Treating SIBO with TCM

Photo Cred: Freepik

By Melissa Carr, BSc, DrTCM

Small Intestine Bacterial Overgrowth (SIBO) is gaining ground as a diagnosis in integrative and functional medicine. While it is a newly identified pattern, many have long been treating it as irritable bowel syndrome (IBS) or candida overgrowth.

One of my physician colleagues asked me recently about how Traditional Chinese Medicine (TCM) treats SIBO. My brief answer, the same way we treat everything else—personalized treatment based on a TCM assessment and diagnosis.

However, there are some more common TCM patterns associated with SIBO that can form a basis from whence customization for each patient can be made.

The small intestines are supposed to be relatively free of bacteria, but when the bacteria of the large intestines migrate to the small intestines and discover an abundance of food, their rapid growth causes a host of problems, including bloating, gas, abdominal pain, diarrhea, constipation, acid reflux, and malabsorption.

While still a controversial topic, the theory is that when SIBO is left untreated, it results in gastritis which leads to damage of the intestinal wall lining. This in turn causes leaky gut syndrome, allowing for larger food particles to enter the blood stream and trigger food sensitivities and autoimmune disorders.

Common treatment protocols for SIBO include the prescribing of antibiotics or herbal antimicrobials to eradicate the bacteria growing in the small intestines. Specific dietary restrictions and diets are given, such as fermentable oligo-, di-, mono-saccharides and polyols (FODMAP), ketogenic, or other low carbohydrate diet to starve the bacteria of their preferred food source. One concern with these diets is that, while it may help decrease bacterial growth in the small intestines, it also leads to less food for the good bacteria in the large intestines. What is commonly seen, even after extensive SIBO treatment, is a recurrence of a positive SIBO test result and a return of symptoms.

In TCM, the goal is to find the root cause so that SIBO cannot keep recurring. In the case of SIBO, the question is what patterns of imbalance allowed for the bacterial overgrowth and what can be done to change those patterns.

When patients present with symptoms of abdominal pain, bloating, diarrhea, constipation, gas, and belching, a TCM practitioner may see signs of Damp-Heat infection and include antimicrobial Chinese herbs like huang lian, huang bai, huang qin, or long dan cao to a base formula. However, TCM practitioners note that, like antibiotics, these herbs are quite cool in nature and can cause digestive stress and even an aggravation of symptoms.

For this reason, it’s important that the practitioner not only work to eradicate the SIBO, but also support and strengthen the digestive system. While a full TCM diagnosis should be completed for each patient in recognition that every person is unique and often presents with a combination of TCM diagnostic patterns, I offer here a starting point of how a TCM practitioner might assess a patient presenting with SIBO when the following two patterns present as root cause.

Spleen Qi Deficiency

Spleen Qi deficiency is one of the most common TCM differential diagnoses for digestive disturbances. While it is usually found in combination with other patterns, it tends to lead to an accumulation of Dampness symptoms, and it presents with symptoms of:

• Bloating
• Soft stools or diarrhea
• Gas
• Fatigue
• Foggy headedness
• Poor appetite and/or sugar cravings

Someone with Spleen Qi deficiency may also bruise easily, have organ prolapse, and tend to worry a lot. Si Jun Zi Tang (Four Gentlemen Decoction), Xiang Sha Liu Jun Zi Tang (Six Gentlemen Decoction with Auklandia and Amomum), Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), or Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) are all possible Chinese herbal formulas that can form a foundation to treat this condition.

While a SIBO diet usually greatly restricts carbohydrates, TCM dietary recommendations for Spleen Qi deficiency often encourage the consumption of complex carbohydrate foods, including the allowance of moderate amounts of fresh fruit, grains, and starchy vegetables like sweet potatoes. Overly sweet, sugary, processed, greasy, and fried foods should be avoided, while easily digested soups, stews, and slow cooked meals are suggested.

Liver Qi Stagnation Attacking Spleen

This is a common pattern in today’s Western world. High stress, expectations, and need for control often lead to Liver Qi stagnation. Irregular eating and sleeping habits, use of the birth control pill and other sex hormones, and the taking of medication or intoxicants also contribute to this pattern. Because all the systems are interrelated, when one system is out of balance, it tends to affect the others. In the case of Liver Qi stagnation, a common pattern is that it “attacks” and weakens the Spleen and/or Stomach.

Liver Qi stagnation attacking the Spleen is one of the common TCM diagnoses for IBS, so it stands to reason that it can also be seen with SIBO cases. Common symptoms include the Spleen Qi deficiency signs above, combined with the following:

• Irregular and/or painful menstruation
• Premenstrual syndrome (PMS)
• Hypochondriac (side torso/rib) pain
• Irritability
• Depression
• Abdominal pain or cramping

Xiao Yao San (Free and Easy Wanderer), Shu Gan Tang (Dredge the Liver Decoction), and Tong Xie Yao Feng (Important Formula for Painful Diarrhea) are some formulas that may be used for this pattern.

Because the Spleen Qi is still weak, the same food recommendations may be used here as for Spleen Qi deficiency. In addition, a patient should eliminate intoxicants. Cooked dark leafy greens, cruciferous vegetables, beets, turmeric, and artichoke are examples of foods that may be helpful.

A Complex Condition

Treating SIBO is not as simple as assessing which of the above two TCM patterns of imbalance the patient suffers with. There are many other patterns that may also present, especially if the condition is long standing or other illnesses are concomitant. A practitioner will need to change up herbal formulas as the bacteria adapt, symptoms change, and the patient improves.

Calming the nervous system with acupuncture, Chinese herbs, supplements, lifestyle modifications, meditation, and breathing exercises is also key to a long-term recovery.

Editor’s note: Photo courtesy of Freepik