Cimetidine 400 or 400 bid or 800 qn

Cimetidine | > 400 or | > 400 bid or 800 qn | > 800 | Ranitidine | > 150 | > 150 bid or 300 qn Famotidine | > 20 | > 20 bid or 40 qn ② Suppress gastric acid secretion. Ulcer healing, especially duodenal ulcer healing, is directly proportional to the intensity and duration of acid suppression; in pharmacological treatment, the total time during which the intragastric pH remains above 3 for 24 hours can predict the ulcer healing rate. ③ Protect the gastric mucosa. Aluminum hydroxide: Its anti-ulcer mechanism mainly involves adhesion and coverage of the ulcer surface to prevent gastric acid and pepsin from attacking the ulcer, as well as promotion of endogenous prostaglandin synthesis, primarily used in the treatment of gastric ulcers. Aluminum hydroxide has few side effects, with constipation being its main adverse reaction. Colloidal bismuth subsalicylate: In addition to having a similar mechanism of action to aluminum hydroxide, it also has a strong effect in eradicating Helicobacter pylori, mainly used in combination therapies for Helicobacter pylori eradication. Misoprostol: It increases the secretion of mucus and bicarbonate in the gastric and duodenal mucosa, enhances mucosal blood flow, and moderately suppresses gastric acid secretion, mainly used for preventing NSAID-related ulcers. (3) Surgical treatment Indications include: ① Massive bleeding unresponsive to emergency medical treatment; ② Acute perforation; ③ Scarred pyloric obstruction; ④ Refractory ulcers unresponsive to medical treatment; ⑤ Suspected malignant transformation of gastric ulcers. III. Professor Pei Zhengxue’s Thinking Method Professor Pei Zhengxue believes that gastritis and peptic ulcers can both be categorized under the “stomach pain,” “noisy stomach,” “fullness,” and “vomiting” categories in traditional Chinese medicine, thus they can be discussed together and collectively referred to as chronic gastric diseases. Professor Pei Zhengxue holds that both Chinese and Western medicine have their own strengths in treating chronic gastric diseases: in terms of suppressing Helicobacter pylori, Western medicine offers triple or quadruple therapies with direct inhibitory effects superior to those of Traditional Chinese Medicine, but these treatments tend to recur frequently, and repeated use of Helicobacter pylori–suppressing drugs can lead to thinning of the gastric mucosa. Traditional Chinese Medicine’s Sanhuang Xiexin Tang can also inhibit Helicobacter pylori. In terms of acid suppression, Western medicine provides H2-receptor antagonists, proton pump inhibitors, and aluminum hydroxide preparations, with new drugs constantly emerging, giving Western medicine a certain advantage over Traditional Chinese Medicine in this regard; in terms of spasmolysis, both Chinese and Western medicine have their respective strengths, evenly matched; in terms of improving appetite, regulating the autonomic nervous system of the gastrointestinal tract, and alleviating symptoms, Traditional Chinese Medicine outperforms Western medicine. Traditional Chinese Medicine views the spleen and stomach as belonging to the middle jiao, with the spleen responsible for transportation and transformation, and the stomach responsible for receiving and digesting food; the spleen ascends clear substances, distributing the essence of food throughout the body, while the stomach descends turbid substances, expelling waste into the intestines; the two organs ascend and descend, receive and transform, jointly completing the functions of digestion and absorption to generate qi, blood, and essence. At the same time, the liver and gallbladder have a very close relationship with the spleen and stomach: the liver is responsible for dispersing and regulating qi, favoring smoothness and disliking depression, and the spleen’s transportation and reception functions depend on the liver’s qi dispersion; stagnation of liver qi can not only cause its own pathological changes but also invade the spleen, leading to spleen deficiency and insufficient production of qi and blood, while lack of yin nourishment in the liver can result in excess yang floating upward. Therefore, dysfunction of each organ’s function and their interrelationships can all lead to disease. Hence, the primary site of this disease is the stomach, closely related to the liver, gallbladder, and spleen. Based on this understanding, the pathogenesis of these diseases lies in the patient’s weakened spleen and stomach, allowing external pathogenic factors to take advantage of the weakness, causing imbalance of yin and yang in the spleen and stomach, disruption of ascending and descending functions, resulting in a mixed pattern of deficiency and excess, predominantly deficiency, with more cold than heat, and blood stasis permeating the entire course of the disease. In terms of treatment, Professor Pei Zhengxue believes that 60% of gastritis and peptic ulcers can be treated with Xiangsha Liujunzi Tang combined with Banxia Xiexin Tang, making Xiangsha Liujunzi Tang and Banxia Xiexin Tang the two representative formulas for treating these diseases. Xiangsha Liujunzi Tang strengthens the spleen and stomach, while Banxia Xiexin Tang resolves phlegm and eliminates fullness. In addition to Banxia Xiexin Tang and Xiangsha Liujunzi Tang, Professor Pei Zhengxue also commonly uses the following two formulas when treating these diseases: one is Pei’s Yangwei Tang, composed of Beisha Shen, Mai Dong, Yu Zhu, and Shi Hu, created by removing Sheng Di Huang from the “Wenbing Tiaobian” Yangwei Tang and adding Shi Hu; although Di Huang can nourish yin, it is detrimental to the stomach, while Shi Hu benefits the stomach by generating fluids and clearing heat, making this formula particularly suitable for chronic gastritis patients with a red tongue and no coating, experiencing dry mouth and thirst; the other is Huanglian Jiedu Tang, composed of Da Huang, Huang Lian, and Huang Qin, used for patients with yellow and greasy tongue coatings and constipation-related gastric issues. At the same time, according to different syndrome differentiation types, Professor Pei Zhengxue often uses formulas such as Dajianzhong Tang, Shixiao Piping Wan, Tiantai Wuyao San, Fuzi Lizhong Tang, Liangfu Wan, Sanren Tang, Huopu Xia Ling Tang, Shenmai Yin, Zhuye Shigao Tang, Chaihu Shugan San, Xiaoyao San, Danshen Yin, and others, adjusting and modifying them as needed for treatment. Special emphasis is placed on the fact that blood stasis accompanies the entire course of these diseases; blood stasis is both a pathological product of spleen and stomach deficiency and a fundamental cause that further exacerbates disease progression. Ye Tianshi’s “Linzheng Zhi Nan Yi’an” states: “Early-stage illness resides in qi, while long-term illness enters the blood.” Therefore, Professor Pei Zhengxue often adds herbs that activate blood circulation and dissolve stasis when treating these diseases, but dissolving stasis must be combined with regulating qi and tonifying qi to achieve good therapeutic effects, hence commonly using herbs such as Dang Gui, Chuan Xiong, Bai Shao, Zhi Ru Xiang, Zhi Meiyao, Danshen, Sanleng, E’zhu, Muxiang, and Sha Ren in combination. IV. Traditional Chinese Medicine Syndrome Differentiation and Formulas

1. External pathogen invasion of the stomach syndrome Symptoms: Sudden onset, chills and fever, headache and body pain, chest fullness and oppression, nausea and vomiting, and stomach pain. Tongue is red, tongue coating is white and greasy, pulse is moist and slow. This syndrome is commonly seen in Western medicine as acute gastritis. Treatment principle: Disperse exterior pathogens and dispel cold, transform dampness and harmonize the middle jiao. Formulas: Huoxiang Zhengqi San and Pingwei San with modifications: Huoxiang 10 g, Zisu Ye 10 g, Houpu 10 g, Chenpi 6 g, Fuling 10 g, Dafupi 10 g, Muxiang 6 g, Cangshu 10 g, Houpu 10 g, Jineijin 10 g, Chaima Ya 10 g, Chashanzha 10 g, Chashenqu 10 g.
2. Food accumulation syndrome Symptoms: Fullness in the stomach, pain and belching, vomiting of sour and rotten food, poor appetite, difficulty in digesting food, loose stools, and unsatisfying bowel movements. Tongue is red, tongue coating is thick and greasy, pulse is slippery and rapid. Treatment principle: Aid digestion and eliminate stagnation, harmonize the stomach and reverse rebellious qi. Formulas: Baohe Wan with modifications: Fresh ShanZha 30 g, Cooked ShanZha 30 g, Chashenqu 10 g, Chaima Ya 10 g, Banxia 10 g, Fuling 10 g, Qingpi 6 g, Chenpi 6 g, Laizi 10 g, Muxiang 6 g, Lianqiao 15 g, Binglang 10 g.

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