II. Ulcer Disease

II. Ulcer Disease

Ulcer disease includes gastric ulcers and duodenal bulb ulcers, with some patients experiencing both conditions simultaneously.

Unlike chronic gastritis, ulcerative lesions appear on the gastric mucosa, accompanied by significant increases in gastric acid levels. Clinically, the primary symptoms are pain in the gastric antrum and acid reflux. The pain point of gastric ulcers is located slightly to the left of the midline, about one-third of the way along the line from the xiphoid process to the navel; the pain point of duodenal ulcers is slightly to the right of the midline, about one-third of the way along the line from the xiphoid process to the navel. In terms of the severity of pain, duodenal ulcers are more severe than gastric ulcers. Both types of ulcers are closely related to dietary habits, with pain typically alleviating after meals.

For gastric ulcers, pain begins 1 hour after eating and subsides after 2 hours; for duodenal ulcers, pain starts 1 hour after eating and continues until the next meal—this is a characteristic feature of duodenal ulcers. In addition to pain, acid reflux, bloating, and abdominal distension are also common symptoms in both conditions. Given that these diseases often present with acid reflux, bloating, and abdominal pain, traditional Chinese medicine often diagnoses them based on spleen and stomach deficiency-cold patterns; moreover, since both conditions are characterized by pain, traditional Chinese medicine believes that cold causes contraction and restriction, leading to obstruction of qi flow, and thus pain arises when qi is blocked. Ancient practitioners believed that deficiency-cold was the primary treatment approach; however, in recent years, Western medicine has discovered that Helicobacter pylori is a major cause of these diseases. After some patients responded effectively to antibiotics such as Lactulose and Tetracycline, colleagues in the traditional Chinese medicine community quickly adopted formulas like Xie Xin, Sanhuang, and Qing Wei for clinical use, achieving positive results. Based on my experience, the principles, methods, formulas, and medications for treating this condition should be similar to those used for chronic gastritis, but it is essential to incorporate larger doses of herbal remedies that reduce gastric acid production, such as Sheng Longmu, Wuchige, and Luowaleng. The Zuo Jin Wan, composed of equal parts of Huanglian and Wu Yu, is a powerful anti-acid agent in traditional Chinese medicine. This formula originates from Danxi’s Heart Method, originally using six parts Huanglian and one part Wu Yu; in clinical practice, I have found that a 3:1 ratio is the optimal choice.

Both chronic gastritis and ulcer disease can sometimes present with persistent gastric discomfort. When the aforementioned diagnostic and therapeutic approaches prove ineffective, patients often exhibit petechiae on their tongues, while their pulses are usually slippery, rapid, and even涩. Traditional Chinese medicine interprets these conditions as “long-term illness leading to entrapment in the meridians,” and recommends the use of herbs that promote blood circulation and resolve stasis for effective treatment. According to fiberoptic gastroscopy, many cases of epigastric pain are actually duodenal bulb ulcers—deep ulcers with extensive mucosal erosion. If these ulcers are associated with atrophic gastritis, they often show intestinal metaplasia or atypical hyperplasia. I have frequently used the following formulas to treat such epigastric pain. Compound Danshen Formula: 10g Dang Gui, 15g Bai Shao, 6g Chuan Xiong, 20g Huang Qi, 6g Liang Jiang, 6g Zhi Ru Mo, 10g Dang Shen, 6g Tan Xiang, 6g Sha Ren, 6g Yuan Hu, 20g Luowaleng, 3g Ming Fang, decocted and taken once daily. Another formula that can also yield good results is Compound Red Stone Powder: 200g Ji Nei Jin, 200g Wuchige, 200g Bai Shao, 100g Sheng Cao, 200g Han San Qi, 200g Hong Shi, 100g Dang Shen, 60g Mu Xiang, 100g Cao Kou, ground into powder, filtered through a sieve, take 6g each time, twice daily with warm water.