Diagnosis and Treatment of Peptic Ulcer with Integrated Chinese and Western Medicine

Peptic ulcer is a common disease characterized by chronic ulcers forming in the mucosa of the stomach and duodenum. It often recurs and follows a chronic course, and its occurrence is related to the digestive action of gastric juice—hence the name peptic ulcer. Among peptic ulcers, duodenal ulcers account for 70%, gastric ulcers about 25%, and complex ulcers in which both coexist about 5%. The disease is most common in young and middle-aged adults, and is more common in men than in women. Its TCM disease names include “rebellious stomach” (fanwei), “stomach rebellion” (weiwei), “stomach distention” (weizhang), “stomachache” (weitong), and “coarse clamor” (zaocao).

The main clinical symptoms of peptic ulcer are periodic epigastric pain, acid regurgitation, and belching; severe cases may also develop upper gastrointestinal bleeding, gastric perforation, duodenal perforation, and pyloric stenosis.

Upper gastrointestinal bleeding is the most common complication of peptic ulcer, occurring in about 10%–35% of peptic ulcer patients. Bleeding is mainly caused by the rupture of capillaries or larger blood vessels at the base of the ulcer. The former causes only slight bleeding, which is hard to see with the naked eye and must be confirmed by a fecal occult-blood test; the latter causes larger-volume bleeding, and the patient may present with hematemesis (vomitus the color of coffee grounds) and melena (tarry stools).

Perforation may occur in about 5% of peptic ulcer patients, and duodenal ulcer patients are more prone to it; after perforation, leakage of gastrointestinal contents into the abdominal cavity causes peritonitis. Patients with perforation require hospitalization; severe perforations are life-threatening and require surgery.

Pyloric stenosis is relatively uncommon, occurring in only about 3% of patients. It is caused by congestion and edema at the ulcer site, spasmodic contraction of the muscle, and the formation of a large amount of scar tissue from a long-unhealed ulcer. Pyloric stenosis makes it hard for gastric contents to pass, secondarily causing gastric dilation and repeated vomiting; in TCM this belongs to “rebellious stomach” (fanwei) or “stomach rebellion” (weiwei).

Gastric ulcer is a precancerous lesion of gastric cancer; about 1% of gastric ulcer patients eventually develop gastric cancer, but duodenal ulcer basically never becomes cancerous. Gastric ulcers are generally solitary, round or oval, mostly within 2 cm in diameter, knife-cut in appearance, with a flat, clean base. If the ulcer is irregular in shape or appears umbonate or cauliflower-like with a dirty surface, further biopsy should be performed to determine whether cancerous transformation has occurred. Duodenal ulcers are generally smaller, within 1 cm in diameter, shallower, and easy to heal.

Periodic epigastric pain is the main clinical feature of ulcer disease. Pain in gastric ulcer patients often occurs half an hour to an hour after eating, related to food-stimulated gastrin secretion of gastric acid. Pain in duodenal ulcer patients often occurs 3–4 hours after a meal, presenting as empty-stomach pain and nocturnal pain. Ulcer pain is often triggered or worsened by emotional stress, overwork, irregular diet, or sudden changes in climate.

The causes of peptic ulcer are mainly related to Helicobacter pylori infection, the digestive action of gastric juice, reduced mucosal anti-digestive capacity, neuroendocrine dysfunction, and genetic factors, but the most important cause is Helicobacter pylori infection.

About 84% of gastric ulcer patients have Helicobacter pylori infection, and 95% of duodenal ulcer patients have it. If examination confirms H. pylori infection, triple or quadruple therapy to eradicate H. pylori should be used; once eradication is achieved, the peptic ulcer often also heals.

Routine methods for checking H. pylori mainly include the carbon-13 or carbon-14 breath test and gastroscopy; these must be scheduled in the gastroenterology department, and fasting and water deprivation should begin from the night before the test.

TCM treatment of peptic ulcer follows the principle of treatment based on pattern differentiation, mainly choosing a treatment plan according to the patient's symptoms. Patients with rebellious stomach use Zuojin Wan, Daizhe Xuanfu Tang (Inula and Haematite Decoction), Dingdong Shidi San, or Jupi Zhuru Tang; patients with acid regurgitation use Wu Ji San; patients with stomachache use Shaoyao Gancao Tang (Peony and Licorice Decoction), and so on.

The above formulas can relieve the corresponding symptoms, but at present there is no TCM method that can definitively eradicate H. pylori, so H. pylori-positive patients are not advised to use TCM to eradicate H. pylori. H. pylori-infected patients should use Western triple or quadruple therapy; after H. pylori is eradicated, if symptoms remain, they can be treated through TCM pattern differentiation.

My own empirical formula for treating peptic ulcer, “Wei An San” (Stomach-Powder), is composed as follows: Baiji (Bletillae Rhizoma) 50 g, Wuzeigu (Endoconcha Sepiae) 50 g, Baishao (Paeoniae Alba Radix) 30 g, Sheng Gancao (raw Glycyrrhizae Radix) 30 g, Huanglian (Coptidis Rhizoma) 15 g, Rougui (Cinnamomi Cortex) 15 g, Wuzhuyu (Evodiae Fructus) 15 g, Xuanfuhua (Inulae Flos) 15 g. The above herbs are ground together into powder.

Each time take 3–6 g of the above powder, dissolved in warm boiled water, 2–3 times a day, taken after meals, or made into pills and swallowed. The above formula can basically relieve the various symptoms of peptic ulcer, quickly repair the ulcer surface, and has a hemostatic effect, but it does not have the effect of eradicating H. pylori.