Abstract
Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia characterized by an exaggerated increase in heart rate upon standing, often accompanied by dizziness, fatigue, palpitations, and cognitive dysfunction. While pharmacological therapies remain limited, acupuncture and Chinese herbal medicine provide a promising complementary approach. In my clinical practice, I integrate Traditional Chinese Medicine (TCM) principles with biomedical understanding to develop individualized, evidence-informed treatment plans for POTS patients.
PATTERN DIFFERENTIATION
POTS is not a classical TCM diagnosis but is commonly associated with syndromes such as:
Heart and spleen Qi deficiency Kidney Yin deficiency with empty heat Liver Qi stagnation with phlegm accumulation Dual deficiency of Qi and Yin with Shen disturbance
Accurate pattern differentiation guides both acupuncture and herbal prescriptions.
ACUPUNCTURE TREATMENT PROTOCOL
Treatment principles: Regulate autonomic function, tonify Qi and Yin, calm the Shen, and harmonize heart, spleen, and kidney functions.
Primary acupuncture points include PC6 (Neiguan), ST36 (Zusanli), BL15 (Xinshu), BL20 (Pishu), ST25, SP15, BL23 (Shenshu), GV20 (Baihui), Yintang, KI3 (Taixi), SP6 (Sanyinjiao), and LR3 (Taichong).
Technique: Sterile, single-use stainless steel needles (0.25 mm × 30 mm) are inserted with moderate manual stimulation to achieve deqi. In selected cases, low-frequency electroacupuncture (2 Hz) is applied to PC6–ST36, ST25–SP15, and SP6–KI3 point pairs for 40 min.
Treatment duration and frequency: Each session lasts approximately 40 min. Treatments are administered twice weekly for 2 weeks, followed by weekly maintenance. Clinical reevaluation is conducted after 6–8 sessions using symptom scores, heart rate variability, and orthostatic response.
Clinical outcomes: Patients frequently report reduced fatigue, improved orthostatic tolerance, and decreased palpitations. A moderate decrease in heart rate response during postural change suggests enhanced autonomic balance.
CHINESE HERBAL MEDICINE PROTOCOL
Herbal prescriptions are tailored to individual pattern differentiation. Two common approaches include:
Qi and Yin deficiency: Modified Sheng Mai San (Generate the Pulse Powder)
Ren Shen (Panax ginseng) Mai Men Dong (Ophiopogon japonicus) Wu Wei Zi (Schisandra chinensis) Additional herbs: Dang Shen, Bai Zhu, Huang Jing, Shu Di Huang
This formula supports cardiopulmonary function and strengthens upright posture.
Liver Qi stagnation with phlegm: Modified Ban Xia Hou Po Tang + Er Chen Tang
Ban Xia, Hou Po, Fu Ling, Chen Pi, Sheng Jiang, Zhu Ru
Used in patients with emotional tension, dizziness, and chest tightness.
Dosage and administration: Herbal granules are prescribed two to three times daily. Prescriptions are adjusted every 1–2 weeks based on patient response, pulse, and tongue diagnosis.
Monitoring: Clinical outcomes are monitored through symptom tracking (fatigue, palpitations, dizziness), postural heart rate, and quality of sleep. Collaboration with cardiologists is encouraged when necessary.
CONCLUSION
Acupuncture and Chinese herbal medicine offer a valuable complementary approach for patients with POTS, particularly those who exhibit signs of autonomic instability and fatigue. Through individualized pattern differentiation and a focus on regulating the heart, spleen, and kidney systems, this integrative protocol supports symptom relief and functional recovery. Patients often experience improved orthostatic stability, reduced anxiety, and enhanced quality of life. Further controlled studies are needed to confirm clinical efficacy and explore underlying mechanisms.
Footnotes
AUTHOR DISCLOSURE STATEMENT
No competing financial interests exist.
FUNDING INFORMATION
No funding was received for this article.