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¡úpain¡úremission, while in duodenal ulcer the rule is pain¡úfood intake¡úremission. 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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