Think of your autonomic nervous system as your body's background "autopilot" - it automatically manages involuntary jobs like your heart rate, blood pressure, digestion, temperature regulation, and sleep without you having to think about it. When this autopilot system malfunctions persistently, it is called dysautonomia, and Postural Orthostatic Tachycardia Syndrome (POTS) is one major form of it.
POTS frequently develops within three months of a physical triggering event, such as a viral infection (like COVID-19, flu, or mono), a concussion, surgery, or pregnancy. Studies reveal that roughly 2% to 14% of COVID-19 survivors develop POTS, while 9% to 61% report POTS-like symptoms - such as rapid heart rate, fatigue, dizziness when standing, and brain fog - within 6 to 8 months after infection. Among non-hospitalized individuals suffering from severe Long COVID symptoms, 31% meet full POTS criteria and an additional 27% experience POTS-like symptoms. Post-COVID POTS affects younger adults and females at higher rates, with women accounting for 91% of diagnosed patients.
How POTS Is Diagnosed and How It Feels
To receive an official POTS diagnosis, a person’s heart rate must jump by at least 30 beats per minute (bpm) - or at least 40 bpm for teenagers aged 12 to 19 - within 10 minutes of standing up, without a significant drop in blood pressure. Standing up can trigger symptoms including dizziness or lightheadedness, a racing heart rate (palpitations), severe fatigue, and cognitive difficulties known as "brain fog". Other common symptoms include exercise intolerance, stomach issues (nausea, bloating, constipation, or diarrhea), sleep problems, and headaches. POTS also frequently overlaps with joint hypermobility conditions like Ehlers-Danlos Syndrome (EDS) and autoimmune issues.
The Three Main Subtypes
POTS is not just a single disease; it is a collection of symptoms driven by three main body glitches:
Neurogenic POTS: Leg nerve signals fail to properly squeeze blood vessels when standing, causing blood to pool in the lower body so the heart beats faster to compensate.
Hypovolemic POTS: Caused by low total blood volume, meaning not enough blood returns to the heart, forcing rapid pumping.
Hyperadrenergic POTS: Triggered by an overactive "fight-or-flight" system that floods the body with extra norepinephrine upon standing, causing high blood pressure, tremors, anxiety-like feelings, and a racing heart rate.
Management and Treatment Strategies
First-line management relies on non-drug lifestyle habits to boost blood volume and circulation: drinking plenty of fluids, eating extra salt/sodium, wearing lower-body compression garments, engaging in structured aerobic exercise, and avoiding heat or long periods of standing.
Additionally, acupuncture helps regulate the autonomic nervous system by boosting vagal (parasympathetic) activity and heart rate variability. Traditional Chinese medicine uses targeted herbal formulas tailored to the body's specific underlying imbalance:
Neurogenic POTS is treated as a heart rhythm and energy instability using formulas that stabilize neurogenic rhythms.
Hypovolemic POTS reflects a fluid and energy deficiency (qi and yin deficiency) managed with fluid-restoring formulas.
Hyperadrenergic POTS addresses an unanchored "fight-or-flight" state with calming, anchoring formulas.