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Black arrow points at pseudomembranes
























Pseudomembranous Colitis, Bacterial Vaginosis, and Antibiotics
by Brian Benjamin Carter, MSci, LAc

Brian is the founder of the Pulse of Oriental Medicine. He teaches at the Pacific College of Oriental Medicine, maintains a private acupuncture and herbal practice in San Diego, California, and is the author of Powerful Body, Peaceful Mind: How to Heal Yourself with Foods, Herbs, and Acupressure.


I found your website and was very interested. Do you have any natural remedies for someone with pseudomembranous colitis (antibiotic associated colitis) who is suffering from BV (bacterial vaginosis). I get very ill when I take any of the antibiotics prescribed and currently have no way to treat it and I am very concerned that it is not going away.

Please let me know if you have any suggestions. Thank you so much.



Dear V,

This is a similar topic to our chronic diarrhea article (one of the most popular for some time). But it's different. We're dealing with a specific cause of stubborn diarrhea and also the vaginosis. Since antibiotics are problematic for you, we have to discuss alternative treatments.

First let's cover some of the basics...

Article Contents:

Pseudomembranous Colitis (PMC) - An Antibiotic Colitis

PMC is a serious inflammation of the bowel lining with the formation of pseudomembranous plaques. The plaques are a yellow-green mucinous inflammatory exudate (yeah, I know, that's gross) that sit in patches throughout the lining of the colon and sometimes the small intestine.

PMC is an antibiotic-associated colitis. That means it happens after antibiotics unbalance the natural flora of the intestine. 1% of patients on antibiotics develop this condition.

Clostridium (C.) difficile, a "bad" bacteria, is normally present in the bowel in small quantites. But when antibiotics destroy the "good" bacteria, C. difficile overgrows. Then it releases a powerful toxin that causes the symptoms of PMC...

Symptoms of Pseudomembranous Colitis

  • Watery or mucoid green foul-smelling diarrhea
  • Urge to defecate
  • Abdominal cramps and pain
  • Low-grade fever (although it can reach 103-105 F)

There may also be:

  • Tenderness in the left lower quadrant of the abdomen (5-19% of patients may have this tenderness without diarrhea. Stool studies and CT scan aid in diagnosis)
  • Bloody stool
  • Signs of sepsis

Sepsis is hard to identify, but some signs and symptoms of it are:

  • Malaise (ill feeling)
  • Fatigue
  • Fever
  • Rapid heart rate
  • Low blood pressure
  • Shock

I'm assuming your doctor already did a stool culture and got a positive result for the C. difficile toxin, and did a colonoscopy that showed the characteristic pseudomembranous plaques.

Conventional Treatment for PMC

Most commonly prescribed drugs are Metronidazole and Vancomycin. Some other treatment are used too. Here is a chart to compare them:

Treatment Administration Result Side Effects / Risks

125 mg every 6 hours for 7-14 days for adults

500 mg/1.73 m2 every 6 hours for infants

Most reliable one - 90-100% response in adult men May cause fever, lowered immune system, kidney damage, hearing loss, eye tearing.
Metronidazole (Flagyl) Dose of 250 mg 4 times per day for 7-10 days is recommended. Not recommended for children or for women during pregnancy Inexpensive and effective- 86-92% response from adult men Can cause manic episodes ("antibiomania"), and may severely injure the liver (rare or never)
Bacitracin 500-1000 mg 4 times per day for 7-19 days Symptomatic relief- Vancomycin better at clearing C difficile from stool Low blood pressure, chest tightness, pain, rash, itching, no appetite, nausea, vomiting, diarrhea, rectal itching, sweating
Teicoplanin 500-1000 mg 2 times per day for 7-19 days Longer half-life than Vancomycin; less frequent dosage required  
Cholestyramine 4 grams 4 times per day For mild cases or relapse - response varies and is generally low Constipation, heartburn, nausea, vomiting, stomach pain, headache, bloating, belching, diarrhea
Antidiarrheal agents (antiperstaltics) DON'T USE THEM May relieve symptoms but result in more damage to intestines by keeping the toxin inside  
Lactobacillus GG The most successful studies involve the use of Lactobacillus GG at a dose of 1 x 1010 viable organisms per day Restores the natural flora to suppress the C difficile Lactobacillus GG alone, or the combination of Bifidobacterium bifidum and Streptococcus thermophilus, is effective in the treatment of Clostridium difficile. Oral administration of probiotic compounds has been demonstrated to be well tolerated and safe.
nonpathogenic yeast, such as Saccharomyces boulardii   Effective in treatment of multiple relapses  
Steroids (corticosteroids)   Safe and effective for severe cases but not recommended Insomnia, nervousness, increased appetite, indigestion, excess body hair in women, diabetes, joint pain, cataracts, glaucoma
Diverting ileostomy or resection of diseased bowel (subtotal colectomy)
Was the standard before antibiotic therapy- is now a life-saving measure in perforated cecum or toxic megacolon  
Colostomy or ileostomy
Gets antibiotics in directly in patients with paralytic ileus  
Early subtotal colectomy
For fulminant toxic cases that don't respond after a week of intensive medical therapy because the risk of perforation increases after 7 days of ineffective medical therapy.  

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With diarrhea, there is always a danger of dehydration. Refer to the chronic diarrhea article.

The more serious complications of PMC are cecal perforation, toxic megacolon, hemorrhage, and sepsis. These can be life-threatening, so don't play around! Make sure you're under the care of a competent physician who can help you identify these before it's too late.

Alternatives to Antibiotic Treatment

I think the Lactobacillus GG is pretty exciting (it's in the chart above). There are a number of studies that confirm its effectiveness or at least say it's promising.

It basically replaces the friendly flora that the antibiotics destroyed. The GG form can survive the stomach acid and make it to your intestines. (Note: The acidophilus form has been shown to be destroyed by stomach acid so it never reaches the place you want it to!)

Lactobacillus GG:

  • Reduces the recurrence rate of Clostridium difficile
  • Patients feel better when taking Lactobacillus GG, as compared with the placebo, and
  • Their abdominal cramps and diarrhea go away pretty quickly.

I'll give you this link. It may not be the only company that offers GG, but I don't want you to accidentally buy a non-GG form of Lactobacillus. Check out No, I'm not making any money for referring you. Maybe I should!

Chinese Medicine Pseudomembranous Colitis Treatment

Now comes the fun part. What chinese herbal medicines can you take for PMC?

If you've read the diarrhea article, you may have noticed that the symptoms of PMC fit the chinese medical disease Li Ji.

The Chinese Medical Disease: Li Ji

Li Ji (you can remember it by the rhyming word "leaky" - as in leaky... well you know!) can be divided into 6 major types. It generally has the symptoms of:

  • Increased frequency of bowel movements
  • Tenesmus (straining to free the stool)
  • Abdominal Pain
  • Stool mixed with mucus, pus, and blood

However, the 6 types of Li Ji vary in their symptoms and signs. Here's a table for ya:

Type of
Li Ji
Unique Symptoms
Herbal Formula
Burning sensation in anus, dark scanty urine, fever, irritability, thirst
Shao Yao Tang
Epidemic toxin
Sudden onset, high fever, headache, thirst, irritability
Bai Tou Weng Tang
Yin vacuity
Elimination of fresh blood and thick mucus, burning pain in abdomen, loss of appetite, irritability, thirst
Zhu Che Wan
Sticky stools, more pus than blood, oppression in chest and fullness in epigastrum, aversion to cold, preference for warmth, loss of appetite, no thirst, heavy head and limbs
Wei Ling Tang
Liquid stool with pus, incontinence of stool, dull cold abdominal pain, loss of appetite, fatigue, feel cold, cold extremities, lower back ache
Zhen Ren Yang Zang Tang
Chronic intermittent
recurring, no impovement over extended period of time, tiredness, fatigue, lethargy, no appetite
Lian Li Tang

The first two "hot" patterns are probably well-treated by antibiotics. The third hot type may require a kind of yin supplementation that western medicine doesn't use.

As for the cold patterns... We generally think of antibiotics as being cold in nature, so they would do well against the hot type of Li Ji. However, the cold type might be worsened by a cold medicinal like an antibiotic. (If these ideas of cold and hot are confusing, read my article "Heat and Chilled Coffee")

The point is: Western medicine is not as able to deal with cold and/or deficient types of diarrhea. That means people with the last 4 types of Li Ji should see a Chinese Medicine practitioner.

How to Get a Chinese Herbal Formula for PMC

Get thee to a Chinese Medical Physician. That's basically the same as an acupuncturist. I call them that because many of them practice chinese herbal medicine too (acupuncture's just one modality- not the whole medicine), and in California (where we set the standards for the rest of the country) acupuncturists are physicians by law.

To find one near you, consult this resource. Call them up and make sure they prescribe personalized herbal formulas. Patents, tinctures, and pills might not do the trick in this case. Don't forget- you need to fix the PMC fast because the complications are grave, the end of the line is surgery, and chances of death are much higher if it gets bad enough to require surgery.

FYI, some of the typical herbs we put in the formulas to treat Li Ji are:

Type of
Li Ji
Herbal Formula
Major Herbs in Formula
Shao Yao Tang
  • Bai Shao Yao (White Peony root)
  • Huang Lian (coptis root)
  • Huang Qin (Scutellaria root)
Epidemic toxin
Bai Tou Weng Tang
  • Bai Tou Weng (Pulsatilla root)
  • Huang Bai (Phellodendron bark)
Yin vacuity
Zhu Che Wan
  • Huang Lian (Coptis root)
  • E Jiao (Donkey hide glue)
Wei Ling Tang
  • Cang Zhu (Atractylodes root)
  • Bai Zhu (Ovate Atractylodes root)
  • Fu Ling (Poria)
Zhen Ren Yang Zang Tang
  • Ren Shen (Ginseng)
  • Bai Zhu (Ovate Atractylodes root)
  • Bai Shao Yao (White Peony root)
Chronic intermittent
Lian Li Tang
  • Ren Shen (Ginseng)
  • Bai Zhu (Ovate Atracylodes root)
  • Huang Lian (Coptis root)

Kitchen Medicine

You may notice that one of the cold types includes ginseng. Good kitchen medicine (use of herbs in the kitchen) for the cold types of Li Ji might include fresh ginger tea, ginseng, or even garlic. These herbs are too hot for the hot types... those with hot Li Ji should avoid spicy and greasy foods.

Bacterial Vaginosis

Bacterial infections (bacterial vaginosis) usually cause a thin grayish discharge that has an unpleasant, fishy smell. This type of infection may be spread by sexual contact, but not in all cases. Treatment of this condition requires antibiotics from a doctor.


  • You may notice a discharge from your vagina.
  • The discharge may be clear or colored.
  • It may be very light or heavy.
  • It may have a fishy smell, especially after you have intercourse.
  • Some women have bacterial vaginosis without any symptoms.

Is Sexually Transmitted?

It's not something you catch from someone else- it's an overgrowth of normal vaginal bacteria. While it's more common in women who are sexually active, it also occurs in women who are not sexually active. It's not usually necessary for your sex partner to be treated.


If the infection isn't treated, the bacteria may get up into the uterus or the fallopian tubes and cause more serious infections. Treating bacterial vaginosis lowers this risk. Treatment is especially important in pregnant women.

Conventional Treatments

Cure rate
Metronidazole (Flagyl) 500 mg twice daily for seven days or 2 g in a single dose

From 84 to 96 percent cure rate

Higher rate of recurrence with single dose

Clindamycin 300 mg twice daily for seven days
94 percent
Clindamycin 2% vaginal cream 5 g at bedtime for seven days
86 percent (estimated)
Metronidazole vaginal gel 5 g twice daily or at bedtime for five days
75 percent

Alternative Treatments for Bacterial Vaginosis
(to be take with a figurative "Grain of Salt")

I found a number of other alternative treatments online- I must say that I don't know how much they've been studied- someone out there may have some info I don't... in which case I ask you to email me about it.

First, some recommend to AVOID:

  • alcohol
  • coffee
  • fast foods
  • processed foods
  • refined flour products (bread, pasta, etc.)
  • saturated fats from animal products
  • sugar

However, a lot of people suggest avoiding those things at all time for all conditions! Generally, unhealthy foods are harder on the digestion system- maybe that's the point.

Here's a list of the things people suggest you SHOULD TAKE:

  • flax seed (Linseed) meal and oil
  • fresh vegetables and fruits
  • grains
  • meats, including fish, poultry
  • plenty of fresh water
  • Vitamin C (1,000 mg three times daily with meals)
  • Zinc (30 mg daily)
  • Bromelain (400mg)
  • Wobenzme N (5 tablets three times a day away from meals)
  • Goldenseal (Hydrastis canadensis) vaginal suppositories
  • Goldenseal/Vitamin A vaginal suppository twice daily
  • Warm sitz baths with tea tree oil (Melaleuca alternifolia)
  • Vaginal douching using:
    · Goldenseal (Hydrastis canadensis)
    · Oregon Grape Root (Mahonia aqjuifolium)

Chinese Medicine for Bacterial Vaginosis

Broken record- see a Chinese Medicine practitioner. There are herbs that could be used as a douche, and there are internal herbal approaches too. Probably the best approach would be to do both... or to use an internal herbal formula for the PMC and an external one for the vaginosis.

Find a practitioner here.

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