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¡ª4 cm. Ulcer in the posterior wall may have pain
hypersensitive area on the back at T11¡ª12 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.
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