I. Diagnostic Points

I. Diagnostic Points

(1) Clinical Symptoms and Signs

(1) Upper abdominal pain often has a chronic course, lasting anywhere from a few years to several decades.

(2) Pain attacks are seasonal, typically occurring in late autumn and early winter or late winter and early spring. The condition may also relapse or worsen during periods of mental stress, emotional fluctuations, overwork, irregular eating habits (overeating or undereating, or consumption of strong liquor, strong tea, coffee, etc.), unclean diet, or drug stimulation. Rest or taking alkaline medications can provide relief.

(3) The nature of the pain is usually hunger-like discomfort, or dull pain, distending pain, burning pain, sometimes severe pain.

(4) The pain is often rhythmic: for gastric ulcers, pain usually occurs 0.5–2 hours after eating, lasts 1–2 hours, then subsides on its own—this is the so-called "eating—pain—relief" pattern. For duodenal ulcers, pain often occurs 3–4 hours after eating and persists until the next meal, hence the "pain—eating—relief" pattern; sometimes patients are awakened by pain at night.

(5) There is localized tenderness in the upper abdomen: for gastric ulcers, the tender area is usually right in the center under the xiphoid process or slightly to the left; for duodenal ulcers, the tender area is usually right in the center under the xiphoid process or slightly to the right.

(2) Barium Meal X-ray Examination

Double-contrast barium radiography has high diagnostic value, with a confirmation rate of 80%–90%. The discovery of niche shadows confirms the diagnosis. If there are indirect X-ray signs such as local tenderness, irritation, or deformation, a clear diagnosis should be made in conjunction with clinical manifestations and other examination results.

(3) Fiber Gastroscopy

Gastroscopy is a valuable diagnostic tool for peptic ulcers and for differentiating benign from malignant ulcers. It can not only distinguish whether an ulcer is active, healing, or scarred, but also allow for biopsy sampling, Helicobacter pylori testing, or brushing off exfoliated cells for pathological examination.

(4) Auxiliary Examinations

1. Gastric Juice Analysis: Normal individuals have a basal gastric acid secretion of 4–6 mmol/h, with a maximum secretion of 18–22 mmol/h. Gastric ulcer patients may have gastric acid secretion within the normal range or even lower than normal; duodenal ulcer patients, however, generally have significantly higher gastric acid secretion than normal.

2. Fecal Occult Blood Test: The test is more accurate after a 3-day vegetarian diet. A positive result indicates active ulceration; after rest or treatment, the occult blood test may turn negative.

3. Gastric Electrogastrography: Has some auxiliary diagnostic value for duodenal ulcers. Typical high-frequency waves appear, with a frequency of about 3.8–4.5 times/min and an amplitude greater than 250–350 μV (microvolts).

II. Diagnosis of Complications

1. Perforation: Patients with acute perforation of peptic ulcers often experience sudden, severe upper abdominal pain, accompanied by fever, nausea, vomiting, restlessness, and even shock. Physical examination reveals a board-like rigidity of the upper abdomen, along with marked tenderness and rebound tenderness, and diminished bowel sounds. X-ray examination shows free gas under the diaphragm. Chronic perforation of ulcers may lead to adhesion with surrounding organs and subsequent penetration into adjacent organs (such as the liver or pancreas), causing changes and aggravation in the pain rhythm and radiating pain toward the back. Factors that can cause ulcer perforation include mental stress, overwork, overeating, irritating diet, severe vomiting, severe coughing, trauma, cold stimulation, barium meal examination, and gastric lavage.

2. Bleeding: About 10%–25% of peptic ulcers are complicated by massive bleeding, making it the most common cause of upper gastrointestinal massive bleeding. Gastric ulcer bleeding often presents as hematemesis, usually dark brown; duodenal ulcer bleeding manifests as melena. If there is massive bleeding in a short period, hematemesis or melena may appear dark red or even bright red. At the same time, symptoms such as dizziness, palpitations, fatigue, cold sweat, rapid pulse, decreased blood pressure, and even fainting may occur. Before acute massive bleeding, upper abdominal pain often worsens; after bleeding, the pain may actually ease. If the pain does not subside or even worsens after bleeding, consider the possibility of re-bleeding or perforation. Chronic minor bleeding mainly manifests as a positive fecal occult blood test.

3. Pyloric Obstruction: Duodenal bulb ulcers and ulcers in the pyloric region can lead to pyloric obstruction. The main symptoms are postprandial fullness, belching, and vomiting (vomit contains overnight food). Physical examination reveals abdominal distension, splashing sounds, and sometimes visible gastric shape and peristaltic waves. There are roughly two reasons for pyloric obstruction: first, repeated ulcer stimulation and inflammation causing congestion and edema; second, excessive scar tissue formed during ulcer healing. The obstruction caused by the former can be reversed—once the ulcer and inflammation are controlled, congestion and edema disappear, and the obstruction naturally resolves; however, the obstruction caused by the latter is more difficult to reverse.

4. Carcinoma: To prevent ulcer carcinoma, it is recommended to follow up gastric ulcer patients over 45 years old, especially those whose symptoms improve little after active, standard internal medicine treatment, or whose fecal occult blood remains positive, to conduct appropriate examinations for early diagnosis and early treatment.

III. Differential Diagnosis

1. Gastric Neurosis: Although this condition involves chronic upper abdominal pain, it lacks rhythmicity and is heavily influenced by psychological factors, often accompanied by neurotic symptoms outside the digestive tract. Both barium meal X-rays and fiber gastroscopy show negative results, suggesting effective treatment.

2. Chronic Gastritis: Patients with chronic gastritis also often present with chronic upper abdominal pain as the main clinical manifestation; some may even exhibit periodic pain rhythms similar to those of peptic ulcers. However, if gastric juice analysis reveals a lack of gastric acid, peptic ulcer can be ruled out. Barium meal X-rays can help differentiate, while gastroscopy is even more reliable.

3. Gastric Cancer: Gastric cancer mostly occurs in people over 40, has a relatively short course, and progressively worsens. In the advanced stage, patients become increasingly thin, with cachexia characterized by skin stretched tightly over bones. The pain lacks a fixed rhythm and cannot be relieved by eating or antacid medications. In some cases, a mass can be felt in the upper abdomen, supraclavicular lymph nodes are enlarged, gastric juice analysis often shows a lack of gastric acid, fecal occult blood tests remain positive, and barium meal X-rays and gastroscopy reveal signs of malignant ulcers.

4. Gastric Mucosal Prolapse: This condition can cause upper abdominal pain, and since gastric mucosal prolapse often occurs intermittently, symptoms may also appear periodically. However, it does not have the eating-related pain rhythm characteristic of peptic ulcers. Antacids cannot relieve the pain, but lying on the left side can alleviate it. Barium meal X-rays often show specific phenomena of gastric mucosal prolapse.

5. Cholecystitis and Gallstones: Some duodenal ulcer pains are located slightly to the right under the xiphoid process, easily confused with cholecystitis and gallstones. However, cholecystitis and gallstones often have typical gallbladder tenderness, namely Murphy's sign (the examiner presses the patient's gallbladder area with the left thumb while the patient takes a deep breath; if pain occurs during inhalation, it is judged as a positive Murphy's sign) and a history of acute biliary colic. The pain is usually located in the gallbladder area, often radiating to the right shoulder and back, without rhythmic or periodic pain, and often triggered by eating greasy foods. Cholecystography or ultrasound often yields positive results.

Section 3: Integrated Traditional Chinese and Western Medicine Treatment

Both traditional Chinese and Western medicines are effective in treating peptic ulcers, but Western medicines generally have more side effects, poorer long-term efficacy, and are prone to recurrence; traditional Chinese medicines are difficult for patients to adhere to long-term, which also affects long-term efficacy. Recent clinical research on integrated traditional Chinese and Western medicine shows that combining TCM syndrome differentiation and Western treatment can improve efficacy, reduce recurrence, and significantly lessen side effects.

I. TCM Understanding of Peptic Ulcers

In TCM, the clinical manifestations of peptic ulcers generally fall under categories such as "epigastric pain," "heart-stomach qi pain," "distention," and "acid regurgitation." What people commonly call "heartburn" includes peptic ulcers. In addition to "epigastric pain," peptic ulcers also have some special clinical symptoms and signs, such as "acid regurgitation," "melena," and "retching" when accompanied by pyloric obstruction. Throughout history, physicians have offered insightful discussions on these symptoms; here are a few excerpts for readers' reference.

"The Plain Questions: The Great Treatise on Supreme Truth" believes that the pathogenesis of acid regurgitation is heat in the middle jiao, stating: "All cases of vomiting acid, sudden and forceful, belong to heat." Meanwhile, "The Treatise on the Origins and Symptoms of Various Diseases" argues from a cold perspective, saying: "Belching acid is caused by stagnant fluid in the upper jiao and chronic cold in the spleen and stomach, preventing digestion. Undigested food leads to bloating and qi reversal, causing frequent belching and acidic odor. The qi itself smells sour." Zhang's Medical Compendium on Acid Regurgitation offers a view more aligned with clinical practice, pointing out: "If dampness accumulates in the stomach and turns into stagnation, heat arises from the dampness, transforming into acid regurgitation. If left unchecked for a long time, the wood element in the liver becomes rampant while the earth element in the stomach declines. Therefore, we should soothe the liver and strengthen the stomach, using Xiaoyao San and Zuojin Wan. If food stagnates in the middle jiao, use Pingwei San with cardamom, patchouli, sandalwood, and Shenqu." This viewpoint is thorough, with clear treatment principles and appropriate herbal formulas, laying the foundation for TCM's current approach of soothing the liver and strengthening the stomach, using pungent opening and bitter descending methods to control acid for heat-type acid regurgitation, and warming the middle burner and dispersing cold to control acid for cold-type acid regurgitation. "The Spiritual Pivot: The Chapter on the Origin of All Diseases" states: "When yin channels are injured and internal blood overflows, blood overflows externally." This is the earliest mention of "external blood," referring to hematochezia. Zhang Zhongjing, in "Essential Prescriptions for Emergencies," defines "external blood" as "remote blood": "Bleeding starts with stool, then blood—this is remote blood, treated with Huangtu Tang." Melena after peptic ulcer bleeding should be called "remote blood," and Huangtu Tang remains an effective prescription for treating peptic ulcers today. The term "remote blood" merely distinguishes it from bleeding near the anus and does not specify the exact site of bleeding. It wasn't until 1624, when Ming dynasty physician Zhang Jingyue described the location of "remote blood" in his "Complete Works of Jingyue": "Remote blood may occur in the small intestine or the stomach," attributing it to "spleen yang deficiency unable to control blood." "Compendium of Symptom and Treatment" uses the color of bleeding to identify the pathogenesis, providing some clinical guidance: bright red blood indicates heat, dark blood indicates cold, and black blood indicates blood stasis. Zhang's Medical Compendium on Hematochezia believes that treating "hematochezia" should not rely solely on bitter cold herbs; pungent dispersing herbs must be added as the main component. If treatment fails for a long time, it is advisable to regulate stomach qi—these are all based on practical experience. Retching, also known as stomach reversal, is described in "Essential Prescriptions for Emergencies" as follows: "The foot-yang pulse is floating and constricted; floating indicates deficiency, constricted indicates spleen injury. When the spleen is injured, it cannot grind food properly, leading to morning eating and evening vomiting, evening eating and morning vomiting, undigested food accumulating—this is called stomach reversal." This situation closely resembles the vomiting characteristics of peptic ulcers (duodenal ulcers or pyloric canal ulcers) complicated by pyloric obstruction. Zhang Zhongjing pioneered the use of Dahuaxia Tang and Fuling Zexie Tang to treat this condition. Meanwhile, "Danxi Heart Method" proposes that "stomach reversal" has roughly four causes: "blood deficiency, qi deficiency, heat, and phlegm," enriching the syndrome differentiation and treatment of this condition. "Miscellaneous Disease Source and Flow Candle" begins to recognize that "some cases also involve blood stasis blocking the flow," seemingly getting closer to the pathological essence of obstruction.

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The combined analysis of historical medical theories and modern medical insights into the pathogenic factors of peptic ulcer disease reveals that the etiological and pathogenetic characteristics of peptic ulcers, when viewed through the lens of both traditional Chinese medicine and Western medicine, can be summarized in the following four aspects.

(1) Dietary indiscretion

This includes long-term imbalances in hunger and fullness, excessive consumption of raw and cold foods as well as spicy, acidic, fried, strong alcoholic beverages, and strong tea. Additionally, ingesting spoiled or decomposed food, food contaminated with pesticide or fertilizer residues, or certain medications can also contribute. These factors either directly damage the gastric mucosa, stimulate increased gastric acid secretion, or weaken the protective barrier of the gastric mucosa, thereby creating conditions conducive to ulcer formation.

(2) Emotional disturbances

Frequent anger or excessive rumination are often major contributing factors to the onset and exacerbation of this condition, particularly in duodenal ulcers. Emotions are governed by the liver; when emotional imbalance leads to stagnation of liver qi, the wood energy of the liver overpowers the earth energy of the spleen and stomach, inevitably affecting their function. Furthermore, prolonged mental stress and overwork can also precipitate this disease or trigger a relapse of an existing condition. From a modern medical perspective, the impact of emotional disturbances on the occurrence and progression of ulcers essentially reflects dysregulation of central nervous system functions, which in turn affects autonomic nerve function, leading to local changes in the stomach and duodenum—including alterations in motility, secretion, and blood circulation—and ultimately resulting in the development of this disease.

(3) Invasion of external pathogens

Peptic ulcers frequently occur during late autumn and early winter or at the transition from winter to spring. This suggests that during seasonal transitions and fluctuations in temperature, patients often struggle to adapt to changes in the external environment, making them susceptible to external pathogenic factors and thus triggering the onset of the disease. Therefore, exposure to the six pathogenic factors of wind, cold, summer heat, dampness, dryness, and fire is also an important predisposing factor for peptic ulcers.

(4) Constitutional factors

Clinical experience indicates that peptic ulcers are predominantly associated with deficiency of spleen-stomach qi and yang, while yin-deficiency constitutions are relatively rare. Qi and yang deficiency make individuals more vulnerable to invasion by wind-cold-damp pathogens and more easily obstructed by cold and raw foods. Thus, the fundamental cause of peptic ulcer disease lies in the weakness of vital qi; moreover, prolonged exposure to external pathogenic factors is another significant contributor to this weakness. In traditional Chinese medicine, these circumstances are summarized as insufficient innate endowment and inadequate postnatal nurturing. From a modern medical standpoint, peptic ulcers are linked to genetic factors: individuals with an ulcer-prone constitution may exhibit elevated gastric acid secretion levels, which can readily compromise the mucus-mucosal barrier, and their own mucus-mucosal barrier may inherently be weaker. In summary, both traditional Chinese medicine and Western medicine place great emphasis on the role of constitutional factors in the pathogenesis of peptic ulcers.

The onset of peptic ulcers results from the interplay of these four factors, with constitutional weakness being the root cause, while dietary indiscretion, emotional disturbances, and external pathogen invasion serve as critical precipitating factors. Of course, constitutional weakness is not only due to insufficient innate endowment but also to inadequate postnatal nurturing, which is directly related to long-term dietary indiscretion, emotional disturbances, and exposure to external pathogens. It can be said that constitutional weakness provides an opportunity for these precipitating factors to take effect, whereas the persistent presence of these factors further exacerbates constitutional weakness. From the perspective of integrated traditional Chinese and Western medicine, the pathological basis of vital qi deficiency in peptic ulcers can be viewed as a weakening of the mucus-mucosal barrier, and postnatal dysfunction encompasses all external pathogenic factors as well as internal psychological factors. Both traditional Chinese medicine and Western medicine share a common understanding regarding the etiology of this disease: they both emphasize that weakness of vital qi is the key determinant of its onset, with external factors exerting their influence through internal mechanisms—“wherever evil gathers, vital qi must be deficient; when vital qi resides within, evil cannot invade.” This description is indeed apt.

Peptic ulcers are most closely related to the spleen, stomach, and liver. Weakness of spleen-stomach yang qi is the fundamental manifestation of vital qi deficiency. Some patients may also present with kidney-yang deficiency, precisely because this condition is associated with insufficient innate endowment. Moreover, since kidney-yang serves as the foundation for spleen-yang, prolonged illness without cure will inevitably harm the innate constitution, which is entirely consistent with traditional Chinese medical theory. For those whose emotions are internally injured, the issue pertains to the liver’s dispersing and regulating function; clinically, disharmony between the liver and stomach is the most common presentation. Prolonged stagnation of liver qi can transform into heat, and when combined with spleen deficiency in transportation and transformation, it easily gives rise to damp-heat. Spleen-stomach yang deficiency leads to internal cold, impeded qi and blood circulation, and coupled with liver qi stagnation, qi blockage hinders normal blood flow, ultimately resulting in symptoms of qi stagnation and blood stasis. Clinically, we also observe patients with stomach-yin deficiency, which is likewise attributable to different constitutions.

Pain is the primary subjective symptom of peptic ulcers; therefore, accurately identifying the nature of the pain is crucial for differential diagnosis and tailored treatment. The pain associated with duodenal ulcers is typically dull and aching, often alleviating after eating and worsening when hungry—this is a “deficient-type pain” caused by spleen-stomach qi deficiency or spleen-stomach cold deficiency. If the pain is sharp, localized, and does not change even after eating, or if it intensifies after meals accompanied by black stools and petechiae along the tongue margin, then it is a “real-type pain,” resulting from a long-standing, unhealed ulcer that has invaded the collateral channels, causing blood stasis and obstruction of the channels, which in turn leads to pain. There is also distending pain that worsens after eating, which also falls under the category of “real-type pain” and is very common in clinical practice, arising from qi stagnation in the middle jiao due to impaired qi movement in the spleen and stomach. Some ulcer patients experience extremely severe qi-stagnation and distension before bleeding, to the point where they cannot bear it; the epigastric region refuses palpation, yet once bleeding occurs, the pain immediately subsides—this too is a “real-type pain.” If one encounters burning pain, it is usually due to spleen-stomach damp-heat and also qualifies as “real-type pain.” Of course, the patterns of gastric pain in peptic ulcers extend far beyond these examples; there are also cases of mixed deficiency and excess, alternating cold and heat, concurrent qi and blood disorders, and simultaneous involvement of both exterior and interior conditions. Clinicians must remain flexible and adaptable in their diagnostic approach to accommodate such variations.

II. Treatment Based on Syndrome Differentiation

(1) Spleen-Stomach Deficiency-Cold Type

① Symptoms: Dull epigastric pain that worsens when hungry and eases after eating, with three characteristic preferences: fondness for warmth, pressure, and hot food; cold sensation in the stomach; vomiting clear water. Accompanied by general symptoms such as fatigue, poor appetite, loose stools, weight loss, aversion to cold, and cold extremities. Tongue is pale red, swollen, with tooth marks on the edges, and coated with thin white or slippery white coating.

② Treatment Principle: Warm the center and strengthen the spleen, harmonize the stomach and relieve pain.

③ Formula: Modified Huangqi Jianzhong Tang. Ingredients: 15g of raw astragalus, 6g of cinnamon, 12g of white peony, 10g of atractylodes, 10g of stir-fried Corydalis, 5g of processed ginger, 5g of patchouli, and 5g of honey-fried licorice. Decoct twice, mix well, divide into three doses, take one dose daily.

④ Notes: This syndrome type is commonly seen in the remission phase of duodenal ulcers or in patients with long-standing, refractory disease. As long as the diagnosis is accurate and Huangqi Jianzhong Tang is appropriately modified, satisfactory therapeutic effects can often be achieved. Professor Zhang Haifeng from Jiangxi stated: “For gastric pain, cold syndromes are easier to treat than heat syndromes, because the stomach is yang soil, so yang is easy to restore while cold is easy to dispel.” Huangqi Jianzhong Tang has become a classic formula for treating spleen-stomach deficiency-cold type peptic ulcers. In the above modifications, astragalus, atractylodes, and honey-fried licorice strengthen the spleen; cinnamon and processed ginger warm the center and dispel cold; stir-fried Corydalis and patchouli harmonize the stomach; white peony and licorice work together to relieve urgency and stop pain. For those who vomit clear water, Wu Zhu Yu Tang can be added (with codonopsis, evodia, and pinellia); for those who regurgitate acidic fluid, cuttlebone, oyster shell, and fritillaria can be added, or antacid medications can be used in combination. As early as the 1950s and 1960s, the renowned TCM scholar Mr. Qin Bowei wrote extensively about using Huangqi Jianzhong Tang to treat peptic ulcers, and even today, his writings remain highly instructive. He said: “When using this formula, one should consider specific clinical features of peptic ulcers as well as potential changes and accompanying syndromes, and make appropriate adjustments. For example, fresh ginger is quite pungent and stimulating, so it can be replaced with charred processed ginger, which warms the center without being overly harsh and can also treat deficiency-cold-related bleeding; maltose is the main ingredient, but it can affect those with excessive acidity and is even less suitable for those with phlegm-dampness, so it can be used sparingly or temporarily omitted; licorice tonifies the center but can also cause qi stagnation, so if there is bloating, fullness, or belching, it should be used sparingly or discontinued. On this basis, if there is blood deficiency, angelica can be added; if there is bleeding, donkey-hide gelatin can be added to replenish blood; if shortness of breath and fatigue are obvious, codonopsis can be added; if the feet are cold or the whole body is particularly sensitive to cold, prepared aconite can be added. In addition, if recurrence is triggered by catching a cold or eating raw and cold foods, cinnamon can be increased, or su ling and wu yao can be added; if spleen deficiency leads to dampness and phlegm, pinellia and tangerine peel can be added, and if dampness is severe, atractylodes can also be added; if anger causes severe pain or flank pain, green tangerine peel and turmeric can be added; if indigestion is caused by food stagnation, shenqu can be added.” (“Qianzhai Medical Lectures”) Furthermore, Huangqi Jianzhong Tang generally uses a large amount of astragalus—typically 20–30g—which has a special effect on strengthening the spleen and boosting qi, but can also lead to stagnation in the middle jiao. The renowned TCM scholar Professor Yue Meizhong remarked: “Li Dongyuan used astragalus… but he was afraid it would cause stagnation, so he always added tangerine peel to counteract it—this was one of Dongyuan’s great inventions. I have personally experienced the necessity of pairing astragalus with tangerine peel. Early in my career in Tangshan, I treated a patient who had taken a large dose of astragalus and ended up with severe abdominal distension, almost to the point of death. Despite using licorice, mung beans, patchouli, and magnolia bark—medicines meant to detoxify and break up the blockage—the distension persisted, leaving both the patient and the physician helpless. I advised them to use tangerine peel, and the result proved effective.” For severe pain triggered by cold in peptic ulcers, the renowned veteran TCM doctor Professor Jiang Chunhua has a proven prescription that is said to work instantly: 6g of chuanwu, 3g of cinnamon, 9g of frankincense, 9g of nine-spotted bug, and 6g of galangal, decocted and taken in divided doses.

(2) Liver-Stomach Disharmony Type

① Symptoms: Epigastric distension and pain radiating to the flanks, pain with no fixed location, relieved by belching, irritability and quick temper; regurgitation of acidic fluid, frequent sighing, red tongue with white coating, and wiry pulse.

② Treatment Principle: Soothe the liver and harmonize the stomach, move qi and relieve pain.

③ Formula: Modified Chaihu Shugan San combined with Jinlingzi San. Ingredients: 10g of bupleurum, 12g of hangzhou white peony, 10g of stir-fried citronella, 10g of cyperus, 10g of tangerine peel, 10g of melia, 10g of stir-fried Corydalis, 6g of raw licorice, decocted twice, mixed well, divided into three doses, take one dose daily.

④ Notes: This syndrome type is observed during acute attacks of peptic ulcers, often triggered by emotional frustration and pent-up anger. In the above modifications, bupleurum, cyperus, and stir-fried citronella help soothe the liver and regulate qi; hangzhou white peony and licorice work together to soften the liver and relieve urgency and stop pain; tangerine peel, melia, and stir-fried Corydalis move qi and harmonize the stomach to relieve pain. If qi stagnation turns into heat, accompanied by burning epigastric pain, dry mouth, bitter taste, sheep-like stools, and yellow tongue coating, add coptis and wine army. Patients in this type often have elevated gastric acid levels, so in addition to epigastric pain, regurgitation of acidic fluid is also a hallmark of this type. Traditional Chinese medicines that suppress gastric acid include cuttlebone, calcined oyster shell, calcined eggshell, calcined mussel shell, fritillaria, and fructus amomi, among others. Cuttlebone (80%), fritillaria (15%), and licorice (5%) combined are known as “Wubei San.” Fritillaria is frequently used in formulas for treating peptic ulcers, a unique experience of the renowned modern Chinese physician Ding Ganren. Modern pharmacological research has found that fritillaria has spasmolytic and gastric acid-suppressing effects similar to atropine; it has also been discovered that cuttlebone’s acid-suppressing effect is superior to that of aluminum hydroxide, magnesium oxide, calcium oxide, and other Western medications like Weishu. In addition, for patients with burning gastric pain, many experienced experts believe that dandelion is an excellent herb that clears heat without harming the stomach and nourishes yin without promoting dampness; while the Qing dynasty physician Ma Peizhi favored using ginger juice to stir-fry gardenia, which has a similar effect and is worth emulating. For simple pain relief, one can choose melia, stir-fried Corydalis, frankincense, myrrh, mandrake flower, green sandalwood, and patchouli, among others.

(3) Spleen-Stomach Damp-Heat Type

① Symptoms: Upper abdominal distension and pain, heartburn, acid reflux, thirst without desire to drink, poor appetite, reduced food intake, sticky feeling in the mouth, dry or uncomfortable bowel movements, red tongue, thick yellow or greasy yellow coating, slippery or wiry-slippery pulse.

② Treatment Principle: Clear damp-heat, resolve stagnation, and relieve pain.

③ Formula: Modified Banxia Xiexin Tang. Ingredients: 10g of pinellia, 10g of scutellaria, 10g of coptis, 6g of processed ginger, 10g of stir-fried gardenia, 10g of cyperus, 10g of poria, 10g of tangerine peel, 10g of dandelion, 6g of ginger, and 5g of licorice. Decoct twice, mix well, divide into three doses, take one dose daily.

④ Notes: This syndrome type is also commonly seen during acute attacks of peptic ulcers, or as a further development of the liver-stomach disharmony type, or as a result of consuming spicy and irritating foods, strong alcohol, and other such stimuli. In short, it arises when pathogenic factors transform into heat and combine with dampness, forming a spleen-stomach damp-heat syndrome, which must be recognized. Banxia Xiexin Tang is the foundational formula for treating damp-heat in the middle jiao; in the above modifications, scutellaria, coptis, gardenia, and dandelion clear heat and dry dampness, while pinellia, poria, tangerine peel, licorice, and ginger dry dampness and transform it into phlegm, harmonizing the stomach; processed ginger plays a supporting role in warming the center. For those experiencing nausea and vomiting, Zuo Jin Wan can be added (stir-fried evodia and coptis). Since “the stomach prefers moisture and dislikes dryness,” stomach yin tends to be easily depleted and difficult to restore, making heat-based syndromes harder to treat. When heat combines with dampness, it’s like oil in dough—vapors linger and are hard to disperse, making the situation even more complicated. Professor Zhou Ciqing, a renowned TCM practitioner from Shandong, believes: “For damp-heat obstructive ulcers, the overall condition is generally good, so treatment should focus on clearing dampness and heat, resolving stagnation, and relieving pain. The Qingyu Erchen Tang from ‘Shoushibao Yuan’ (pinellia, poria, tangerine peel, licorice, atractylodes, coptis, gardenia, cyperus, zhulin, shenqu, chuanxiong, white peony) and the Zhulian Wan (atractylodes, pinellia, poria, tangerine peel, coptis, evodia) both have good effects. During treatment, it’s essential to distinguish between mild dampness and mild heat, as well as whether liver qi is invading the stomach. For those leaning toward dampness, the focus should be on atractylodes and Erchen; for those leaning toward heat, the focus should be on coptis and gardenia. For those with liver qi invading the stomach, wu yao, chuanxiong, and cyperus are indispensable. When treating diseases where dampness and heat are intertwined, one must adhere to the principle of drying dampness without adding heat, and cooling without hindering dampness. Generally, prioritize drying dampness, followed by clearing heat, with qi regulation as a supplement, so that dampness is eliminated and heat is subdued, stagnation is resolved and fire is extinguished. Avoid overusing cooling agents, as they can damage the yang qi of the spleen and stomach and delay recovery.” Truly a testament to practical experience.

(4) Qi Stagnation and Blood Stasis Type

① Symptoms: Sharp, stabbing pain in the epigastric region, or pain like a knife cut, localized and unchanging, with obvious tenderness upon palpation; patients can often pinpoint the exact location of the pain and refuse pressure; pain worsens after eating, or there may be bleeding or black stools, with petechiae or purplish-dark discoloration on the tongue, white and moist coating, and wiry or涩 pulse.

② Treatment Principle: Activate blood circulation and dissolve blood stasis, regulate qi and harmonize blood.

③ Formula: Modified Danshen Yin combined with Shixiao San. Ingredients: 10g of danshen, 10g of raw pu huang, 10g of five spirit fats, 10g of angelica, 10g of red peony, 10g of hangzhou white peony, 6g of patchouli, and 10g of sanqi (ground into powder and taken in three divided doses), decocted twice, mixed well, divided into three doses, take one dose daily.

④ Notes: This syndrome type is commonly seen in peptic ulcers accompanied by bleeding, though there are also cases without bleeding but with severe pain, and even cases with bleeding but no pain. Clinicians should pay particular attention to such situations. Besides the aforementioned blood stasis syndrome, bleeding can also occur in cases of spleen-stomach deficiency-cold and damp-heat syndromes. If the bleeding is bright red, with yellow tongue coating and rapid wiry pulse, it indicates that stagnant heat is forcing blood to flow abnormally; in such cases, Sanhuang Xiexin Tang can be used, supplemented with stir-fried pu huang, donkey-hide gelatin, carbonized diyu, white and sanqi, to clear heat, cool blood, and stop bleeding. If the bleeding is dark purple, with sallow complexion, cold limbs, pale tongue, and weak pulse, it indicates spleen-stomach deficiency-cold and inability of the spleen to control blood, in which case Huangtu Tang can be modified to warm the spleen, boost qi, and help control blood. If the bleeding is heavy (with black stools or vomiting), blood pressure should be monitored continuously (see chapter on “Upper Gastrointestinal Bleeding”). If symptoms such as pallor, cold extremities, cold sweat, and faint, sinking pulse appear—signs of “qi depletion” or “blood depletion”—immediate integrated Western and Chinese medical rescue is required, employing modern medical methods such as intravenous blood transfusion and fluid replacement, while traditional Chinese medicine can use Duoshen Tang: 15–30g of concentrated ginseng decoction administered via gastric tube.

III. Single Formula Treatments

(1) Xilei San: Main ingredients include bezoar, pearl layer powder, ivory shavings, indigo, and borneol, dosage is 1.6g per two capsules, taken every night before bed, one course lasts four weeks. Treatment of duodenal ulcers shows an 84% healing rate after four weeks, comparable to cimetidine, but with significantly better long-term efficacy.

(2) Shengweining: Main ingredients include raw gastric ketone, loperamide, cuttlebone, white and sanqi, golden flower, chuanxiong, and astragalus, dosage is 5–10mg each time, three to four times daily, one course lasts four weeks, with a 65.9% ulcer healing rate.

(3) Thirty grams of dried and finely ground guava, sifted, taken three times a day, nine grams each time, half an hour before meals, treats excessive gastric acid causing discomfort.

(4) One hundred and twenty grams of cuttlebone and thirty grams of amomum, ground into powder, three grams each time, taken with boiling water, treats stomach cold and regurgitation of acidic fluid.

(5) Six grams each of chebulic myrobalan, agastache rugosa, and cardamom, ground into powder, three grams each time, taken with ginger soup, treats nausea and acid regurgitation.

(6) Nine grams of cuttlebone and eighteen grams of horsetail (lightly stir-fried), combined with nine grams of chuanjun, ground into fine powder, six grams each time, taken with boiling water, morning and evening, avoid raw and spicy foods. Treats stomach pain and acid regurgitation.

(7) Four seashells, calcined on a tile and ground into fine powder, one gram each time, mixed with brown sugar and taken with boiling water, continuous use is effective, but long-term use may cause constipation, suitable for stomach pain and acid regurgitation.

(8) Several eggshells, inner membrane removed and washed clean, dried (or stir-fried until yellow), ground into fine powder, adults take three grams each time, twice daily, taken with boiling water, treats excessive gastric acid and discomfort.

(9) Eggshells plus an appropriate amount of fingerroot flowers, stir-fried until yellow and ground into fine powder, six grams each time, taken with boiling water, treats excessive gastric acid and discomfort.

(10) Equal parts of calcined oysters and calcined eggshells, ground into powder, four and a half grams each time, three times daily, treats excessive gastric acid and discomfort.

(11) Equal parts of calcined oysters and eggplant, ground into powder, nine grams each time, treats stomach pain and excessive gastric acid.

(12) Equal parts of calcined oysters and calcined stonecrop, ground into fine powder, three to six grams each time, three times daily, taken before meals, treats excessive gastric acid in ulcer patients.

(13) Calcined oysters and Chinese yam, thirty grams each, ground into fine powder, nine grams each time, three times daily, treats stomach pain and acid regurgitation.

(14) Pumpkin porridge: Five hundred grams of pumpkin and one hundred grams of japonica rice, add water as needed, cook into porridge, can be eaten as a staple food, one to two times daily, moderate diet. This is a folk remedy. According to modern medical research, the pectin in pumpkin can protect the gastrointestinal mucosa from damage caused by coarse foods, thereby promoting the healing of gastric and duodenal ulcers, while also preventing constipation.

(15) Barley rice: Two hundred and fifty grams of barley rice, add water as needed, simmer slowly until cooked, can be eaten as a staple food. The allantoin contained in barley is effective in treating ulcers, promoting the healing of suppurative wounds and stubborn ulcers.

(16) Potato honey paste: One thousand grams of fresh potatoes and an appropriate amount of honey, juice the potatoes and boil vigorously, then reduce the heat and continue simmering until thickened, add honey, simmer again until it takes the form of honey paste, cool and bottle for storage, take one tablespoon on an empty stomach twice daily, has the effect of promoting ulcer healing.

(17) Red date and glutinous rice porridge: Glutinous rice and red dates in appropriate amounts, cook into porridge. Take twice daily in moderation, consistent long-term use helps protect the ulcer surface and promotes granulation, suitable for frail patients.

(18) Ginger-leek milk soup: Two hundred and fifty grams of fresh leeks, twenty-five grams of ginger, two hundred and fifty grams of milk (or fifty grams of powdered milk dissolved in water), wash and chop the leeks and ginger, crush them thoroughly, wrap in clean gauze to extract the juice, pour into a pot, add milk, heat and boil, drink while hot, one to two times daily, ten to fifteen days constitute one course. This formula originates from “Danxi Xinfa” written by the Yuan dynasty physician Zhu Danxi, used to treat “gastric reversal,” applicable to vomiting of retained food caused by pyloric obstruction, or to epigastric pain that worsens in cold and eases in heat—a deficiency-cold syndrome.

(19) Sweet-and-salty bok choy juice: Two hundred and fifty grams of bok choy, salt and sugar in appropriate amounts. Wash and chop the bok choy, marinate with a little salt for ten minutes, then squeeze out the juice with clean gauze, add sugar as needed. Drink on an empty stomach three times daily. Functions include clearing heat, cooling blood, and stopping bleeding, suitable for those with blood stasis accompanied by minor bleeding.

(20) Sugar and lotus root juice: Five hundred grams of tender white lotus root, three grams of white and sugar in appropriate amounts. Juice the lotus root, grind the white into powder, mix with sugar, take with boiling water, twice daily. Functions include cooling blood and stopping bleeding, suitable for gastric ulcers with minor bleeding.

IV. Acupuncture Treatment

For gastric pain associated with peptic ulcers, acupuncture or moxibustion can be used to relieve pain; specific methods can be found in relevant sections such as “Acute Gastritis” and “Chronic Gastritis.”

V. Western Medical Treatment