TCM and Therapy for Peptic Ulcer
By Dr. Hong-Yen Hsu
Peptic ulcers occur most frequently in the stomach and duodenum. Their etiology, in spite of a variety of theories, is not well understood. Currently, the balance theory contends that ulcers occur as a consequence of an imbalance between attacking factors, such as secretions of acid or pepsin, and defensive factors, such as the resistivity of the mucous membrane. However, it is usually acknowledged that the strongest potential inducer of peptic ulcers is the mental or physical stresses suffered by the individual, such as overwork and worry. Current scientific advances have enabled us to diagnose the disease with X-ray and fiberscope. Gastric ulcers occur predominantly in the lesser curvature and pyloric portion of the intestinal tract. Most duodenal ulcers occur in the duodenal bulb. The simultaneous occurrence of gastric and duodenal ulcers is called a complex ulcer. Peptic ulcers attack the young and middle-aged, and gastric ulcers usually occur later in life than duodenal ulcers.
The cardinal symptom of this disease is chronic epigastralgia, marked by dull or pinching pain. Sometimes it manifests as distending or burning pain, often radiating to the lumbar region or the back. These pains are closely related to the content and frequency of meals. Pain occurs periodically and is often induced by coldness, fatigue and improper food intake. Other symptoms include acid regurgitation, belching, nausea and vomiting. In some cases, perforative peritonitis or hematemesis with melena are the first clinical findings.
Peptic ulcer, in traditional Chinese medicine, is categorized as wei wan tong (stomachache), gan wei qi tong (stomachache caused by the excess liver qi), xing tong (epigastric pain), tu shuan (acid regurgitation), chao zha (epigastric upset) and ou tu (vomiting).
According to the different etiologies attributed to this disease, Chinese herbal medicine discriminates between different formulas which may be used to treat it, as follows:
1. Qi stagnation: characterized by epigastric distention and pain, distention and fullness in the hypochondria, belching, acid regurgitation, poor appetite, thin and whitish coating on the tongue, and string-taut pulse. Prescribed treatments are Tang-kuei and Bupleurum Formula with Melia and Corydalis Formula; or Bupleurum and Chih-shih Formula, or Bupleurum & Evodia Combination, with Melia and Corydalis Formula. It has been proven that Bupleurum and Chih-shih Formula tranquilizes the mind, and relieves spasms and pain; and Tang-kuei and Bupleurum Formula relieves spasms, promotes digestion and strengthens the stomach.
2. Heat stagnation: characterized by epigastric pain which is aggravated by food intake, acid regurgitation, burning sensation in the stomach, dry mouth with bitter taste, fondness for cold drinks, constipation, dark-colored urine, red tongue with yellow fur, and tense and rapid pulse. Coptis and Evodia Formula or Gardenia and Peony Formula is commonly prescribed.
3. Blood stagnation: characterized by stabbing pain in the epigastrium, in a fixed location, after meals, pain which feels like being cut with a knife, dark purple tongue or ecchymoses, and a string-taut or hesitant pulse. Pteropus and Bulrush Formula, or other formulas which remove blood stasis, such as Tang-kuei and Cnidium Formula, are prescribed.
4. Deficiency cold: characterized by latent pain in the upper abdomen relieved by heat and pressing the pain site, intolerance of cold (which aggravates the pain), sallow complexion, lassitude, weakness, loose stools, pale tongue with thin whitish fur, and a deep, slow and weak pulse. Astragalus Combination, Saussurea and Cardamon Combination, or Ginseng and Ginger Combination may be used.
5. Food stagnation: characterized by abdominal pain that becomes more severe on eating, eructation with fetid odor, aversion to food, feeling of fullness in the chest and hypochondria, acid regurgitation, greasy fur on the tongue and slippery pulse. Magnolia and Ginger Formula is commonly used. This formula has the effect of regulating gastrointestinal function.
6. Phlegm retention: characterized by mild, intermittent and hidden pains with frequent acid regurgitation, white and greasy fur on the tongue, and a soft and floating pulse. Citrus and Pinellia Combination, or Hoelen and Atractylodes Combination, in combination with Pinellia and Magnolia Combination is commonly used. It has been confirmed that Citrus and Pinellia Combination has the effect of strengthening the stomach to arrest vomiting, and of preventing and treating ulcers.
7. Deficiency or 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 a string-taut and thready pulse. Adenophora and Ophiopogon Combination is recommended.
8. Other formulas commonly used for the treatment of peptic ulcers:
(1) Cuttlefish Bone and Fritillaria Formula; which is composed of cuttlefish bone and fritillaria, in a ratio of 4:1. Administration is 3-6g per dosage, and continuous use is markedly effective for repetitive epigastralgia.
(2) Pinellia Combination; used in the early stage of ulcers, when the patient experiences nausea, vomiting, an obstructive sensation, eructation, sensation of distention at the substernum with pain, and loss of appetite, Administration increases appetite and alleviates dull epigastric pain. This formula also relieves inflammation, arrests vomiting and regulates the function of the gastrointestinal tract.
(3) Peony and Licorice Combination; very severe epigastric pain may be relieved with this formula.
(4) Cardamon and Fennel Formula; indicated for poor complexion, symptoms of chill, chronic gastralgia, acid eructation, persistence of stagnant water in the stomach, and abdominal palpitation.
(5) Minor Cinnamon and Peony Combination; indicated for gastralgia with deficiency cold, and marked by abdominal pain which is relieved by warmth and pressing, pale complexion, whitish coating on the tongue, and string-taut and thready pulse. In the treatment of gastroduodenal ulcers, administration of this formula, plus angelica and an increased dosage of licorice, yields remarkable results. This formula has the effect of relieving spasms, alleviating pain, promoting blood circulation, promoting the healing of ulcers, nourishing the body and consolidating the constitution.
(6) Tang-kuei Combination; indicated for somewhat deficient conformations with slight chills and chronic gastralgia.
(7) Bupleurum and Cinnamon Combination; considered quite good for preventing the recurrence of gastric or duodenal ulcers.
(8) Herbs for bleeding ulcers (hematemesis and tarry stools) (according to modern studies of Chinese herbal medicine);
a. Powder of bletilla, 1.0-1.5g, 4-5 times per day;
b. Powder or pseudoginseng, 1.0-1.5g, 4-5 times per day;
c. Powder of rhubarb, 1.0-1.5g, 4-5 times per day.
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