Abstract: Auto-brewery syndrome (ABS) is a rare and easily overlooked disease. Overgrowth of certain high-alcohol-producing fungi and bacteria in the intestine leads to the production of endogenous ethanol that exceeds the liver′s maximum metabolic capacity, resulting in an elevated ethanol concentration in the patient′s peripheral blood. Even without alcohol intake, patients may exhibit symptoms similar to intoxication, causing various social, occupational, and health-related distress. This article provides an overview of the diagnosis and differential diagnosis of ABS, reveals that gut microbiota dysbiosis is the core of ABS, and introduces multiple intervention strategies involving the regulation of the gut microbiota, including dietary intervention, pharmacotherapy, probiotic therapy, fecal microbiota transplantation, and phage therapy, with the aim of assisting clinicians in the early identification and treatment of ABS.