Western Medical Treatment of POTS and Managing POTS with Acupuncture and Chinese Herbal Medicine
POTS - Diagnosis and Western Medical Perspective
Postural Orthostatic Tachycardia Syndrome (POTS) is not a disease in itself, but a collection of symptoms that can include:
mental cloudiness, blurred vision, shortness of breath, rapid heartbeat, shakiness, chest discomfort, headaches, lightheadedness, nausea, and/or palpitations upon standing
The hallmark criteria of POTS diagnosis includes:
A 30+ BPM increase in Heart Rate (HR) within 10 minutes of standing
A 20/10 mmHG fall in BP with standing relieved by lying down
POTS can occur on its own without an obvious cause. It is commonly seen alongside chronic fatigue syndrome, autoimmune disorders, Elhers-Danlos, Lyme disease, and with post viral illnesses like long Covid.
POTS is most commonly diagnosed using a Tilt Table Test to asses for fluctutions in HR and BP with postural changes.
Studies have found two main subtypes of POTS: Neurogenic POTS and Hyperadrenergic POTS
Neurogenic POTS is believed to result from dysfunction of the Autonomic nervous System (ANS), which is responsible for the tone of smooth muscle in the body, including our vascular system - upon standing, the ANS fails to constrict the blood vessels in the lower extremities, causing blood pooling in the limbs - the body respond with tachycardia to maintain stable blood pressure
Hyperadrenergic POTS is associated with a spike in stress hormones like Norepinephrine - upon standing, stress hormones increase vasoconstriction in the extremities leading to a blood pressure decrease
Pharmaceutical treatment of POTS - 2 common medications
Ivabradine, which affects firing of the sinoatrial node, lowering heart rate without lowering blood pressure
Midodrine, an adrenergic receptor agonist, works to increase calf vascular resistance and decrease heart rate spikes
Treatment of POTS with Chinese Medicine
Traditional Chinese Medicine treatments will vary across individuals presenting with POTS; the best course of treatment will depend on accurate pattern diagnosis, taking into account the whole person, their manifestation of POTS, and concurrent symptoms.
Patterns to consider
Dual Heart and Spleen Qi and Blood deficiency
Damage to Heart and Spleen by overthinking, chronic disease, or blood loss (childbirth) consumes Qi and Blood, causing dual Qi and Blood deficiency; not enough Qi and Blood to reach head causing dizziness
Manifestations include dizziness and vertigo, blurred vision, worse with overthinking/worry, palpitations, fatigue, SOB, insomnia, low appetite, pale complexion, pale lips
General Qi deficiency
Caused by overwork, constitutional spleen/stomach deficiency results in general Qi deficiency; not enough Qi to reach the head causing dizziness
Dizziness and vertigo with desire to lie down, worse with standing up, worse with overwork, fatigue, dislike of speaking, SOB, spontaneous sweating, low appetite, loose stools
Kidney Essence deficiency
The Brain in TCM is known as the “Sea of Marrow” and relies on Kidney Essence for maintenance and nourishment - decline in Kidney Essence causes dizziness
This can be caused by a constitutional deficiency (genetics) or can result from long term disease taxing the body’s reserves
Manifestations include dizziness and vertigo with tinnitus, empty sensation of the head, fatigue, poor memory, blurred vision, low back and knee pain/weakness, seminal emission, impotence, premature greying of hair
Phlegm Damp
An excess presentation resulting from damage to the Spleen and Stomach which then cannot transform and transport food essences and fluids = damp accumulation; damp congeals (phlegm) and prevents clear Yang from ascending to the head, causing dizziness
Manifests as dizziness with heavy feeling of the head, chest oppression, maybe nausea, vomiting, low appetite, hypersomnia, heavy body sensation
Some lifestyle adaptations for POTS to consider
Compression socks - help maintain vascular resistance and prevent blood pooling in the legs
Adequate fluid intake - including electrolytes to help the body adequately hold onto and use fluid
Avoid overheating - this can make blood pooling worse
Regular light exercise - this can increase blood vessel tone and increase Heart Rate Variability
Remembering to rest - not only is this helpful when overextended, but regular rest helps regulate the nervous system
Eating at regular intervals - most TCM patterns that manifest with POTS symptoms result from damage to our digestive system - taking care to eat regularly not only support this from a Chinese Medicine point of view, but also keeps blood sugar stable and can decrease spikes in stress hormones which can worsen POTS
If you are experiencing POTS symptoms, treatment options are available. Western medical treatments are mainly centered around symptom management and while pharmaceutical approaches may work for some, many people suffering with POTS require a more comprehensive approach. Acupuncture and Chinese Herbal medicine can work concurrently with Western Medical interventions as well as individual lifestyle changes.
References
Ross et al. (2014). A double-blind placebo-controlled cross-over study of the vascular effects of midodrine in neuropathic compared with hyperadrenergic postural tachycardia syndrome. Clinical science (London, England: 1979), 126(4), 289–296. https://doi.org/10.1042/CS20130222
Sionneau, & Gang. (1996). “Dizziness”. In The treatment of disease in TCM Vol.1: Diseases of the head and face including mental/emotional disorders (pp. 51–59). Blue Poppy Press.
Taub et al. (2021). Randomized Trial of Ivabradine in Patients With Hyperadrenergic Postural Orthostatic Tachycardia Syndrome, Journal of the American College of Cardiology, Volume 77, Issue 7, pp. 861-871, ISSN 0735-1097, https://doi.org/10.1016/j.jacc.2020.12.029. (https://www.sciencedirect.com/science/article/pii/S0735109720381316) Vasavada et al. (2023).
Choices and Challenges With Drug Therapy in Postural Orthostatic Tachycardia Syndrome: A Systematic Review. Cureus, 15(5), e38887. https://doi.org/10.7759/cureus.38887
