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Last update: June 25, 2011; 9 p.m. LAH

 

 

Peptic  Ulcer 胃十二指腸潰  (in English and Chinese 中英文)

   Edited by: Joe Hing Kwok Chu      按此看中文

 

To read the whole article, please click on the blue or pink underlined links, as you read along.

 

Symptoms:

a burning sensation in the upper abdomen or chest after meals or when the stomach is empty.

 For more information see under the item: Chinese herb therapy

These symptoms of peptic ulcers can also exist in:

  • GERD ( gastro-esophageal reflux disease),

  • Non-ulcer dyspepsia (chronic dyspepsia without the presence of ulcers or functional dyspepsia),

  • gallbladder disease,

  • liver disease

  • other disorders.

Causes:

Most peptic ulcers are caused by:

  1.  Primary cause:  Helicobacter pylori, a bacteria

  2.  Inducing causes:  system suppressed by stress, and/or consumption of alcohol, tobacco, aspirin,  corticosteroids, coffee and spicy food, non-steroidal anti-inflammatory drugs (NSAIDS)

  3. Secondary causes: tumors on the pancreas and duodenum.

Most people who have the infection are without symptoms, but long-term emotional stress and/or long-term consumption of aggravating substances can disrupt the protective mucus linings of the stomach and duodenum. This allows the strong digestive acid to directly contact the tissues of the stomach or duodenum and triggers ulcers.

 

H. pylori diagnosis:

1.      Tissue test: during Endoscopy small bits of tissue are removed and tested for H. pylori.

2.      Breathing test: patients are given urea orally, and an enzyme of the H. pylori breaks down the urea into carbon dioxide, which is exhaled and can be measured.

3.      Antibody test: antibodies are formed when the patient is infected with H. pylori. If in the antibody is present, it means the patient is either currently or previously infected. This test may not determine whether the patientís infection is active.

Western Treatments include :

(1) using antibiotics:

H. pylori is difficult to eradicate because it burrows deep into the mucus layers. Usually several antibiotics are used in combination, such as metronidazole (Flagyl), tetracycline (Achromycin), clarithromycin (Biaxin), or amoxicillin (Amoxil).

The side effects of antibiotic use include disruption of the balance of the beneficial bacteria (Escherichia coli, also known as E. coli). Low level of E. coli can promote  the  growth of yeast in the digestive tract, causing a yeast infection.

Bismuth subsalicylate (an active ingredient of Pepto-Bismol) also provides the effect of antibiotics  It may help to inhibit or eradicate the bacteria but it may also create the side effects like antibiotics.

(2) using anti-acid:

alkaline include sodium bicarbonate (baking soda), aluminum hydroxide, magnesium hydroxide

H2 antagonists  include Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid Pulvules), and ranitidine (Zantac)

proton pump inhibitors (PPIs) are a group of prescription medications that prevent the release of stomach acid by inhibiting the enzyme in the wall of the stomach that produces acid. PPIs include omeprazole sodium (Losec), esomeprazole sodium (Nexium), lansoprazole sodium (Zoton), pantoprazole sodium (Protium), and rabeprazole sodium (Pariet).

Common side effects of PPIs include diarrhea, nausea, constipation, abdominal pain and headache. In rare instances, side effects can also include allergic reactions, itchiness, dizziness, swollen ankles, muscle and joint pain, blurred vision, depression, dry mouth, osteoporosis and hip fracture. Long-term inhibition of digestive acid using acid neutralizers or PPIs can promote bacteria growth in the stomach and also can may interfere with calcium absorption because of insufficiency of hydrochloride acid but they also may reduce bone resorption [2] through inhibition of osteoclastic vacuolar proton pumps. See here

See this study  that shows that long-term  proton pump inhibitors (PPI) therapy, particularly at high doses, is associated with an increased risk of hip fracture.[2]

Use proton pump inhibitors with care in case of pregnancy or with liver or kidney problems.

(3) Using De-Glycerrhizinated Licorice (DGL) (Caved-S) Therapy:

Caved-S is manufactured by various pharmaceutical companies. One of its  main ingredients is the common Chinese herb gan cao (licorice,  Glycyrrhiza glabra L)  but has been deglycerrhinated, to eliminate the side effects of the glycyrrhizinic acid in the licorice which possess the effect of mineralcortical hormone.  See a study of : a two year comparison between Caved-S and cimetidine treatment in the prevention of symptomatic gastric ulcer recurrence.

Side effects of Caved-S:  can include calcium depletion through excretion (both urine and stool) caused by aluminum hydroxide, one of the components of Caved-S. Aluminum hydroxide also depletes phosphorus in the normal body, and long-term use can bring phosphorus down to an unnaturally low level which may cause adverse effect on memory..

 

Chinese herb therapy includes:    

 (click to go back to top)

I.  Ulcers of the duodenum with internal heat and fullness syndrome: burning sensation in the upper abdomen or inside chest area. Usually these symptoms are common in ulcers of the duodenum which usually occur in younger persons of 20 to 30 years old. The stomach acid secretion can be normal or increased and usually accompanied with erosive (hemorrhagic) gastritis (inflammation of the lining of the stomach).

Therapy:

huang lian jie du tang combine with shao yao gan cao tang is commonly used.

Huang lian jie du tang is also effective for bleeding of the ulcers and has been proven it can inhibit Helicobactor pylori.

II.  Ulcers of the stomach with liver and spleen inharmony or with yang deficient (yangxu) condition: mostly occur among persons of 40 to 50 years old. The stomach acid secretion can be normal or decreased and along with atrophic gastritis. Symptoms include upper abdomen achiness after meals or when stomach is empty. Sometimes it does not have any pain but only with the sensation of fullness in the upper abdomen.

Therapy:

An zhong san is commonly used but during bleeding huang lian jie du tang with adjustment can be use temporarily. For those with yang deficient. warming formulae like an zhong san, ren shen tang  or liu jun zi tang are commonly used.

The rate of success using an zhong san has been about 75%. It is about as effective as H2 antagonists.

In case of liver qi stagnation , formulae like dan zhi xiao yao san, chai hu shu gan tang are commonly used.

The long term maintenance usage of the  formula chai hu gui zhi tang  has been proven for preventing the recurring of the peptic ulcers.

It has been proven that chai hu gui zhi tang can inhibit pepsin and stomach acid secretion. It also can enhance the secretion of stomach mucus and promote blood circulation in the stomach and enhance the protection of the stomach.

Liiver qi stagnation  can lead to the inflammatory pathological changes in gastric mucosa. The reduction of concentration of free mucus, PGE2 in gastric juice and SOD, NO in gastric mucosa were one of the main pathophysiological foundations of the gastric mucosa inflammation caused by liver-qi stagnation. The herbs of relieving depressed liver can prevent and treat stomach ailment that caused by liver-qi stagnation, the inner mechanism was associated with its regulation to the aforesaid indices and its reinforce to the protective function of gastric mucosa. 【1】

Note:

Endoscopy: Using an instrument (endoscope) to look into the colon, bladder,  aesophagus or stomach. (Click to go back)

H2 antagonists inhibit histamine action on the H2 receptor of the gastric parietal cell and slow down the secrete hydrochloric acid which digests protein. (Click to go back)

Caved-S main ingredients:

Aluminum hydroxide 100 mg

Sodium bicarbonate  100 mg

Bismuth subnitrate  100 mg

Magnesium carbonate  200 mg

Deglycyrrhinated gan cao 300 mg  (Click to go back)

 

mineralcortical hormone is a hormone secreted by the adrenocortex, the outer parts of the adrenal glands that sit on top the kidneys. When this hormone is high, the body retains sodium and expels potassium. As early as 1946 gan cao extract showed the characteristics of mineralcorticoid.  Glycyrrhiza (gan cao) is metabolically converted to glycyrrhetic acid (GA). GA, when incubated in-vitro with adrenal gland cells increases production of dehydroepiandrosterone (DHEA), a precursor of androstenedione, testosterone and estrogen. (Click  to go back)

 

One of the digestive juices secreted by the stomach is hydrochloride acid which digests protein. The stomach and duodenum have linings that protect themselves from being digested. If ulcers are formed the acid gets into contact with the stomach or duodenum tissues then it will cause injuries and  pain.               (Click to go back)

Pepsin is a digestive enzyme found in gastric juice that helps the breakdown of protein to peptides (digested protein).

Superoxide dismutase (SOD) is an enzymatic antioxidant that removes the potentially toxic superoxide ion (O2- ) by dismutating it to O2 and hydrogen peroxide (H2O2).

Nitric oxide (NO): The peptic mucus produces nitric oxide (NO) which relaxes the wall of the blood vessels and promotes blood flow and help heal the peptic ulcers.
 

Bone resorption: Osteoclasts are multi-nucleated cells that perform bone resorption. Bone resorption Is the process of removing bone tissue by removing the bone's mineralized matrix.  Osteoclasts play a key role in bone-remodelling, like in forming canals and cavities, changing sizes and structure as demand arises.

(Click to go back)

 

Nonsteroidal anti-inflammatory drugs: like ibuprofen (Motrin, Advil, Rufen), diclofenac (Voltaren), etodolac (Lodine), flurbiprofen (Ansaid), ketorolac (Toradol), nabumetone (Relafen), naproxen (Naprosyn); naproxen sodium (Aleve, Anaprox, Naprelan); and oxaprozin (Daypro).                  (Click to go back)

 

Zollinger-Ellison syndrome: Tumors of the pancreas and duodenum may cause the excess production of gastrin, a hormone secreted by glands in the mucous membrane of the stomach which in turn causes the overproduction of stomach acid.                 (Click to go back)

 

Secondary causes: the sickness caused by other illnesses.   (Click to go back)

 

Dyspepsia: painful and disturbed digestion usually with nausea, vomiting, heartburn and bloating.    (Click to go back)

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The following Chinese article was written by the vice director of Xiu Chuan Memorial Hospital. (Links were added by the editor of this web page)

以下中文文章:

撰稿人:秀傳紀念醫院副院長陳明豐

消化性潰瘍 中藥治癒率高

消化性潰瘍是常令人寢食難安的毛病。根據胃鏡的檢查 ,消化性潰瘍又分為胃潰瘍及十二指腸潰瘍。

  近年來學者們更進一步發現,大部份消化性潰瘍的 患者在其胃幽門部有一種稱為幽門曲狀桿菌的感染,此細菌會分泌多種酵素及毒素侵蝕胃及十二指腸黏膜組織。

 中醫學的發展過程中並無胃鏡的發明,因此無法明確區分胃潰瘍及十二指腸潰瘍,然而根據中醫辨證理論卻往往無意中將此兩者區分出來。一般而言,十二指腸潰 瘍大多初發生於20-30歲左右的年輕人,其胃酸分泌為正常或增加,常合併糜爛性胃炎的存在。症狀 上則常表現空腹時上腹痛或胸內燒灼感,在中醫學的辨證上屬於「裏熱實證」者為多。

 另一方面,胃潰瘍則多初發於40-50歲 的中年人,其胃酸分泌正常或減少,常合併萎縮性胃炎的存在。症狀則有時為飯後上腹痛或空腹時上腹痛,有些則完全沒有疼痛,只感覺上腹部膨滿感。在中醫學的 辨證上屬於「肝脾失和症」或「裏寒虛症」者為多。

 由於辨證上的差異,十二指腸潰瘍的治療以黃 連解毒湯合併芍藥甘草湯為最常用方劑。黃 連解毒湯對胃出血也有一定效果,並且被證實對幽門曲狀桿菌有一定的抑制作用 。另一方面,胃潰瘍的治療以四逆散為最常使用的中藥方劑,少數於急性期合併出血時可短暫使用黃 連解毒湯加 減。對體質特別虛冷的患者而言,則必須選擇 安中散人參湯六君子湯等具溫補性的方劑。 四逆散治 療胃潰瘍的成功率高達百分之75左右,略遜於H2阻斷劑及質子幫浦阻斷劑。

 對於已經瘢痕化的消化性潰瘍而言,柴 胡桂枝湯的長期服用已被證實可以減低潰瘍復發的可能性。根據研究,以柴胡桂枝湯合併少量H2受 體阻斷劑比單獨服用H2 受體阻斷劑,其潰瘍復發率減少一半以上。在基礎醫學的實驗上,柴 胡桂枝湯已被證實可以抑制胃酸及胃蛋白脢的分泌,而也可以增加胃黏液的分泌及促進胃血流,提高胃壁保護能力。

撰稿人:秀傳紀念醫院副院長陳明豐

注:連線為 編譯者所加入,以方便同學們參考。
 

肝氣鬱結者,可用丹梔逍遙散,  柴胡疏肝湯

肝鬰可致胃黏膜產生炎性改變。胃液游離黏液量,PGE2含量及胃黏膜組織SODNO 平降低,是肝鬰引起胃黏膜炎 症的病理生理基礎之一。疏肝解鬰 中藥可有效預防肝鬰及胃病理 變化產生,內在機制與其能夠調節上述指標,增強胃黏膜防御保護機能有關。

【1】遼寧中醫雜誌 34卷2期(2007/02) 229-232.

【2】 http://jama.ama-assn.org/cgi/content/abstract/296/24/2947

編者注:

  • 肝 脾失和 癥狀為:腹中拘急疼 痛, 喜溫喜按, 神疲乏力,虛怯少氣, 面色無華 , 或:心中動悸,虛煩不寧,或:四肢酸楚,手足煩熱, 咽干口燥 , 舌淡,苔白, 脈細弦 。

  • 裏寒虛症 」即為陽 虛,指機能減退的症候群。如畏寒肢冷,喜臥少立。

  •  氧化物歧化酶 (SOD) 是生物體內清除超氧陰離子自由基的一種重要酶,它能有效地使機體抗禦氧自由基的毒性。它能將超 氧陰離子自由基分解為氧與雙氧水。

  • 胃粘液產 生一氧化氮 而將血管壁放鬆增加血液流通量,而促進胃潰瘍之修復。


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