Sarah came in carrying a list. Not a shopping list. A symptom list, handwritten on two sides of an A4 page, items added in different pens like she’d been building it over months.
Heart racing every time she stood up. Dizzy spells that turned mornings into obstacle courses. Exhaustion so deep it had a texture. She’d seen four doctors in two years. They’d ruled out everything they could think of, and one had gently suggested she consider anxiety.
She sat across from me looking tired in a very specific way. Not sad. Not dramatic. Just worn.
She didn’t have anxiety. She had POTS.
Postural Orthostatic Tachycardia Syndrome (POTS) is one of those conditions that doesn’t fit neatly into a single specialty. Cardiology looks at the heart. Neurology looks at the nervous system. Endocrinology looks at hormones. Nobody coordinates the whole picture.
What it looks like: you stand up, your heart rate surges by 30 beats per minute or more, and your body scrambles to compensate. Dizziness, fatigue, brain fog, palpitations, sometimes nausea. It’s not imaginary, and it’s not rare. Estimates put it at between 50,000 and 250,000 Australians, mostly women, often triggered by illness, surgery, or a stretch of sustained stress.
Western medicine is still working out why. Chinese medicine has its own map for it. And the map is useful.
The Pump Needs Three Things
Think of the Heart as the pump in a system that depends on three things: enough fluid to pump, enough power to move it, and steady control of that rhythm. When all three are working, you stand up and the body adjusts without you noticing. When any one of them is off, standing up becomes a problem.
The Spleen handles supply. Everything you eat and drink gets converted into Qi and Blood, the fluid filling the system. When digestion is weak, volume drops. Not enough volume means not enough to push uphill when you stand. The brain is the highest point. It feels the shortage first.
The Kidneys provide the driving force. They’re the body’s root energy, the pressure behind circulation that helps push blood upward against gravity. The Kidneys also provide the warmth and energy for the Spleen and Heart.
The Heart regulates the rhythm. It adjusts constantly, when you move, when you stand, when demand changes. A healthy heart makes that adjustment without drama, not just to movement, but also your emotions.
POTS is what happens when this coordination fails. Gravity pulls blood downward, and the system can’t hold steady. The volume may be too low. The driving force too weak. The regulation too unstable. Usually some combination of all three.
So the Heart does the only thing it can: it speeds up. Not because it’s broken. Because it’s trying to manage a system that isn’t holding.
That’s where the symptoms come from. Not enough reaching the brain: dizziness, fog. System underpowered: fatigue that sits in your bones. Regulation unstable: racing, pounding, that uncomfortable awareness of your own heartbeat.
The patterns below map to which part of the system is failing.
Which Pattern Are You?
🌱 Weak Cooking Pot: Spleen Qi Deficiency
The Spleen in Chinese medicine is the body’s cooking pot. It transforms food and drink into blood and Qi. When the pot is weak, it can’t produce enough. Not enough blood to fill the vessels. Not enough fuel to keep the pressure up. Stand up, and there’s simply not enough volume to reach the higher ground. The brain gets less blood. The heart races to compensate.
Key symptoms: Fatigue worse after eating · bloating · loose stools · heavy limbs · brain fog · pale face · low appetite · dizziness on standing
How to check yourself:
- Tongue: Pale, slightly swollen, scalloped (wavy) edges, thin white coat
- Do you crash after meals instead of feeling fuelled?
- Is your stomach often bloated or unsettled?
- Cold, slightly puffy hands?
Read more: What is Spleen Qi Deficiency?
🔥 The Empty Campfire: Kidney Yang Deficiency
Kidney Yang is the body’s pilot light, the warmth and drive that keeps everything moving. When it’s low, blood volume isn’t the only problem. The force behind circulation is underpowered too.
Key symptoms: Bone-deep exhaustion · cold hands and feet · lower back ache · worse in cold weather · slow metabolism · needing extra sleep · pale/puffy face
How to check yourself:
- Belly warmth: Place your hand just below your navel. It should be one of the warmest spots on your body. Compare it to the side of your abdomen, or ask someone to compare theirs. If it feels cold or the same temperature, the Kidney Yang flame is low.
- Tongue: Pale, wet, possibly swollen with a white coat
- Always the coldest person in the room?
- Wake up already depleted even after a full night’s sleep?
❤️ The Restless Heart: Heart Yin Deficiency
The heart races partly because it’s undernourished, running hot and empty. Heart Yin deficiency often sits on top of other patterns. Same fatigue, but with anxiety and sleeplessness layered on.
Key symptoms: Palpitations · racing heart at rest · anxiety · poor sleep · night sweats · dry mouth at night · restless mind · afternoon flushing
How to check yourself:
- Tongue: Red tip (Heart zone), dry with little or no coat
- Do you wake between 11pm–1am with your mind running?
- Night sweats that stop when you wake up?
- Awareness of your own heartbeat when lying still?
🌊 The Waterlogged Ground: Dampness/Phlegm
Sometimes the problem isn’t depletion. It’s accumulation. Dampness and Phlegm build when the body can’t process and move fluids properly. Instead of a river running dry, think boggy ground: waterlogged, heavy, nothing draining. The legs feel like wet clay. The head is stuffed from the inside. Not the exhaustion of running on empty. Something heavier.
Key symptoms: Heavy waterlogged feeling · thick brain fog (“thinking through wet cotton”) · muzzy head on standing · nausea or chest fullness · mucus · puffiness · sluggish digestion · worse in humid weather
How to check yourself:
- Tongue: Swollen and wet, thick greasy white or yellow coat
- Do your limbs feel heavy and hard to move, especially in the morning?
- Is your brain fog more like thickness than tiredness? Muffled and stuffed, not just flat?
- Feel noticeably worse on humid or rainy days?
What Started It?
When Sarah came in, nobody had asked her what happened before the POTS started. It turned out she’d had a bad viral illness two years earlier, one of those “never quite recovered” situations. In Chinese medicine, we’d say the illness left a residue, depleted her Qi and blood, and left her Spleen and Heart running on empty.
That’s not a diagnosis conventional medicine has a great name for. But it’s a pattern we recognise. And it’s a pattern we can work with.
POTS doesn’t have a cure yet. But there’s usually room to feel better than you do right now. That’s a worthwhile place to start.
If you’re living with POTS or suspect you might be, get a proper diagnosis through your GP or cardiologist first. A tilt-table test is the gold standard. From there, Chinese medicine can work alongside your existing care to support recovery.
When do your symptoms hit hardest? Morning, after eating, in cold weather? The timing is a clue.
Living with POTS?
Getting a diagnosis is the first step. Working out which part of your system is struggling is the next one. Chinese medicine won’t replace your cardiologist. But it can work alongside your existing care to address what’s underneath.
If you’d like to work out your pattern and build a plan around it, I’m happy to help.