POTS Through the Lens of Chinese Medicine: Beyond the Heart

When the heart begins to race, our natural instinct is to look at the heart.

But what if the heart is not where the story begins?

Recently, I have been seeing more patients with tachycardia and symptoms associated with POTS—Postural Orthostatic Tachycardia Syndrome—in my clinic. What has especially caught my attention is seeing these kinds of complex conditions appearing in younger people as well.

POTS can be a frustrating condition. A person may experience a racing heart when standing, dizziness, weakness, fatigue, brain fog, exercise intolerance, palpitations, and difficulty regulating their body's response to changes in position. In adolescents, the diagnostic threshold for the increase in heart rate is higher than in adults, and symptoms can significantly interfere with school, daily activities, and quality of life.

Modern medicine recognizes that POTS is not simply a problem of the heart. Researchers have proposed several overlapping mechanisms, including neuropathic dysfunction, hypovolemia, hyperadrenergic activity, immune-related mechanisms, and cardiovascular deconditioning. These mechanisms can occur together, and there is still much to learn about why one person develops POTS and another does not.

And this complexity is actually very familiar to Chinese medicine.

The Heart Is Part of a Family

One of the ways Chinese medicine understands the body is through the Five Elements: Wood, Fire, Earth, Metal, and Water.

But rather than thinking of these as five separate boxes, I like to think of them as a family.

Family members nourish one another, support one another, regulate one another, and sometimes become strained by one another. When one member of the family is struggling, the effects may eventually be felt by everyone else.

The Heart belongs to the Fire element.

In Chinese medicine, we don't automatically see the Heart as an isolated organ simply because the most obvious symptom is a racing heartbeat. We look at its relationships with the other systems.

The Liver, belonging to Wood, is the Mother of the Heart's Fire. The Heart, in turn, nourishes its Son, the Spleen and Stomach, which belong to Earth.

There is also another important relationship: the controlling cycle. Kidney Water helps regulate Heart Fire, while Heart Fire should also descend to warm and support the Kidney.

You don't need to memorize the Five Elements chart to understand the basic idea.

The body is a family. The Heart is one member of that family—not the whole family.

When Water Is Too Weak to Regulate Fire

This is one of the patterns I pay close attention to in patients who have been under prolonged stress or depletion.

In the Water–Fire relationship, Kidney Water should help nourish, cool, and regulate Heart Fire. At the same time, Heart Fire should descend and warm the Kidney.

When this relationship is healthy, there is communication between the two.

Water supports Fire.

Fire warms Water.

There is movement, communication, and balance.

But when Kidney Water becomes deficient, it may no longer have enough strength to adequately regulate the Fire of the Heart.

The Fire can then become relatively excessive and rise upward rather than descending to warm the Kidney.

And this is where something interesting can happen.

A person may have too much activity above and not enough strength below.

The Heart may feel overactive—palpitations, racing heart, restlessness, poor sleep—while the person at the same time feels deeply fatigued, weak, depleted, or unable to regulate body temperature.

To someone looking only at the symptom, these may seem like unrelated problems.

To a Chinese medicine practitioner, they may be part of the same pattern.

Why I Don't Treat Every Racing Heart the Same Way

This is one of the reasons I find Chinese medicine so valuable.

Two people can walk into the clinic with the same diagnosis, and their underlying patterns may be completely different.

One person may have a pattern involving significant deficiency. Another may have more pronounced excess. Another may have an imbalance involving the Liver, Spleen, Kidney, Heart, or several systems at once.

The diagnosis tells me what is happening.

The pattern helps me understand how this particular person's body arrived there.

And that changes the way I approach treatment.

When I see a patient with POTS or significant tachycardia, I don't want to simply ask:

“How can I slow down the heart?”

I want to ask:

“Why is the body asking the heart to work this hard?”

That is a very different question.

Looking Beyond the Symptom

Modern medicine has helped us understand that POTS can involve several interacting physiological mechanisms. There may be changes in blood volume, vascular tone, autonomic signaling, sympathetic activity, immune processes, or cardiovascular conditioning. These mechanisms can overlap rather than existing as five completely separate categories.

Chinese medicine approaches complexity from another direction.

Instead of separating the body into isolated problems, we look at relationships.

Is the Mother nourishing the Heart?

Is the Heart adequately supporting its Son?

Is the Water–Fire relationship balanced?

Is the body's Qi and Blood sufficient?

Are the systems that should regulate one another still communicating properly?

These are not questions that can be answered from a diagnosis alone. They require listening to the individual sitting in front of me—looking at their symptoms, constitution, tongue, pulse, lifestyle, stress, sleep, digestion, energy, and the many small details that together reveal a pattern.

That is the beauty of Chinese medicine.

We don't always treat the loudest symptom. We look for the conversation underneath it.

The Body Is Always Trying to Find Balance

Our modern lives can place enormous demands on the body.

Long hours, chronic stress, inadequate rest, irregular meals, insufficient nourishment, environmental burdens, and constantly being “on” can gradually affect the body's ability to recover and regulate itself.

This does not mean that any one of these factors causes POTS. POTS is a complex medical syndrome, and appropriate medical evaluation is important to establish the diagnosis and rule out other causes of tachycardia.

But from the perspective of Chinese medicine, these long-term burdens matter because the body does not experience them one at a time.

The family feels the stress together.

When one system becomes depleted, another may compensate.

When compensation continues for too long, another relationship may begin to suffer.

Eventually, the body may speak loudly enough that we can no longer ignore it.

Sometimes that voice is a racing heart.

Beyond the Heart

This is why I believe it is important to look beyond the Heart when working with POTS.

The heart may be where the symptom appears—but it may not be where the imbalance begins.

Chinese medicine gives us a way to look at the body as an interconnected family rather than a collection of isolated organs. The goal is not simply to chase a number on a heart monitor or quiet one symptom. It is to understand the individual pattern and support the body's ability to regulate, communicate, and return toward balance.

For me, this is what practicing Chinese medicine is about.

Not simply asking, “What disease does this person have?”

But asking:

“What is this person's body trying to tell us?”

Sometimes the answer begins with the Heart.

But very often, we need to listen to the whole family.