Peptic ulcer occurs most frequently in the stomach
and duodenum. Its etiology, in spite of a variety of theories about it, has not
been well understood. Gastric ulcer occurs predominantly in the lesser curvatuse
and pyloric part. Duodenal ulcer mostly occurs in the duodenal bulb. The coexistence
of gastric and duodenal ulcers is called complex ulcer. Peptic ulcers are more
frequently found in males than females, and inclined to attack the young and middle-aged
groups, but gastric ulcer usually occurs later than duodenal ulcer. The disease,
in TCM, is categorized as "weiwan tong" (stomachache), "outu"
(vomiting), etc.
Main Points of Diagnosis
1. Symptoms: Cardinal symptom
of the disease is chronic epigastralgia which is marked by dull pain or pinching
pain. Sometimes it is manifested as distending pain or burning pain which often
radiates to the lumbar region or the back. The pains are closely related to meals.
The rule of attack in gastric ulcer is food intake?pain?remission, while in duodenal
ulcer the rule is pain?food intake?remission. The pain occurs periodically and
is often induced by coldness, fatigue and improper food intake. The attack is
frequently in winter and spring.
Other symptoms include acid regurgitation,
belching, nausea and vomiting. In a few cases, perforation or bleeding may be
the first clinical findings.
2. Signs: In active ulcer, there is often tenderness
in the middle and upper abdominal regions. Tenderness on the left side of upper
gastric region is found in gastric ulcer, while in duodenal ulcer it is found
on the right side, often localized in 3-4 cm. Ulcer in the posterior wall may
have pain hypersensitive area on the back at T11-12 level.
3. Laboratory examinations
(1) Fecal occult blood test (OB): OB positive reaction after 3-day vegetarian
meals reveals that the active ulcer exists. OB positive result may turn into negative
if the patient is treated properly. Persistent positive reaction indicates cancerous
change of ulcer or gastric carcinoma.
(2) X-ray barium examination: It is
of great value. Niche is often seen in gastric ulcer. Indirect signs such as irritation
and deformity of duodenal bulbar region may occur in duodenal ulcer.
(3) Fiberscope
examination: It is a main diagnostic method. Small and superficial ulcer can be
seen directly. If fiberscopy is combined with biopsy, benign and cancerous changes
can be differentiated. Gastric juice analysis is not used as a routine examination.
Differentiation and Treatment of Common Syndromes
1. Insufficiency-Cold
Type
Main Symptoms and Signs: Latent pain in the upper abdomen with predilection
for heat, and intolerance of cold which aggravates the pain, sallow complexion,
lassitude and weakness, or loose stool, pale tongue with thin whitish fur, deep,
slow and weak pulse.
Therapeutic Principle: Warming and invigorating middle-warmer.
Recipe: Modified Decoction of Astragalus for Tonifying Middle-Warmer.
astragalus
root
cinnamon twig
white peony root
cuttle-fish bone
dahurian angelica
root
prepared licorice root
All the above herbs are to be decocted in water
for oral administration.
2. Qi-Stagnation Type
Main Symptoms and Signs:
Epigastric distension and pain, distension and fullness in the hypochondria, belching,
acid regurgitation, poor appetite, thin and whitish coating of the tongue, and
taut pulse.
Therapeutic Principle: Soothing the liver, regulating the circulation
of qi and regulating the function of stomach to relieve pain.
Recipe: Modified
Powder for Treating Cold Limbs in combination with Sichuan Chinaberry Powder.
bupleurum root
cyperus tuber
white peony root
bitter orange
tangerine
peel
Sichuan chinaberry
corydalis tuber
aucklandia root
perilla stem
ark
shell
finger citron
prepared licorice root
All the above herbs are to
be decocted in water for oral administration.
3.Stagnated-Heat Type
Main
Symptoms and Signs: Epigastric pain which is aggravated after food intake, burning
sensation in the stomach, dry mouth with bitter taste, fondness of cold drink,
constipation, deep-colored urine, red tongue with yellow fur ,taut and rapid pulse.
Therapeutic Principle: Clearing away pathogenic heat and regulating the function
of stomach.
Recipe: Modified Two Old herbs Decoction in combination with decoction
for Eliminating Pathogenic Heat from the Liver.
coptis rhizome
capejasmine
fruit
scutellaria root
anemarrhena rhizome
white peony root
tangerine
peel
pinellia tuber
poria
finger citron
dendrobium
prepared licorice
root
All the above herbs are to be decocted in water for oral administration.
If the case is complicated with insufficiency of the stomach-yin marked by
latent pain in the epigastric region, dry mouth with reduced saliva, hot sensation
in the palms and soles, red tongue with little fur or absence of fur and taut
weak pulse, it is preferable to administer the Modified decoction of Glehnia and
Ophiopogon instead. Its compositions are: glehnia root 10g, ophiopogon root 10g,
fragrant solomonseal rhizome 10g, white hyaciath bean 10g, finger citron 10g,
dendrobium 10g, prepared licorice root 6g. all the drugs in the above recipe are
to be decocted in water for oral administration.
If the case is manifested
as severe symptom of blood stasis such as epigastric stabbing pain, or fixed pain
just like knife-cutting ,dark purple tongue or with ecchymoses, taut or unsmooth
pulse, the modified Red Sage Drink in combination with Wonderful Powder for Relieving
Blood Stagnation is preferable: 20g, amomum fruit dung 10, Sichuan chinaberry
12g, corydalis tuber 12g, Chinese angelica root 12g, red peony root 10g, prepared
licorice root 6g. All the above drugs are to be decocted in water for oral administration.
For the case with hematemesis and tarry stools, 6 grams of powder of notoginseng
should be added (administered orally after being mixed with the finished decoction).
The above drugs except powder of notoginseng are to be decocted in water for oral
administration.
Dr. Ming's TCM Medical Center,
Hua Xi Xiao Yuan, Hutian
Developing Area,
Huaihua city, Hunan province
China