My Proven Formula for Peptic Ulcer: Modified Wuji Tang

Peptic ulcer is a common digestive tract disease; it may be primary, secondary, or in some cases iatrogenic. Among them, patients with iatrogenic peptic ulcer are mostly chronic disease patients requiring long-term treatment. Some chronic disease patients develop gastric ulcer and reflux esophagitis during a certain course of treatment because of the irritant effect of the drugs used — for example, cancer patients receiving chemotherapy or oral targeted drugs, or patients with hypertension or thrombotic diseases taking oral thrombolytic drugs, are prone to developing gastric ulcer due to drug side effects.

Patients with peptic ulcer usually present with the following features: stomach pain, heartburn (a burning sensation in the stomach), acid regurgitation, reflux, nausea, vomiting, a foreign-body sensation in the throat, abdominal bloating, insomnia, loose stools or constipation. In TCM this disease is mostly categorized as stomach heat, gastric burning, or plum-pit qi (mei-he-qi). Traditional TCM mostly treats it with formulas such as Wuji San, Zuojin Wan and Wumei Wan, which indeed have good efficacy.

Western medicine treats such diseases mainly with H2 receptor antagonists (H2RA), proton pump inhibitors (PPI) and potassium-competitive acid blockers (P-CAB). Commonly used H2 receptor antagonists include cimetidine, ranitidine and famotidine. They reduce gastric acid secretion by blocking the H2 receptors on gastric parietal cells and can inhibit 50%–70% of basal acid secretion. Commonly used proton pump inhibitors include omeprazole, esomeprazole and rabeprazole. Proton pump inhibitors act on the final step of acid secretion; by binding irreversibly to the proton pump they suppress acid secretion, and must be taken half an hour to one hour before meals. Potassium-competitive acid blockers are a new class of acid-suppressing drugs of the 21st century; representative drugs include vonoprazan and tegoprazan. P-CABs can bind both resting and active proton pumps, have rapid onset, strong and long-lasting acid suppression, and are unaffected by meals.

In my clinical practice, I have combined several classical TCM formulas for digestive tract diseases and, integrating modern pathological and pharmacological research, devised an experienced formula of my own: "Jiawei Wuji Tang" (Modified Bletilla-Cuttlebone Decoction). Its composition is: Endoconcha Sepiae (Wuzeigu) 15 g, Rhizoma Bletillae (Baiji) 15 g, Caulis Bambusae in Taeniam (Zhuru) 6 g, Pericarpium Citri Reticulatae (Chenpi) 6 g, Flos Caryophylli (Dingxiang) 6 g, Calyx Kaki (Shidi) 6 g, Folium Eriobotryae (Pipa Ye) 6 g, Poria (Fuling) 9 g, Fructus Evodiae (Wuzhuyu) 6 g, Rhizoma Coptidis (Huanglian) 6 g. If the patient has severe nighttime insomnia, add Herba Ecliptae (Mohanlian) 9 g, Fructus Ligustri Lucidi (Nüzhenzi) 9 g, Semen Ziziphi Spinosae (Suanzaoren) 15 g, and Semen Platycladi (Baiziren) 9 g. For a dry mouth and throat, add Radix Ophiopogonis (Maidong) 10–15 g and Fructus Mume (Wumei) 10–30 g.

The above is the adult one-day dose; decoct in water, one dose daily, taken in 2–3 divided doses, before or after meals. If the patient needs long-term medication, the formula can be prepared in proportion and made into a powder or pills for use. While taking the medicine, avoid pickled foods, spicy foods, hotpot and grilled foods, and abstain entirely from alcoholic beverages.

In clinical practice this formula has good efficacy: it can quickly repair the patient's digestive tract ulcer, suppress excessive gastric acid secretion, and rapidly improve the patient's nausea, vomiting, stomach pain, abdominal distension and other symptoms.

This formula combines classical formulas including Wuji San (composed of cuttlebone and Bletilla), Zuojin Wan (Coptis and Evodia), Dingxiang Shidi San (clove and persimmon calyx), and Juhong Zhuru Tang (Citrus Reticulata, Bamboo Shavings, Jujube, Ginseng, Licorice and Ginger), with corresponding herbs added or subtracted.

The Bletilla in the formula has a powerful effect in repairing the digestive mucosa; cuttlebone neutralizes gastric acid; Coptis has a broad-spectrum therapeutic effect on digestive tract inflammation; Evodia, Clove, Persimmon Calyx, Citrus Reticulata, Bamboo Shavings and Loquat Leaf all descend counterflow and stop vomiting; Poria drains dampness and fortifies the spleen. So whether viewed from the perspective of traditional TCM or modern pharmacology, this is a formula well targeted at peptic ulcer.

But this formula is the opposite of thrombolytic agents; patients with thrombotic diseases (such as cerebral infarction, lower-extremity venous thrombosis, coronary thrombosis, etc.) should have their condition comprehensively assessed by a clinician before deciding whether to use it.