Treating postural orthostatic tachycardia syndrome requires moving beyond homogeneous symptomatic labels to identify underlying regulatory failures. In this insightful episode, POTS is explored through both modern biomedical pathways and classical Chinese herbal pattern differentiation. Biomedically, the syndrome manifests across three primary mechanisms: neurogenic, hypovolemic, and hyperadrenergic dysregulation. Neurogenic POTS stems from autonomic neuropathy causing lower extremity blood pooling, which corresponds in Traditional Chinese Medicine to heart qi and yang instability; rather than forced vasoconstriction, formulas like Zhi Gan Cao Tang effectively stabilize autonomic rhythm. Hypovolemic POTS involves reduced circulating blood volume and poor fluid retention, mapping to profound qi and yin depletion along the lung-spleen-kidney axis, best managed through restorative prescriptions like Sheng Mai San. Finally, hyperadrenergic POTS presents with exaggerated sympathetic surges, elevated norepinephrine, and severe anxiety, reflecting shao yang dysregulation and unanchored yang treatable via Chai Hu Jia Long Gu Mu Li Tang. Because presentations often overlap, practitioners must carefully sequence treatments to restore physiological regulation.