Small intestine bacterial overgrowth (SIBO) & TCM

When dealing with recalcitrant cases of IBS, one of the most important things to consider is small intestine bacterial overgrowth (SIBO), a condition in which abnormally large amounts of commensal bacteria are present in the small intestine. This bacterial overgrowth results in the impairment of digestion and absorption in the small intestine and the production of large amounts of hydrogen and methane gas resulting from the fermentation of carbohydrates by the intestinal bacteria.

Commensal bacteria are not beneficial bacteria, and not pathogenic bacteria. Commensal bacteria are neither beneficial, not pathogenic.

In SIBO, the production of hydrogen and methane gas in the small intestine leads to symptoms such as bloating, gas, pain/cramps, diarrhea, constipation, heartburn, nausea, and malabsorption, with anemia and steatorrhea. Symptoms of SIBO are not limited to gastric symptoms, and often have a systemic expression with symptoms such as joint pain, malaise/fatigue, low grade fever, headache and rosacea.

If you experience significant improvement in IBS symptoms after administration of antibiotics, or experience constipation and worsening of IBS symptoms upon increasing the amount of fiber in the diet, and experiences worsening of symptoms upon taking a probiotics, or and using proton pump inhibitor medications for heartburn.

These scenarios strongly suggest that SIBO may be a contributing factor in IBS symptoms.

Remember that SIBO can also be called “candida” or simply “IBS”

The candida diet designed to reduce the presence of commensal bacteria, and herbal formulas are effective in treating SIBO.

Lab tests can be done to determine the exact bacteria present, and the extent of commensal bacteria. You can purchase these tests at or your doctor can order the test for you. Some tests to detect SIBO are:

  • Basic Microbiology Stool Analysis
  • Comprehensive Stool Analysis
  • Intestinal Permeability
  • SIBO Breath Test

Traditional Chinese Medicine Herbal Remedies For SIBO

The most common TCM patterns which occur in SIBO are:

Spleen Qi Vacuity.

Stomach Heat.

Liver Depression Qi Stagnation.

Liver/Spleen disharmony with Depressive Heat.

Blood Vacuity and Stomach Yin Vacuity (In chronic cases of IBS where bleeding is a symptom and PPI medications have been used long term.)

It is possible to have a combination of patterns.

The following are the most common formulas to target these specific TCM patterns:

  • Spleen Qi Vacuity: Si Jun Zi TangShen Ling Bai Zhu San, Bu Zhong Yi Qi Tang
  • Stomach Heat: Qing Wei San, Xie Huang San
  • Liver Depression: Chai Hu Shu Gan San, Yue Ju Wan, Xiao Yao Wan
  • Liver/Spleen disharmony with Depressive Heat: modified Yue Ju wan, Jia Wei Xiao Yao Wan, modified Xiao Chai Hu Tang, modified Bu Zhong Yi Qi Tang.
  • Blood Vacuity: Dang Gui Bu Xue Tang, modified Si Wu Tang, Dang Gui Shao Yao San
  • Stomach Yin Vacuity: Liu Wei Di Huang Wan, Er Zhi Wan ( in this case gentle Yin tonics are used as the Spleen is often vacuous in IBS / SIBO and heavy cloying Yin tonics will likely cause loose stools.)

SIBO, patterns are complex and rotating 2-3 formulas as symptoms improve and change over course of treatment. Formulas target the root cause of SIBO, and therefore, a treatment plan may be complex and long term, it does more than just mask symptoms for a while.

If you are not compliant with taking herbal extracts, you can continue to treat with appropriate medications simultaneously, and still see significant symptomatic improvement if herbal supplements are taken occasionally.

Finding the right herbal supplement for SIBO without a TCM Dr consultation is difficult.

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