Unraveling the Mystery of POTS with Chinese Medicine

A Unique Take on a Ubiquitous Problem

Introduction to POTS

P.O.T.S. (hereinafter ‘POTS’), also known as Postural Orthostatic Tachycardia Syndrome, is a once rare and unheard of medical disorder (the term was coined in 1993[1], and though not necessarily a new disorder, was relatively uncommon). It first came to my clinical awareness a couple decades ago in the teenage population, especially among young girls.  I also noticed many years ago that its occurrence was highly associated as a sequelae to the Gardasil vaccination, and today I am diagnosing it with an ever-increasing prevalence subsequent to the rushed-to-market Covid vaccine experiment.  It is now becoming a world-wide phenomenon.

With a particular specialty in Chinese pulse diagnosis, I began noticing and correlating particular presentations and patterns that allowed me to formulate a nuanced and comprehensive understanding of the underlying dynamics of POTS. This enabled me to craft effective strategies and treatments via the Chinese medicine paradigm.

Some of the main symptoms of POTS include:

• --rapid heart rate

• --dizziness

• --feeling of light headedness

• --fainting episodes (usually upon standing from a seated or reclined position)

• --visual disturbances

• --headaches

• --palpitations

• --fatigue

• --weakness

• --insomnia and a host of sleep disorders

• --anxiety and panic disorders

• --poor circulation and cold hands and feet

• --feeling of heat in the head or flushing

• --tightness in the chest

• --trouble concentrating or staying focused

• --nausea, bloating, constipation, etc.

• --in severe cases, dissociations, feeling as if not in one’s own body; limbs, body parts feel as if floating away….

From a conventional Western medicine perspective, POTS patients experience orthostatic intolerance and have low blood volume, with elevated plasma norepinephrine upon standing (reflecting hyperactive sympathetic nervous system functioning).  It is characterized as a dysfunction of the autonomic nervous system (dysautonomia), and hence reveals itself as a systemic disorder.  From a Chinese medical stance, we can interpret this, and the symptoms above (and additional ones below), as revealing major root causes in all of the major five organ systems (Heart, Lungs, Liver, Kidneys and Spleen/Stomach), but its most direct cause, as I will detail below, is in the Heart and Liver organ systems.  Some of the common Chinese medical patterns that POTS encompasses (with associated symptoms) include:

The Western medical diagnosis of POTS is often made via the tilt table test, wherein a patient’s heart rate and blood pressure are monitored while lying down, sitting, and upon standing up.  From a Chinese medical paradigm, we can see this process manifest from specific pulse configurations, waveforms, changes to specific pulse positions, as well as assessing the Change of Rate on Exertion (pulse test unique to the Shen-Hammer Pulse Diagnosis system and lineage: see demonstration below). 

One aspect of a pathognomonic finding of POTS on the pulse can be found in the Shen-Hammer lineage of assessing the patient’s heart rate on exertion.  This profoundly informative technique is easy to learn and can be performed by anyone, practitioner or layperson alike.  It is performed as follows: 

Rate on Exertion Demo

After completing the full pulse evaluation, one should assess the patient’s resting heart rate.  Next, the patient is asked to stand up, and while we hold one wrist, the patient swings the other ten times vigorously, then stopping, as we count the rate for ten seconds. That number of beats is multiplied by six to determine the beats per minute and is compared to the resting heart rate. A normal increase is between 12 and 15 beats per minute, ensuring the Heart’s proper response to the energetic demands placed upon it. Outside of this parameter is considered pathological. The chart below details the possibilities and attending diagnoses.

An elevation above 15 beats per minute is a sign of Heart blood deficiency (note we are looking at blood volume here, not anemia/iron/hemoglobin, etc.). Heart qi deficiency (underactive functioning of the Heart organ system) is diagnosed if the rate stays the same or rises less than 10 beats per minute. If it drops below the resting heart rate, that is severe Heart yang deficiency (more severe and advanced deficiency). Usually those people tend to have overt Western medically defined heart diseases and are symptomatic with shortness of breath, tightness in the chest, oppression in the chest, difficulty lying down, etc.  With POTS patients, one will find a Heart Blood deficient scenario, often in the ‘Very Severe’ and above categories as laid out in the previous chart.  The more severe the pulse finding, the more severe the POTS symptoms will be found. For those who are familiar with a common POTS treatment of salt, we can see the logic here in the salt’s ability to increase blood volume by retaining fluids. However, this strategy is simply a partial band-aid, as it only addresses one small aspect of the overarching clinical presentation. Below, I discuss a number of other confluent diagnoses that all converge to create a POTS scenario.

The Role of Stagnation

As one of my mentors, Dr. Leon Hammer, has often stated and written, the ability to create stagnation in the body is an ecological adaptive response of a strong resilient system. Imagine a simple real world scenario in which you are at work and your boss gets angry at you and unleashes a tirade of insults and demeaning behavior. Without an ability to create stagnation, eg. suppress your own emotional response, you would respond in ways that would most likely threaten your job, livelihood and ability to financially take care of your family. That suppression requires strength and resources.  And while stagnation can (and often does) create the sequelae for a host of pathologies if not released safely (mostly downstream impacts of inflammation), the more serious predicament is the inability of the body to maintain stagnation (suppression/latency). This can become more destructive, as in the simple example above, eg loss of job and financial security. In other words, the inability to contain and create stagnation is the greater pathology.  This over time creates a fundamental weakness and instability with devastating consequences, some of which include POTS and other types of disorders that are now ubiquitous with a root of deficiency, including, but not limited to chronic fatigue syndrome, breast cancers, lymphomas, autoimmune disorders, and the proliferation of 'turbo cancers,’ etc. 

Another way of thinking about this idea of creating stagnation is via containment of pathology so that it does not spread. This is a common theme in Chinese medicine energetics and lays out a crucial concept of latency. When a body-mind is confronted with pathology that it cannot defend against, it threatens to move inwards towards the organ systems. If the body-mind has enough integrity, it can divert those threats away from the vital organs and deposit them in a safer place to keep it dormant. Latency usually occurs in the bony cavities, eg joints, sinus cavity, teeth, etc. and can even be part of the process of the formation of tumors in various parts of the body (eg, wherever the pathogen was located and immobilized). If enough resources are maintained, such pathogens can remain dormant for years, if not even an entire lifetime. But maintaining latency is a drain on energy and resources, and when pathogens come out of latency, unrestrained inflammmation reeks havoc. We might see arthritic problems manifest, chronic sinusitis, teeth and gum infections, etc. and then eventually it makes its way to the bowels, colitis, Crohn’s, etc. and then to the major organs. If the latency was involved in the containment of tumor activity, when lost we see an unchecked spreading of this pathology in metastatic and of more recently seen turbo cancers. So, the ability of creating stagnation is of utmost importance to our physiological integrity. Without it, pathology runs rampant and can overtake the system.

The Empty pulse

A distinguishing factor in the nature of the stagnation in these more serious disorders, is that the stagnation comes from a state of deficiency (an inability to mobilize resources), rather than strength, with the concurrent inability to contain pathology and the spreading thereof.  A hallmark feature is an Empty pulse (see below) in the middle position of the left radial artery that represents the energetics of the Liver organ system and its dynamics.  The Empty pulse is characterized by the absence of a pulse in the Organ depth (Empty stage I), and/or the absence of the pulse in the Blood and Organ depths (Empty stage II). 

Normal Pulse Shape:

The Normal pulse should reflect a bell or sine curve/wave which rises from the Organ depth through the Blood depth and to the Qi depth and gradually recedes back to the Organ.  In other words, the pulse is strongest at the bottom where the base has the most substance, reflecting a system whose energies are rooted. This reflects normal physiology wherein the Organ depth is the root of the organ system’s energetics, vitality, foundation.  The Empty pulse demonstrates a lack of foundation and is essentially a state of chaos wherein the organ can no longer adequately perform all its functions.  In the images below, you will see that the deepest aspects of the pulse, where it should be strongest and most substantial, diminishes and becomes absent and occluded with pressure (as I press down to Organ depth the pulse disappears). This is a dangerous scenario and a precondition to significant life threatening illness, autoimmune disorders, metastatic cancers, etc. When this occurs in the Liver position, this suggests the incapacity to detoxify (which manifests in multiple ways, including ensuring that blood from the capillaries and the exchange of oxygen and gases/wastes returns back to the Heart and Lungs, as well as the ability to discharge toxins) and a breakdown of all the crucial functions that the Liver organ system controls (some discussed below). 

Early Empty Pulse:

Middle Stage Empty I Pulse:

Later Stage Empty II Pulse:

When looking at the diagnoses of POTS, I always find an Empty Liver position (amongst the other signs), typically along with significant blood deficiency, both in the Liver and the Heart (see Rate on Exertion test above).  The question that often presents is why the Empty Liver is associated to these disorders, and what can be done to reverse the problem.

Blood deficiency

From a western medical perspective, we can look at the work of David Systrom, MD at Brigham Hospital in Mass., who specializes in these disorders.  In his lab, a number of factors are measured via catheterization of the radial artery at the wrist and the pulmonary artery in the heart.  What he has found in a vast majority of patients is two-fold.  First, patients present with an internal preload failure due to an inability or unwillingness of the big veins in the legs, abdomen and pelvis to squeeze and push blood back to the right side of heart to ‘prime the pump’, eg, low filling pressure of the right side of the heart.  And second, poor systemic oxygen extraction and an inability to mobilize blood to the muscles and redirect it to the microcirculation in the capillaries and management of the slow-twitch mitochondrial-laden muscle fibers.   This creates poor oxygen uptake back to the pulmonary artery.  While the causes from western medicine seem to be unknown, both Chinese medicine and conventional paradigms exhibit the relationships and correlation to traumas and/or bacterial/viral/fungal infections as typically the symptoms can present after some triggering event.

The work of Thomas Cowan, MD (and those that have influenced him) is also instructive and informative here.  In his book, Human Heart, Cosmic Heart, Cowan writes about the 4th phase of water (gel) and how the heart is really less of a pump than an electrical system.  He describes how once blood gets into the capillary system it actually stops briefly and the exchange of oxygen and gases take place, followed by an oscillation in the capillaries before flow resumes.  The nature of this movement is due to the electrical charges taking place wherein the vessel is a hydrophilic tube which moves blood flow in capillaries and up through venous circulation.  This process is ensured by the electrostatic charges and the vortices created by the Heart and vessels, and the creation of structured water and an ‘exclusion zone’ which prevents improper leakage and also buffers inflammation, while promoting circulation via maintaining the proper charge.  A breakdown here will cause inflammation and disrupt proper circulation to these tissues, as well as inhibit venous return. 

From a Chinese medicine perspective, we can look at this as relating to the Liver and its coordinated functions with the Heart.  An analogy would be water moving upwards to nourish a tree against gravity.  According to physics this should only allow for a 35-40 ft. elevation, but of course some trees can reach upwards of 300 feet.  Another interesting aspect of the hydrophilic nature of the vessels and the vortices created by the electrical charge is that it requires very little energy and not the big output that conventional medicine adheres to as related to ATP.  We can see this in nature, too, as Cowan describes the movement (or ease of movement) and little effort required by trout in untouched rivers where these vortices are found (they are found only in areas untouched by industrialization).  Here, the trout are plump and healthy and utilize the vortices of the structured water to allow food to come to them as opposed to a vigorous swim upstream against the current.  Here we see analogies to the free and easy wanderer (Daoist model of health) and Liver energetics from the Chinese medicine paradigm. 

Another example to see the strong correlations and relationship of the Liver to POTS is that in Chinese medicine one of the ascribed functions of the Liver is to shunt blood to the periphery to support skeletal muscles and allow for proper peripheral circulation to assist with movement and body activity. We know that excess blood that is not mobilized to the periphery pools in the Liver organ. It’s a main reason why even if part of the Liver is resected, it can grow back. It has a more abundant blood supply than other organs. This excess blood also allows for its detoxification functions as well. So, the Liver is called upon to send blood and enhance circulation to the limbs to allow for this dynamic to take place and assist with smooth articulated movement. In Chinese medicine, the head is considered the fifth limb, and it is very specifically the Liver that governs blood circulation to the brain from the Chinese medicine perspective.

So, applying the above energetics discussed about the Change in Rate on Exertion exam, as well as identifying Empty pulses in the Liver, we can see how this sets the stage for the inability of the Liver to send a deficient amount of blood volume/supply to properly nourish the five limbs. As this happens, we see an insufficient amount of blood volume to fill the vessels, creating a gap between the diminished blood volume and the arterial walls. We know that nature abhors a vacuum, and this dynamic creates the reflexive blood pressure issues and all the subsequent symptoms that define POTS. Interestingly, as well, Chinese medicine postulates that the spirit resides in, and circulates with, the blood. Thus, the lack of blood volume creates an inability to contain/house the spirit, which wanders, creating the anxiety, panic and when severe enough, dissociative states so common in POTS presentations.

Of course, there are many more dynamics at play as established in the table above showing all the organ systems relationships to this process, but the Liver and the Heart are the primary players, and the others are part of the interrelated mechanisms, eg., the role of the Kidneys and Liver together and the nervous system roles they comprise, etc. etc.

Response to sudden changes

A very similar dynamic is commonly encountered in athletes who stop exercising suddenly, often the result of injuries, failure, being cut from a team (high school athletes not making collegiate level teams), etc.  The excessive nature of the athletes’ exercise schedules and the intensities of their aerobic workouts create an increased volume of blood circulation and a dilation of the blood vessels to accommodate it.  When stopping suddenly, the blood volume decreases much faster than the vessels, which constrict much more slowly, leaving a ‘separation’ between the blood and the vessel wall, which requires its abundant contact to maintain its health, integrity, pressure, etc.  This space, often described as a blood deficiency (relatively), eg, nature abhors a vacuum, creates “wind” (dizziness, light headedness, vertigo, weakness, etc.) and the resultant pathognomonic symptoms of POTS as outlined above. The concept of “wind” is an interesting one, and at is core is about the body-mind’s ability to adapt to and navigate an invitation to change. When this “invitation” is brought about abruptly, and perhaps even violently as with traumas, drugs, vaccine adjuvants, etc., it can present with dramatic symptoms as per POTS.

With the explosion of POTS over the years as a consequence to Gardasil vaccines and the Covid vaccines, we see this dynamic playing out. The spike proteins and highly inflammatory nature of these interventions is creating both a dilation of vessel and deficiency of blood (relatively), triggering the activation of POTS in those susceptible. The good news is that Chinese medicine can provide effective treatments thanks to a nuanced understanding of the body-mind energetics. Acupuncture, Chinese herbal medicine, supplements, eastern nutritional therapy, etc. etc. can work wonders for reversing this pathological process.

This article is but a short explanation of some of the most pressing dynamics at play in the creation of POTS. It is by no means exhaustive. Many more of the Chinese medicine energetics, including dozens of other pulse dynamics, are commonly seen with this pathological process that I have not mentioned. Another common trigger, well beyond the scope of this article, is the role that trauma plays. I have detailed these dynamics in my text Heart Shock: Diagnosing and Treating Trauma with Chinese Medicine.

For those of you who have made it this far and would like a little more info on some other interrelated dynamics, here is some additional information.

Trauma:

The etiologies behind POTS are often not singular, and typically represent a constellation of factors, including, the experience of traumas (e.g., major accidents, injuries, concussions, abuse, etc.), constitutional predispositions, surgeries, stopping exercise suddenly, vaccinations, etc.  And, commonly one may encounter multiple aspects of the above creating the trigger to a POTS diagnosis.  As an example, one recent patient underwent a knee surgery, followed by the Gardasil vaccination a month later, triggering a severe POTS condition with attendant severe symptoms such as unabating dizziness, headaches, dissociations, etc. that caused her to miss a full year of school.

Trauma is a prevalent triggering factor and is the subject of my aforementioned text, which spends nearly 500 pages detailing the subject.  Simply put, trauma creates a systemic insult to the patient, destabilizing the Heart, Nervous System and Kidney-adrenal systems, and also impacting the other major organs (see chart above detailing the Chinese medical patterns of diagnosis).  The initial dynamics of the trauma results in the Heart sending its blood and Yin-fluids to the interior of the body in order to protect the organs.  The Yang, which becomes hyperactive from said trauma, loses operative contact with the Yin-Blood, and becomes aimless and unrestrained, leading to the tachycardia.  The Kidney-adrenals become hyperactive, secreting adrenaline as the fight-flight-freeze response kicks in, and the Nervous System (mediated by the Liver organ system dynamics, which also metabolizes adrenaline in the blood) becomes hypervigilant, constantly on guard for threats to the organism.  With trauma, these systems do not find their way back to homeostasis and act as if the systems are under constant threat, requiring an overworking and eventual deterioration.  Other systems are likewise engaged, as is evident from the chart above detailing the symptoms that often present.

Vaccine-induced traumas:

As I alluded to above, one such trauma to the system can be found with particular vaccines, especially with the current schedule that overwhelms many with the onslaught of toxins and adjuvants that force the immune system to hyper-respond, creating febrile illnesses which stimulate the heart rate, the adrenals, and the nervous system.  Many of the ingredients in these vaccine cocktails are highly toxic and inflammatory, and some specifically allow the passage of these toxins through the blood brain barrier and into the central nervous system itself (e.g., polysorbate 80).  One such vaccine, Gardasil, has been associated directly to the development of POTS.[2] And, we are currently seeing the explosion of POTS post Covid-19 MRNA vaccinations.

Other common triggers can also include concussions (especially multiple), surgeries, anesthesia, and the concomitant blood loss that can ensue.

Rhythm changes:

As POTS reflects the health and integrity of the Heart and Liver and their governance over the blood vessels, it is not surprising to note the common finding of arrhythmias with POTS patients.  And, once again, the severity of the arrhythmia is directly correlated to the severity of symptoms.  Thus, patients with Changing Rate at Rest (heart rate speeding up and slowing down) can range from mild POTS (small changes), to more moderate forms (larger changes).  And those patients with Interrupted (skipping beats with no regular cadence) and Intermittent (skipping beats with regular cadence) pulses will generally have more severe symptoms as these qualities are reflective of more profound imbalances to the Heart (and, with these, the more consistent the skips, and the fewer beats between skips, the more severe the presentation).

Mitral Valve Prolapse:

A common pulse finding that presents itself with POTS is a positive Mitral Valve Prolapse, diagnosable when a Slippery pulse is found on the Mitral Valve position as delineated in the Shen-Hammer Pulse lineage.  Here, the Slippery pulse is a corroboration of the turbulence created from the back flow of blood due to the incompetent valve.  Two things that are worth noting about this finding is that even Western medicine has correlated mitral valve prolapses to anxiety and panic, racing heart rate and palpitations, but most intriguing is that POTS was once known by an alternate name, Mitral Valve Prolapse Syndrome[1] (as well as some others, including Soldier’s Heart, Chronic Orthostatic Intolerance, etc.). 

More info:

If anyone is interested in more detail on my approach to understanding and treating POTS, I recorded a 5 hour course with Healthy Seminars a few years back. It is available at the following link: Healthy Seminars POTS Course

My book, Heart Shock

Two hour interview I did on the relationship of POTS and Covid-19

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[1] e Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management. Satish R Raj, MD MSCI, Indian Pacing Electrophysiol J. 2006 April-Jun; 6(2): 84-99.

[2] Clin Rheumatol. 2015 Nov;34(11):1981-3. doi: 10.1007/s10067-015-3070-3. Epub 2015 Sep 10.  Vaccine. 2015 May 21;33(22):2602-5. doi: 10.1016/j.vaccine.2015.03.098. Epub 2015 Apr 14.  Eur J Neurol. 2014;21(1):135-9. doi: 10.1111/ene.12272. Epub 2013 Sep 16.

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[1] Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia. Schondorf R, Low PA; Neurology 1993 Jan;43(1):132-7.