework, their 2-day cardiopulmonary exercise test revealed oxidative stress–driven collapse, not lack of effort (Tomas et al., 2017; Castro-Marrero et al., 2016).

• Integration: VitalGuard™ overlays environmental stressors (heat, wildfire smoke) that worsen mitochondrial fragility.

  
  

4. Hormone–Immune Alignment

Endocrine signals are terrain timing devices. When cortisol, estrogen, thyroid, and autonomic rhythms fall out of phase, hypersensitivity worsens. Women with ME/CFS or Long COVID often describe cyclical flares, yet these patterns remain under-researched.

• Therapeutic focus: estrogen/cortisol phasing, HPA axis recalibration, flare-timed interventions.

• Case example: A perimenopausal patient with recurrent crashes showed flares tightly correlated with hormonal fluctuations. BST logic identified hormone–immune misalignment; tailored estrogen stabilization plus mast-cell support improved flare predictability (Theoharides, 2019).

  
  

5. Neuroplastic Repair

Brains in terrain collapse are not broken but overloaded. Cognitive pacing, flare-sequenced workloads, and neuromodulation (e.g., tVNS) enable repair.

• Therapeutic focus: cognitive pacing, tVNS-guided cognitive load, and flare sequencing.

• Case example: A fibromyalgia patient dismissed for “psychological overlay” improved cognitive stamina only when BST applied flare-sequencing protocols alongside autonomic stabilization.

  
  

6. Environmental Interfacing

Environment is not background noise — it is terrain. Mold, VOCs, wildfire smoke, and pesticides all serve as PCTs or amplifiers.

• Therapeutic focus: environmental stabilization, HEPA filtration, low-VOC environments, proactive flare suppression.

• Case example: A patient with overlapping ME/CFS and MCAS saw a 50% reduction in hospitalizations after moving from mold-damaged housing, confirming environmental terrain’s central role (Brewer et al., 2013).

• Integration: VitalGuard-MoldX™, FIRE™, and PMC™ map patient flare risk based on geography and housing.

  
  

7. Viral Terrain & Persistence

Latent viral reactivation (EBV, HHV-6, CMV) or incomplete clearance acts as a continual destabilizer.

• Therapeutic focus: shedding delay modeling, immune recalibration, phase-aware antiviral strategies.

• Case example: Long COVID patients with EBV reactivation showed higher rates of persistent fatigue; terrain stabilization was incomplete until viral reactivation was addressed (Gold et al., 2021; Bernal & Whitehurst, 2023).

  
  

Meta Systems

1. Flare Intelligence

In BST, a flare is not failure but feedback. Subthreshold flares signal terrain instability before collapse.

• Therapeutic focus: STAIR readiness modeling, flare trajectory tracking, flare-aware intervention.

• Case example: A patient stabilized only when clinicians tracked flare precursors (HRV dips, subtle MCAS signals) and intervened pre-emptively.

  
  

2. Remission Engineering

BST’s endgame is not symptom suppression but remission pathways. Recovery is engineered through phased stabilization, branch-dominant logic, and adaptive recalibration.

• Therapeutic focus: multi-phase recovery mapping, dynamic escalation logic.

• Case example: A multi-morbid patient (ME/CFS + POTS + MCAS) returned to part-time work after BST remission mapping staged care sequentially — immune, then autonomic, then mitochondrial.

  
  

Alignment Note: How BST’s 7 terrains map to IACC’s 5 branches

• IACC Terrain (5 branches) is a clinical staging set for 15-minute intake and stabilization: Autonomic, Mast cell, Mitochondrial, Autoimmune, Connective-tissue/ECM–barrier.

• BST (7 terrains) is a systems/therapy map that keeps modulators/overlays explicit: Hormone–Immune, Neuroplastic, Environmental, Viral. These aren’t separate clinical branches in IACC; they cross-cut and modulate the five.

  
  

Working rule

• Use IACC’s 5 for clinical dominance scoring and coding.

• Use BST’s 7 to engineer remission: you treat the branch, while tracking overlays (hormone, neuroplastic, environmental, viral) that tune thresholds, variance, and response.

  
  

Section VI: The Map Behind BST: From Survival to System Architecture

The terrain maps that underpin BST were not constructed in a vacuum. They were built across a rapid-fire sequence of white papers published between late 2024 and mid-2025 — each one a missing piece that, once assembled, created a coherent architecture. Unlike most medical “frameworks,” these were authored not by consortia over decades, but solo, in five months, under survival pressure. That speed of publication is not incidental; it reflects the urgency of terrain collapse and the inadequacy of existing categories.

• IACC Terrain™ reframed infection-associated chronic conditions (IACCs) not as isolated syndromes but as branches of a unified tree.

• Pathos™ introduced severity-weighted scoring, translating patient instability into measurable data rather than anecdotes.

• SymCas™ modeled flare sequences in real time, providing predictive signals before collapse.

• VitalGuard™ integrated environmental overlays, turning air quality, mold risk, and climate data into chronic illness prevention logic.

• BRAGS™ closed the accountability loop, scoring institutions for bias, trial failure, and equity retreat.

  
  

Each module was necessary, but only in aggregation did a new field emerge. Together, they form the map of remission conditions: a system that not only explains why patients collapse but offers reproducible pathways to stability.

This is the distinction: traditional medicine mapped disease onset. CYNAERA mapped recovery conditions. BST is that synthesis in action.

Section VII: BST in Action: Case Studies That Break Silos

Case Study 1: The Misclassified Adolescent

A 15-year-old girl was told she had “anxiety” after recurrent fainting episodes. Her parents cycled her through psychiatry and cardiology. BST mapping revealed autonomic dominance with mast-cell spillover. Pyridostigmine, fluid repletion, and mast-cell stabilization reduced episodes by 70% within months (Raj et al., 2020). Without BST, she would have remained in psychiatric misclassification.

Case Study 2: The EBV Veteran

A middle-aged patient developed ME/CFS after mononucleosis, later dismissed as “post-viral fatigue.” In a clinical trial, he was randomized into a GET arm that worsened symptoms. BST logic reframed exertion as metabolic collapse. Once pacing was adopted as metabolic buffering, ATP recovery improved, aligning with mitochondrial findings (Tomas et al., 2017).

Case Study 3: The EDS Overlap

An Ehlers-Danlos patient with recurrent joint instability, mast-cell storms, and autonomic collapse was repeatedly denied disability because “no single diagnosis explained impairment.” BST terrain mapping documented connective tissue fragility as an amplifier of autonomic and immune collapse. With branch-dominant coding, both clinical stabilization and policy coverage became possible. These examples underscore BST’s value: it is not “innovation for the future,” it is triage for the present.

Section VIII: BST as System Architecture

A. Beyond Clinical Protocols

BST is not just a new therapeutic approach; it is a re-architecture of medicine. Instead of stacking specialties like silos, BST designs recovery as an ecosystem. Each subsystem is phased, adaptive, and responsive to real-time variability.

B. Macro-Socio-Epidemiology

Traditional epidemiology counts prevalence. BST introduces macro-socio-epidemiology, merging biology, environment, and social determinants into one terrain logic. This is not optional. To separate them would be like removing polarity from water; the system ceases to behave as designed.

• Example: Mold exposure in flood-prone housing amplifies mast-cell storms, which in turn destabilize autonomic recovery, leading to economic loss through disability. A pulmonologist may only see asthma; an economist may only see productivity decline. BST sees the feedback loop as one system.

  
  

C. Infrastructure Shift

• ICD codes must stratify by branch dominance.

• NIH funding must allocate by mechanism clusters, not pathogen labels.

• FDA trials must adapt endpoints to flare-sequence biology.

This is a system-level redesign. BST doesn’t add another lane to the highway — it rewires the traffic grid.

Section IX: Forecast — BST as the Future Default

Clinical Trials

Mechanism-cluster recruitment will salvage decades of failed interventions. Adaptive designs will prevent promising therapies from being discarded due to heterogeneity.

FDA Approvals

Regulators can anchor on flare-aware endpoints, heart rate variability, cytokine windows, and mitochondrial assays, rather than blunt symptom scales.

Healthcare Delivery

Triage shifts: stabilize before escalate. Mast-cell storms are treated as medical emergencies, not psychosomatic noise.

Economic Impact

If IACC prevalence continues its upward trajectory, the U.S. alone faces a $1 trillion annual burden (Cutler, 2022; Brookings Institution, 2023). BST offers cost savings through prevention of hospitalizations, earlier stabilization, and return-to-work readiness.

Global Application

BST is not U.S.-bound. In wildfire zones of Australia, post-dengue syndromes in South America, and post-Ebola terrain collapse in Africa, the logic holds. BST is global infrastructure.

Founder’s Statement

“I did not set out to invent a discipline. I set out to survive. Once remission was mapped for one, I realized it could be scaled to millions. Bioadaptive Systems Therapeutics is lived infrastructure, born of necessity, validated by convergence, and ready to replace fragmentation with coherence.”

X. Conclusion — This Is the Turn

For decades, patients were told to pick a lane: immunology, neurology, rheumatology, psychiatry. But the body never had lanes; it had interacting systems. Bioadaptive Systems Therapeutics™ (BST) is the moment we admit that truth and act on it. We stop chasing labels and start engineering remission. We stop asking patients to fit the system and start shaping the system to fit the biology.

This is not an incremental tweak. It is a pivot from “manage a diagnosis” to “stabilize a terrain.” It is the difference between suppressing symptoms and restoring capacity; between averaging away responders in megatrials and revealing signal through mechanism-cluster design; between writing off the “too complex” and building a discipline for them on purpose.

The map is already drawn. In five months, CYNAERA published the scaffolding, IACC Terrain™, SymCas™, Pathos™, VitalGuard™, BRAGS™, that clinicians can use today to stage by branch dominance, that researchers can use to stratify cohorts, and that policymakers can use to count what was invisible. If you can read a terrain, you can plan a remission. If you can plan a remission, you can scale it.

The stakes are not abstract. Every day we delay, students withdraw from school, parents leave the workforce, caregivers burn out, and entire communities absorb the cost of preventable instability. Wildfire seasons lengthen; housing floods; latent viruses reactivate; the “rare” becomes routine. Fragmentation is not neutral; it is harm. BST is the antidote: coherence, applied.

So let us be plain: this is the turn. From silos to systems. From onset to recovery. From improvisation to engineering.

What changes now

• Clinical practice: Triage by branch dominance (immune, autonomic, mitochondrial, connective, environmental) before you escalate anything else. Stabilize the loudest branch first. Chart flares as signals, not failures.

• Trials: Recruit by mechanism clusters, instrument flare sequences (HRV windows, PEM latency, cytokine phases), and pre-specify adaptive splits. Stop averaging biology into “no effect.”

• Policy: Add branch-dominant modifiers to codes, fund environmental stabilization as medical necessity where documented, and count overlap in prevalence and cost.

• Access: Treat air, housing, and recovery time as clinical inputs. Because they are.

• Culture: Retire “too complex.” Replace with “not yet stratified.”

  
  

12-Month Commitments

1. BST Clinical Starter Pack—publish open, branch-dominant triage and stabilization protocols (mast-cell, autonomic, mitochondrial) with SymCas™ flare logs and Pathos™ scoring templates.

2. Trial Blueprints—release plug-and-play designs for mechanism-cluster RCTs (autonomic-dominant, mast-cell-dominant, mito-dominant), including digital biomarkers and flare-aware endpoints.

3. VitalGuard™ for Clinics*—a turnkey environment-risk module (mold/PM2.5/VOCs/wildfire) integrated into intake, with billing language for payers.

4. Coding Addendum—a branch-modifier spec that professional bodies can adopt while ICD lags, enabling coverage today.

5. BST Learning Network—a consortium of clinics and patient orgs to share outcomes, de-risk adoption, and publish quarterly signal reports.

   
   

What success will look like

• Emergency visits for orthostatic collapse and mast-cell storms fall.

• Time-to-stability shrinks because sequence and order are correct.

• Trials start reading as signal-positive within subgroups that biology predicted all along.

• Disability determinations reflect lived overlap, not paper silos.

• Patients say, “I am finally being treated as a system,” and mean it.

  
  

Fragmentation has been our default; coherence must be our discipline. BST is that discipline: a practical architecture for turning lived suffering into remission at scale. The map exists. The tools exist. The moment is now. Let’s move.

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Author’s Note:

All insights, frameworks, and recommendations in this white paper reflect the author's independent analysis and synthesis. References to researchers, clinicians, and advocacy organizations acknowledge their contributions to the field but do not imply endorsement of the specific frameworks, conclusions, or policy models proposed herein. This information is not medical guidance.

Applied Infrastructure Models Supporting This Analysis

Several standardized diagnostic and forecasting models developed through CYNAERA were utilized or referenced in the construction of this white paper. These tools support real-time surveillance, economic forecasting, and symptom stabilization planning for infection-associated chronic conditions (IACCs).

Note: These models were developed to bridge critical infrastructure gaps in early diagnosis, stabilization tracking, and economic impact modeling. Select academic and public health partnerships may access these modules under non-commercial terms to accelerate independent research and system modernization efforts.

Licensing and Customization

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Learn More: https://www.cynaera.com/systems

About the Author

Cynthia Adinig is an internationally recognized systems strategist, health policy advisor, and the founder of CYNAERA, an AI-powered intelligence platform advancing diagnostic reform, clinical trial simulation, and real-world modeling for infection-associated chronic conditions (IACCs). She has developed 400+ Core AI Frameworks, 1 Billion + Dynamic AI Modules, including the IACC Progression Continuum™, US-CCUC™, and RAEMI™, which reveal hidden prevalence, map disease pathways, and close gaps in access to early diagnosis and treatment.

Her clinical trial simulator, powered by over 675 million synthesized individual profiles, offers unmatched modeling of intervention outcomes for researchers and clinicians.

Cynthia has served as a trusted advisor to the U.S. Department of Health and Human Services, collaborated with experts at Yale and Mount Sinai, and influenced multiple pieces of federal legislation related to Long COVID and chronic illness.

She has been featured in TIME, Bloomberg, USA Today, and other leading publications. Through CYNAERA, she develops modular AI platforms that operate across 32+ sectors and 180+ countries, with a local commitment to resilience in the Northern Virginia and Washington, D.C. region.