Photo:  Daoist figures and a tiger 13th-14th century, Metropolitan Museum of Art
 
Today marks the beginning of the Year of the Yang Water Tiger.  A year that is sure to be dynamic and hopeful.  The Tiger in Chinese culture represents strength, agility and bravery.  Add that to the powerful Yang, Water element and it conjures the image of a Tiger frolicking at the base of a waterfall.  This is certainly a more bold image than that of the Yin Metal Ox plowing the fields from this past year. 
 
As we enter our third year of the pandemic, the energy of the Tiger represents a resilience that we can all draw upon.  While life seems better for many of us than a year ago, the fact that there is still so much uncertainty means we all need a little Tiger strength and bravery in our lives this year. 
 
The Water element is associated with wisdom, stamina and endurance.  Water covers 75% of the earth and makes up 60% of our body. It flows effortlessly and takes the exact form of whatever contains it.  It is mutable and can become solid as ice or manifest as vapor.  It will break down even the hardest rock over time and find the path of least resistance to move around any obstacle.  Use the Water element to help you go with the flow this year. 
 
Yang is associated with heat, sun, summer, daytime and objects in motion.  This adds a dynamic aspect when combined with the energy of the Tiger and Water. 
 
Wishing you all a year full of hope and positivity as our lives move into our new normal in the Year of the Yang Water Tiger. 

February 12th rings in the Year of The Yin Metal Ox in the Chinese Lunar calendar. I think everyone can agree we are all ready to move on from the scattered, chaotic energy from this past Rat year. Whether you place much stock in Chinese astrology, if there was ever a time to look outside forces for hope or explanations, that time is right now. And, there are a few key things about the Ox year that I think can be relevant to everyone.
 
First of all, think about what an ox is, a large animal that was traditionally used to plow fields. The ox is strong, dependable and not prone to excitement or distraction. When I think about that energy as it applies to this year, I visualize putting my head down and plowing through in a steady, focused and forceful way. This is a year to humbly build back and build on what you have.
 
The second thing I’ve been thinking about has to do with the Metal element attached to this Ox year. In Chinese Medicine, Metal is associated with the lungs and its corresponding emotion is grief. As we emerge from the collective PTSD of the pandemic an important part of healing will be allowing ourselves to grieve. I feel like most people are caught in between grief and needing to hold themselves together with the continued onslaught of trauma. With more people getting vaccinated and as infections decrease it will be important to grieve all that has been lost in this past year.
 
The third thing to keep in mind is that this is a Yin year, meaning we will feel the full weight of our responsibilities and will need to work extra hard to accomplish our goals. It is a time to focus inward on the things that are most important in your life.
 
Looking forward, keep in mind is that next year will be the Year of the Yang Water Tiger that is certain to arrive with a powerful roar. 

Photo:  Water Buffalo 18th century China.  Metropolitan Museum of Art

Truth be told, I've never been a runner.  I've always thought it was boring and painful and not something I was particularly good at.  For most of my adult life I've preferred yoga as my favorite form of exercise.  In yoga I found an exercise that built strength through resistance, helped me develop a solid core, balanced strength with flexibility and most importantly yoga taught me how to calm my mind through meditation. 

When the pandemic hit New York last March it upended not just my exercise routine, but really everything.  With uncontrolled community spread here, rising cases, hospitalizations and deaths, it was a dark and scary time.   Stuck in the apartment with my family I found that just practicing yoga wasn't working for me.  I was nervous, on edge and my mind couldn't settle.  

In Chinese Medicine we call this Qi stagnation.  It happens when our internal energy gets stuck because things are out of our control and when there is a lot of uncertainty.  I commonly see this in patients when they are stressed about something and it can easily happen in the course of normal life.  Covid made my Qi stagnate like nothing I've ever experienced before. 

Given that we were only allowed to go outside for necessities and to exercise I decided to start running.  It was still boring and painful, but I found that on the days I ran my mind was more settled, my Qi less stagnated.  It allowed me to do my yoga practice later the day and more fully get the benefits out of it.  Running also allowed me to spend time outside, where even through my mask, I was getting valuable fresh air for 30 minutes a day. 

As spring wore on and cases come under control in May and then really plummeted in June, much to my surprise I continued to run.  Surrounded by social unrest and political turmoil there were still plenty of things going on to keep me on edge and running had now become a powerful mental health tool in my toolbox.  Surprisingly, I also discovered that it was becoming more meditative and instead of being boring it became an activity I started looking forward too. 

Reduced stress and anxiety were not the only benefits I've gotten from running.  Better flowing Qi lead to better sleep, better mood and fewer menopausal symptoms. 

Now I can firmly say that I am a runner.  I'm still not particularly good at it, but I am stronger and can run farther and faster than last spring.  My intention is to continue to run through the rest of Covid and beyond. 

Enhance your sleep cycles and calm anxiety with topical magnesium!!

In the past seven months, since Covid 19's arrival in New York City, our patients have consistently shared with us their issues with anxiety and sleep.  While cases here have been down for the past few months, despite things gradually opening up, there is still much to be anxious about.  With many people returning from places they escaped to in the summer, schools starting, colder weather returning and a few covid hot spots, NYers are concerned about a second wave.  Additionally, with cases still surging in many parts of the country as well as the globe there is also worry that visitors may bring the virus with them.  Ongoing stress over social justice issues also contributes to our patients telling us they are still not getting the best night's sleep. 

In this article, we'll discuss the bodies stress response, why people are feeling anxious and how this impacts sleep patterns.  More importantly, we'll also discuss strategies to help manage these issues through acupuncture, diet, exercise, sleep hygiene and supplements, plus introduce our New She Mind Body product, Calm Mag+ Oil.  https://www.shemindbody.com/

During times of high stress the body responds by releasing cortisol into the blood stream.  Cortisol is often referred to tas the "stress hormone."  You may have also heard of the stress response called the "fight or flight" response, which has helped humans respond to dangerous situations for thousands of years.  A small amount of cortisol helps regulate blood pressure and blood sugar and keeps us alert.  The problem occurs when we are in a chronic state of stress and our body never calms down from this heightened state.  Too much cortisol contributes to increased blood sugar levels and can lead to weight gain, digestive issues, heart disease, a suppressed immune system and poor sleep. 

Normally cortisol has a regulatory effect on the sleep/wake cycle.  In the early morning cortisol levels start to rise and peak around 9 am.  This brings heightened alertness to begin our days.  Similarly in the evening, cortisol levels drop and hit their low around midnight, thus promoting sleep.  When cortisol levels remain high all day due to stress the result leaves us with a feeling of anxiety and fitful sleep patterns. 

There are several healthy ways to combat stress and high cortisol levels.  Daily exercise and meditation are proven methods to reduce stress.  Reducing sugar and alcohol in the diet will also help.  Other techniques include; getting into the practice of going to bed at the same time each evening, turning off your electronic devices by 8 pm and avoiding highly stimulating news late in the day.  Regular acupuncture treatments calm the nervous system and helps regulate cortisol levels. 

The stress generated by Covid and social justice issues was the inspiration for our new She Mind Body product, Calm Mg+Oil, designed to help our patients manage their stress and anxiety during these difficult times.  Magnesium is a necessary mineral for health and wellness, and because it can be difficult to consume adequate levels through diet we have developed a transdermal application that offers you a secondary application to internal supplements and diet. 

Our innovative blend of magnesium chloride, St. John's wort, aloe, arnica extract and lavender helps to boost magnesium levels while offering a calming effect to sore muscles and stressed out nervous systems.  It is best used each night before bed, massaged into sore muscles, chest and wherever your body feels tense.  On sale now at https://www.shemindbody.com/ 

References: 
"Beware High Levels of Cortisol, the Stress Hormone,"  Feb. 5th, 2017, Premier Health, Retrieved from: https://www.premierhealth.com/your-health/articles/women-wisdom-wellness-/beware-high-levels-of-cortisol-the-stress-hormone

Breus, M., April 10, 2020, "The Effects of Cortisol on your Sleep,"  Psychology Today, Retrieved from:  https://www.psychologytoday.com/us/blog/sleep-newzzz/202004/the-effects-cortisol-your-sleep

As the parent of a high school senior who is applying to college during COVID, I realize the unique stressors this group is under making what is normally a difficult process even more challenging. 

The parent class representatives from my daughter's school recently asked for tips on how to support your daughter.  As I wrote these down it occurred to me that the advice might be beneficial to parents outside of our school as well. 

1.  Be available to talk when she want too, but don't bring up stressful subjects on your own. 

2.  If you have an argument about college, ask your daughter to inquire about the subject with the school college counselor who should be a neutral source of information. 

3.  Provide a protein based breakfast every day.  This helps keep blood sugar levels stable throughout the day and helps keep her mood steady.   

4.  Have healthy snacks on hand for when she needs one (apples with peanut butter or yogurt with nuts are my favorites), to help her avoid eating junk which can also negatively impact mood. 

5.  Avoid too much reliance on stimulants like caffeine and sugar as those tend to exacerbate stress. 

6.  Encourage her to exercise daily.  Evercise of any kind is a great hormone regulator and again helps maintain a steady mood. 

7.  If your daughter is open to it, daily meditation is a wonderful lifelong tool to have.  Both Calm and Headspace are great apps to try for beginners. 

8.  Acupuncture can help boost them up when they are exhausted or calm them down when they are stressed. 

9.  Magnesium is the original anti-anxiety aid.  This can be taken before bed to help with sleep or they can take and epsom salt soak or use magnesium oil on the neck and shoulders that may be stiff and fatigued from too much zoom time. 

10.  Encourage your daughter to spend some time with friends.  It is easy right now to take a masked/socially distanced walk in the park or eat outside.

What to eat if you have SIBO? 
 
The question of what to eat if you are battling SIBO is something I get asked frequently.  There is no easy answer and it varies by individual.  However, there are a few places to start that can help you on your journey to healing. 
 
If you suspect you have SIBO or are newly diagnosed, the easiest diet to begin with is the Low FODMAP.  The Low FODMAP diet was developed by researchers at Monash University in Australia in 2005.  What they discovered was that there were short-chain carbohydrates found in food that are either poorly absorbed in the small intestine or impossible to digest. They called these carbohydrates FODMAPs, an acronym which stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. The researchers discovered that because FODMAPs are relatively small, they attract water into the small intestine. When they reach the large intestine, they are fermented by resident gut bacteria, producing gas. The additional gas and water inside the gut stretches the bowel wall, triggering IBS symptoms such as abdominal pain, gas and bloating, distension, constipation and diarrhea.  In the case of someone with SIBO they have an overgrowth of bacteria in the small intestine.  When high FODMAP foods begin fermenting there it causes hydrogen gasses to be produced causing bloating, gas, and diarrhea or methane gasses that cause burping, reflux and severe constipation.  Eliminating high FODMAP foods will slow down feeding the bacterial overgrowth and can help manage SIBO symptoms. (Monash 2020)
 
 
A second diet that often helps SIBO patients is the Specific Carbohydrate Diet or SCD.  This diet was developed in the 1924 by Dr. Sidney Haas to treat children with celiac disease.  His work was furthered by Elaine Gottschall who recommended it for patients with Inflammatory Bowel Diseases or IBD.  A more recently study at Seattle Children’s Hospital successfully used this diet to place over 80% of their pediatric IBD patients in the study into remission.  This diet is more restrictive than Low FODMAP as in eliminates all forms of grains, but for people with inflammatory and autoimmune conditions not eating grains is important as they are a large source of inflammation. (Nimbal 2020) (Seattle Children’s Hospital 2020)
 
Similar to the SCD is the SIBO Specific Diet.  This was developed by Naturopath Allison Siebecker.  It is also a grain free diet, but gives very specific information about the amounts of foods to eat.   (Siebecker 2014)
 
As offshoot of this diet is the SIBO Bi-Phasic diet that introduces different foods in stages.  (Jacobi 2014)
 
Importantly, with any of these diets is that they will not cure SIBO, but help you manage your symptoms while you go through treatment.  The goal is that you should not have to follow them forever, but in time determine the foods are you are most sensitive too.  Ideally, you should be working with a medical professional to help guide you through treatment and dietary options.
 
References:
High and low FODMAP foods. (n.d.). Retrieved from https://www.monashfodmap.com/about-fodmap-and-ibs/high-and-low-fodmap-foods/
 
 
What is SCD. (n.d.). Retrieved from https://www.nimbal.org/education/the-specific-carbohydrate-diet-/definition-and-history
 
Dietary Therapy for IBD. (n.d.). Retrieved from https://www.seattlechildrens.org/about/stories/dietary-therapy-for-ibd/
 
Siebecker, Allison, Sibo Specific Diet, Retrieved from https://www.siboinfo.com/uploads/5/4/8/4/5484269/sibo_specific_diet_food_guide_sept_2014.pdf
 
Jacobi, Nirala, B-Phasic Diet Protocol, Retrieved from
https://www.siboinfo.com/uploads/5/4/8/4/5484269/bi-phasicdietprotocol_300318.pdf

A common question I get in my practice is, “Should I be taking a probiotic if I have SIBO?”  My reply is always, “NO, do not take probiotics if you have SIBO.”  One of the most important things to remember about SIBO is that it isn’t bad bacteria, it’s bacteria that is in the wrong location.   SIBO will not be cured by taking a probiotic, in fact recent studies indicate probiotics make SIBO symptoms worse.  (Rao S. et al 2018).  Let's take a look at why? 

How bacteria arrived in the small intestine, which is meant to be relatively bacteria free, could be from many causes. The underlying causes thought to contribute to SIBO are; H. Pylori or other parasitic infections, hypochlorhydria, food poisoning, autoimmune diseases that impair digestive transit time, plus some medications such as antibiotics, proton pump inhibitors, SSRI’s, opiods and NSAID’s in addition to poor diet.  Unless the underlying cause of SIBO is addressed, the overgrowth is likely to return.  (Pimental M. 2011) Therefore, some of the best studies that shed light on SIBO have come from studying underlying/related conditions.  For example, H. Pylori infections can cause hypochlorhydria where the lack of stomach acid secretions leads to bacterial overgrowth and can long term lead to gastric cancer.  (Sheh A., Fox J. 2013) Studies indicate that patients with Rhumatoid Arthritis, (Henriksson A. et al 1993), Hashimoto’s Thyroiditis (Patil A. 2014) and both Type 1 and 2 Diabetes (Brunello S. et al 2013) (Bhadada S. et al 2011) all are at increased risk of developing SIBO.  These studies all indicate a decrease in orocecal transit time.  In other cases, medications slow the digestive transit by reducing stomach acid secretions. 
 
The common thread in most underlying causes of SIBO is that food is moving too slowly through the digestive tract and has extra time to ferment and for bacteria to overgrow while in the small intestine. Oral probiotics add fuel to the bacterial overgrowth and can exacerbate SIBO symptoms.  A recent study confirmed the link between taking probiotics for SIBO and an increase of bloating, gas and brain fog symptoms.  (Rao S. et al 2018) What I recommend to my patients instead is after successful treatment of SIBO, deliver probiotics to the large intestine via an enema therefore bypassing the small intestine and eliminating the opportunity for overgrowth to occur.  This places the probiotic where it can be most effective without risking a relapse of SIBO.


References  
 
Bhansali A, Bhadada S, Rana S, Sharma S, Kaur J, Singh K. (2011) Orocecal transit time and small intestinal bacterial overgrowth in type 2 diabetes patients from North India.  Diabestes Technology and Therapeutics. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/21770765
 
Blomquist L, Henriksson A, Nord C, Midtvedt T, Uribe A, (1993), Small intestinal bacterial overgrowth in patients with rheumatoid arthritis, Annals of the Rheumatic Diseases.. Retrieved from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1005088/
Fox J, Sheh A (2013) The role of the gastrointestinal microbiome in Helicobacter pylori pathogenesis.  Gut Microbes.  Retrieved from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928162/
 
Lauritano EC, Bilotta AL, Gabrielli M, Scarpellini E, Lupascu A, Laginestra A, et al.
Association between hypothyroidism and small intestinal bacterial overgrowth. J Clin Endocrinol Metab. 2007;92:4180–4. [PubMed]
 
Pimental, M. (June, 2012), Methanogens in Human Health and Disease, from The Journal of
Gastroenterology.  Retrieved from: http://www.nature.com/ajgsup/journal/v1/n1/full/ajgsup20126a.html
 
Pimental, M. (2011), A New IBS Solution, Bacteria the Missing Link in Treating Irritable Bowel Syndrome. Health Point Press, California

Rao C., Rehman A, Yu S., Martinez de Andino N., Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis., Clincal and Translational Gastroenterology, volume 9, Article number 162 (2018).  Retrieved from: 
https://www.nature.com/articles/s41424-018-0030-7?_ke=eyJrbF9lbWFpbCI6ICJia2hvb3BlckBhb2wuY29tIiwgImtsX2NvbXBhbnlfaWQiOiAibXk3NXk2In0%3D
 
Zekry OA, Abd E., 2013 Dec. The association between Helicobacter pylori infection, type 1
diabetes mellitus, and autoimmune thyroiditis.  J Egypt Public Health Associates, Retrieved From: https://www.ncbi.nlm.nih.gov/pubmed/24374947

Fall is a terrific time to warm up with soups and stews.  Not only are the nourishing, but they taste great and are easy on your digestive system.  Many of my patients have been asking me for recipes, so I am posting a few of my favorites.  Enjoy!!

Bone Broth Chicken Stock
 
Chicken - You can use a whole chicken uncooked or the bones from a roasted chicken that you’ve already eaten.  (Sometimes I use thighs or breasts if I am making a soup where I want to use the chicken as an ingredient.)
1 large onion
4-6 stalks celery  
4 large or 6 medium carrots
1 large potato (optional)
1 can of diced tomatoes (optional)
You can also add any root vegetable to your stock. 
 
Place items in a large pot and fill with water.  Cook covered on low heat for 3-4 hours or overnight in a slow cooker. 
 
 
Yellow Pepper Soup
 
4 cups chicken broth
2 large yellow (or orange) peppers
1 large potato, peeled
1 cup carrots
3 leeks
1 medium onion
Dash of cayenne pepper  
Chop all vegetables and add to broth.
Boil for 30 minutes and purée.
Can be served hot or cold. 
 
 
Tortilla Soup
 
6 cups chicken broth
Shredded chicken meat left over from making broth (from 4 thighs)
1 cup black beans
½ cup corn
½ cup salsa (tomato, onion, cilantro, jalapeño, salt, pepper, amounts all to taste)
Cook on medium heat for 30 min. 
Garnish with avocado and crushed tortilla chips

One of my favorite sayings in Chinese medicine is, “Wind is the carrier of 1000 diseases.”  I love the imagery it conjures and the elemental nature of the phrase.  When I say this to my patients we end up having a conversation about what it means. 

Now that the weather has changed and it is getting colder and windy, cold and flu season is upon us.  In Chinese medicine that means that we take steps to avoid becoming sick by minimizing our exposure to wind.  That means hats and scarves and being dressed properly when we go outside.  At home it means eating warm nourishing foods like soups, congee or stews while sipping ginger tea.  It also means paying attention to nature and going to bed earlier with the darkness that comes with the time change. 

For people battling seasonal colds, it is a great time to check in with your Chinese medicine practitioner for treatment and some immune boosting herbs.  In 2015 there was a study done at Yale University that showed that when core body temperature inside the nose falls by five degrees the immune system does not work as well to fight the cold virus.   This supports the idea that we need to take extra care of ourselves during the colder months. 

ABSTRACT
Small Intestine Bacterial Overgrowth or (SIBO) is a relatively newly diagnosed disorder that falls as a subset of Irritable Bowel Syndrome (IBS).  SIBO is very controversial amongst Western medical practitioners as there are not many RCT to support diagnosis and treatment of the disorder.  Plus, the current treatments are more short term in nature as SIBO has a high rate of reoccurrence.  Naturopaths are doing a lot of research on SIBO and working to understand and treat the root causes of it. Chinese Medicine can offer balanced treatments to patients by using a combination of herbs, acupuncture, qi gong and dietary therapy designed to clear the dampness and heat of the bacterial overgrowth while supporting the SP/ST and restoring balance to whole system for long lasting results. 
Keywords:. SIBO, IBS, Diarrhea, Constipation
 
BACKGROUND
SIBO occurs when commensal bacteria from the large intestine migrates to the small intestine.  While the large intestine is colonated with many bacteria, the small intestine is meant to be relatively bacteria free.  When bacteria finds its way into the small intestine, where there is an endless source of food, it can rapidly overgrow causing many unpleasant symptoms.  For many people that overgrowth produces hydrogen gasses, disrupts digestion, impairs nutrient absorption and causes abdominal pain, diarrhea and exhaustion.  For others, the overgrowth produces both hydrogen and methane gases.  This also disrupts digestion, impairs nutrient absorption and causes abdominal pain, but it also causes severe constipation, acid reflux and burping.  In both cases SIBO will cause gastritis, damaging the lining of the small intestine.  This damaged lining or leaky gut allows larger molecules of food to enter the bloodstream and can trigger food sensitivities and possibly even trigger autoimmune diseases.  (Pimental M. 2011) (Pimental M. 2012)
 
WESTERN MEDICINE
The term SIBO was coined by Dr. Mark Pimental of Cedars Sinai Hospital in Los Angeles in 2004.  Dr. Pimental is a gastroenterologist who noticed in many of his IBS patients that their symptoms improved after taking antibiotics for other conditions.  He confirmed the presence of too much bacteria in the small intestine via small intestine biopsy.  Diagnosis now is typically made by a non-invasive lactulose breath test.  The test measures the amount of hydrogen and methane in a person’s breath over a period of several hours after drinking a mixture of lactulose. As humans do not produce hydrogen and methane gases on their own if there are measureable amounts in their breath it is indicative of SIBO.  (Pimental M. 2012)
 
Western medicine treats SIBO with antibiotics that primarily work in the gut and don’t circulate much outside of that system.  Diarrhea type SIBO is typically treated with a 10-14 day course of Rifaximin (Xifaxin).  This medication treats traveler’s diarrhea, but was approved by the FDA to treat diarrhea predominant IBS in May, 2015.  (Fischer, A. 2015)  Constipation type SIBO is typically treated with both Rifiximin in addition to a second antibiotic, either Metronidazole (Flagyl) or Neomycin for 10-14 days.  If the patient fails the SIBO breath test after taking the above medications, they are repeated.  SIBO has a high rate of reoccurrence after 9-12 months where the patient will be given the antibiotics again each time the SIBO returns.  Dietary recommendations and lifestyle changes are not typically part of the Western medical treatment for SIBO.  The high reoccurrence rate of SIBO is because SIBO is not an end diagnosis, it is the symptom of an underlying condition.  The underlying causes thought to contribute to SIBO are; H. Pylori or other parasitic infections, hypochlorhydria, food poisoning, autoimmune diseases that impair digestive transit time such as Hashimotos Thyroiditis or Diabetes Mellitus, plus antibiotic, proton pump inhibitor and NSAID overuse.  Unless the underlying cause of SIBO is addressed, the overgrowth is likely to return.  (Pimental M. 2011)
 
CHINESE MEDICINE
In Chinese medicine we can look at SIBO as damp heat stagnation in the Lower Jiao.  However, that diagnosis does not include the reasons for the underlying cause of SIBO.  The differential diagnosis for the underlying conditions can be broken down into the excess patters of LV Qi Stagnation, LV overacting on SP/ST and deficiency patterns of SP Qi, SP Yang and Wei Qi deficiency. 
 
The first step in treating SIBO with Chinese medicine is to clear the SIBO from the small intestine before beginning tonification.  For diarrhea type SIBO, this can be done by having the patient take Huang Lian Su (Berberine) for 2-3 weeks.  During this treatment time it is also important to have the patient adhere to a lower carbohydrate, anti-inflammatory diet, such as the Specific Carbohydrate Diet (SDC).  (Gottschall E. 1994) Of primary importance is the elimination of common food triggers like gluten/other grains, dairy, soy, eggs and starchy vegetables.  The idea is to eliminate foods that get digested in the ileum portion of the small intestine where the highest concentration of SIBO exists.  This helps to eliminate their endless supply of food and allows the damaged area of the intestines to heal.  Other dietary considerations should include having the patient spread out their meals by 3-4 hours with no snacking so the stomach completely empties allowing for smooth flow of digestion, plus having them drink fresh Sheng Jiang, (ginger) tea, a natural pro-kinetic also encourages that flow.  Ginger also helps breakdown the biofilm that builds up around bacteria that prevents antibiotics from destroying it.
 
The less common constipation type SIBO can be treated with medical grade Allicin from Da Suan, (garlic) for 2-3 weeks before taking the Huang Lian Su.  According to the Huang Di Nei Jing (Yellow Emperor’s Inner Classic), garlic is "warming in nature and has an affinity toward the Stomach and Spleen, Heart and Small Intestine, and the Lungs and Large Intestine."  (Unschuld P, 2011).  The Chinese Materia Medica categorizes Da Suan (garlic) as an anti-parasitic.  In cases of constipation type SIBO garlic will help eliminate the archea or methane producing organisms in the gut.  Once the archea are eliminated, the patient can move on to Huang Lian Su to treat the hydrogen producing bacteria and heal the lining of the small intestine.  (Pimental, M. 2012)
 
Having SIBO can be very stressful and developing a mindfulness meditation practices, either through qi gong or a gentle yoga class can help a patient manage that stress.  Acupuncture is also supportive and helpful to clearing SIBO and calming the patient’s nervous system.  Points to consider, adjusting for presentation include: Hegu LI-4, Wai Guan SJ5, Qu Quan LV8, Yin Ling Quan SP9, Da Ling PC-6, Tong Li HT5, Lei Que LU7, Zu San Li ST-36, Yang Ling Quan GB34, Daju ST27 and Dadu SP3 along with Ear Shen Men and Sympathetic. 
 
After the 4-6 weeks of treatment listed above to clear the SIBO, if the patient is feeling significantly better and their digestive symptoms have resolved, turn your attention towards bringing the patient’s health back into balance.  Some herbal formulas to consider include:
LV Qi Stagnation – Chai Hu Shu Gan Wan, Bupleurum Powder to Spread the Liver
LV overacting on SP/ST – Shu Gan Wan, Dredge the Liver Decoction
ST Qi Stagnation – Xiang Xia Yang Wei Wan, Nourish the Stomach Decoction with Aucklandia and Amomum
 
SP Qi Deficiency – Xiang Sha Liu Jun Zi Tang Six Gentlemen Decoction with Aucklandia and Amomum OR Zi Sheng Wan Nourish Life Pill
 
SP Yang Deficiency – Fu Zi Li Zhong Tan, Prepared Aconite Pill to Regulate the Middle
Wei Qi Deficiceny – Yu Ping Feng San, Jade Windscreen Powder
 
Many of these formulas help increase natural HCL production and all of them are good at healing the small intestine lining. 
 
Patients should continue to monitor their diets, reduce stress and aim towards a healthy lifestyle that includes a mindfulness meditation practice for the best long term recovery from SIBO and its underlying causes. 
 
BIOGRAPHY
Beth Hooper, DACM has been in private practice in New York City since 2003 where she specializes in gastrointestinal disorders and women’s health.  www.bethhooperhealth.com.

REFERENCES
Fischer A., (May 27, 2015), FDA approves two therapies to treat IBS-D, US Food and Drug Administration, Retrieved from: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm448328.htm

Gottschall E., (1994), Breaking the Vicious Cycle, Intestinal Health Through Diet, The Kirkton Press
 
O’Brien P., Garlic in Traditional Chinese Medicine, Spezzitino.com, Retrieved from: http://www.meridian-acupuncture-clinic.com/support-files/garlic-in-tcm.pdf
 
Pimental, M. (June, 2012), Methanogens in Human Health and Disease, from The Journal of
Gastroenterology.  Retrieved from: http://www.nature.com/ajgsup/journal/v1/n1/full/ajgsup20126a.html
 
Pimental, M. (2011), A New IBS Solution, Bacteria the Missing Link in Treating Irritable Bowel Syndrome. Health Point Press, California

Unschuld P, Tessenow H, (2011), Huang Di Nei Jing Su Wen: An Annotated Translation of Yellow Emperor’s Inner Classic – Basic Questions, University of California Press