Peptic Ulcer
胃脘痛 · wèi wǎn tòng+13 other namesHide other names
Also known as: Peptic Ulcers, Peptic ulcer disease, Gastric or duodenal ulcer, Peptic Ulcer Bleeding, Bleeding Gastric Ulcer, Bleeding In Peptic Ulcers, Ulcerative Hemorrhage, Bleeding Peptic Ulcer, Bleeding Stomach Sore, Hemorrhaging Gastric Ulcer, Ulcerative Hemorrhage In The Digestive Tract, Peptic Ulcer with Fluid Retention, Gastric or duodenal ulcer with fluid retention
The type of pain you feel - dull and cold, burning and gnawing, or stabbing and fixed - is the map that tells a TCM practitioner which pattern is driving your ulcer. Most patients see significant pain relief within 2-4 weeks, with the goal of healing the ulcer and preventing recurrence by correcting the root imbalance over 2-3 months.
About this page · what it is and isn't
What this is. A plain-English synthesis of how classical TCM and modern clinical research describe peptic ulcer. Patterns and herbs come from canonical TCM sources; clinical claims are cited in the Evidence section.
What it isn't. A diagnosis. Me&Qi is an editorial team, not a licensed clinic. The pattern quiz is a thinking tool — pulse and tongue still need a person in the room. Anything in the Safety section should send you to a doctor, not a herb.
Last reviewed Jun 2026.
Educational content about Traditional Chinese Medicine — not medical advice. See a qualified practitioner for diagnosis and treatment.
Peptic ulcer isn't a single condition in TCM - it's a family of seven distinct patterns, each with its own cause, its own characteristic pain, and its own treatment. Whether your pain is dull and better with warmth, burning and gnawing, or sharp and stabbing after a cold drink points to a different underlying imbalance. TCM doesn't just suppress stomach acid; it restores the stomach's natural ability to protect itself by addressing the root cause - emotional stress, dietary habits, or constitutional weakness. The right treatment depends on identifying which pattern is driving your ulcer.
Peptic ulcers are open sores that develop on the lining of the stomach or the upper part of the small intestine (duodenum). The most common cause is infection with Helicobacter pylori bacteria, followed by long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. The hallmark symptom is a burning or gnawing pain in the upper abdomen, often between meals or at night, that may temporarily improve with eating or antacids. Diagnosis is typically confirmed via endoscopy or tests for H. pylori.
Conventional treatments
Standard treatment involves a combination of antibiotics to eradicate H. pylori if present, and medications that reduce stomach acid production - proton pump inhibitors (PPIs) like omeprazole, or H2-receptor blockers. Antacids may provide short-term symptom relief. Patients are also advised to avoid NSAIDs, alcohol, and smoking. In severe cases, endoscopic procedures or surgery may be needed for bleeding or perforation.
Where conventional treatment falls short
While acid suppression and antibiotics heal many ulcers, recurrence is common after treatment stops, especially if lifestyle or dietary factors aren't addressed. PPIs can cause side effects with long-term use, including nutrient malabsorption and increased infection risk. The conventional approach also doesn't differentiate between the type of pain - dull, burning, stabbing - or its triggers, treating all ulcers with a one-size-fits-all protocol. TCM's pattern-based approach aims to strengthen the stomach lining and prevent recurrence by correcting the underlying imbalance that allowed the ulcer to form.
How TCM understands peptic ulcer
In TCM, the Stomach is the 'sea of grain and water,' responsible for receiving food and sending it downward. When its Qi flows smoothly downward, digestion is comfortable. But if something blocks that downward movement - whether emotional stress, cold, or undigested food - Qi stagnates and rises, causing pain, bloating, and acid reflux. An ulcer is seen not just as a physical sore, but as a sign that the Stomach's ecosystem is out of balance.
The Liver plays a central role because it controls the smooth flow of Qi throughout the body, including the Stomach's downward movement. Emotional stress, frustration, or chronic anger can cause Liver Qi to stagnate, which then 'invades' the Stomach (wood overacting on earth). This is why stress is a major trigger for ulcer pain - it directly disrupts the Stomach's rhythm, leading to distending pain that radiates to the ribs, belching, and acid reflux.
On the other hand, when the Stomach's warming Yang is deficient - from chronic illness, aging, or overconsumption of cold foods - the digestive fire weakens. Cold accumulates, congealing Qi and Blood, producing a dull, constant ache that feels better with warmth and gentle pressure. This pattern is like a fire that's gone out; the Stomach can't process food properly, leading to poor appetite and loose stools.
Diet is another major factor. Overeating, eating too quickly, or consuming greasy, spicy, or sugary foods can overwhelm the Spleen and Stomach, creating Dampness and Heat. This Damp-Heat smolders in the stomach lining, causing burning pain, a sticky bitter taste, and a thick yellow tongue coating. Similarly, acute food stagnation from a heavy meal can cause sudden bloating, sour belching, and relief only after vomiting - a temporary but intense pattern.
In chronic cases, long-standing inflammation can consume the Stomach's Yin, the moistening and nourishing aspect. This leaves the stomach lining dry and vulnerable to 'empty heat,' causing a burning hunger-pain that's worse with eating. When Qi stagnation or Cold persists for years, Blood flow slows and congeals, leading to fixed, stabbing pain - a sign of deeper damage that requires moving Blood and healing the tissue.
「心下满而痛者，此为结胸也，大陷胸汤主之。但满而不痛者，此为痞，柴胡不中与之，宜半夏泻心汤。」
"When there is fullness and pain below the heart, this is a chest bind disorder and Da Xian Xiong Tang governs it. When there is only fullness without pain, this is glomus; Chai Hu is not appropriate, and Ban Xia Xie Xin Tang is suitable. This passage distinguishes epigastric pain from simple bloating, guiding the treatment of peptic ulcer-like conditions."
How a TCM practitioner diagnoses peptic ulcer
Inside the consultation
A TCM practitioner first explores the character of the epigastric pain-whether it is sharp, dull, burning, or stabbing-and what makes it better or worse. The timing, dietary triggers, emotional state, and sensations like cold or heat are the first clues that guide the diagnosis toward one of several distinct patterns.
When the pain is a dull ache that feels better with warmth and gentle pressure, and worsens after cold food or fatigue, Stomach Yang Deficient and Cold is likely. The person often feels chilly, has loose stools, and shows a pale tongue with a white coating and a deep, slow pulse.
If the discomfort is a burning sensation with a feeling of hunger that is not relieved by eating, accompanied by dry mouth and a red tongue with little or no coating, Stomach Yin Deficiency is the picture. This pattern often develops after long-standing inflammation that has consumed the stomach’s moistening fluids.
A sudden, sharp pain that strikes right after exposure to cold or drinking iced beverages, and eases with a hot compress, signals Cold invading the Stomach. The tongue coating is white, the pulse is tight, and the pain is intense but transient-it reflects a temporary congelation of Stomach Qi.
When the pain is linked to emotional stress, with distension and belching that may radiate to the sides of the ribs, Liver Qi Stagnation invading the Stomach is the key pattern. The tongue looks normal or has a thin white coating, and the pulse feels wiry, especially on the left side.
If the epigastric area feels full and distended, with sour regurgitation, a thick greasy tongue coating, and pain that improves after vomiting, Food Stagnation in the Stomach is present. This pattern follows overeating or eating rich, hard-to-digest foods, and the pulse often feels slippery.
A heavy, burning pain with nausea, a bitter taste, and a sensation of fullness that does not ease after bowel movements points to Damp-Heat in Stomach and Spleen. The tongue is red with a thick, yellow, greasy coating, and the pulse is rapid and slippery, reflecting inflammation and fluid retention in the middle burner.
When the pain is fixed, stabbing, and worse at night, and may be accompanied by dark, tarry stools, Stomach Blood Stagnation has developed. The tongue appears purple or has dark spots, and the pulse feels choppy. This pattern often arises from long-term Qi stagnation or chronic ulceration.
TCM Patterns for Peptic Ulcer
In TCM, the aim is to address the root cause, not just the symptom — it calls that root cause a “pattern.” The same peptic ulcer can come from several different patterns, each treated differently. The quickest way to find yours is the quiz below.
Find your pattern
Tap any sign that fits how yours feels.
- 1Your signs
- 2What makes it worse
- 3What helps
Which signs match your experience?
It is common to see a blend of patterns, especially in chronic peptic ulcers. For example, long-standing emotional stress may start as Liver Qi Stagnation and gradually lead to Blood Stagnation, while a weak digestive system can produce both Yang deficiency and occasional food stagnation. Overlap is the rule, not the exception.
To narrow things down, focus on the dominant sensation and what changes it. A pain that reliably eases with a warm drink and pressure leans toward a cold or deficiency pattern, whereas a pain that flares with spicy food, alcohol, or stress suggests heat or stagnation. Notice whether the tongue is pale or red, thickly coated or dry-these clues help distinguish deficiency from excess.
Because patterns can shift and mix, a professional diagnosis with tongue and pulse examination is invaluable. If the pain is severe, persistent, or accompanied by black stools, vomiting blood, or unintended weight loss, see a practitioner immediately. Self-treatment can mask serious complications.
Even when patterns overlap, TCM treatment is tailored to the dominant disharmony. A practitioner can safely combine strategies-for instance, moving Qi while gently warming the middle-and adjust as the pattern evolves, something that is difficult to do on your own.
Liver Qi Stagnation invading the Stomach
Cold invading the Stomach
Stomach Yin Deficiency
Stomach Blood Stagnation
Treatment
Four ways to address peptic ulcer in TCM — explore each, or take the quiz to see what fits you first.
Formulas traditionally used for peptic ulcer
10 formulas across the patterns above. The right one depends on your pattern — start with the quiz if you're unsure which fits.
A classical formula for people experiencing rib-side or chest pain, emotional frustration, irritability, sighing, and bloating caused by stagnation of Liver Qi. It works by smoothing the flow of Liver Qi, relieving tension, and gently moving blood to stop pain. It is one of the most widely used formulas for stress-related digestive and emotional complaints.
A warming, strengthening formula for people with chronic weakness, fatigue, and digestive discomfort marked by abdominal cramping, poor appetite, and spontaneous sweating. It gently rebuilds the body's core digestive strength and Qi, making it especially well suited for long-standing stomach problems with cold sensitivity and general exhaustion.
A classical formula for treating acute digestive upsets caused by a combination of Dampness and Heat lodging in the Stomach and intestines. It addresses simultaneous vomiting and diarrhea, a feeling of fullness and stuffiness in the chest and upper abdomen, irritability, and dark scanty urine, particularly during hot and humid seasons.
A classical formula used to clear Heat and resolve Phlegm that is disturbing the mind and digestive system. It is commonly used for insomnia, restlessness, nausea, and a bitter taste in the mouth caused by the accumulation of Phlegm-Heat in the Gallbladder and Stomach. Think of it as a formula that calms both an agitated mind and an upset stomach by addressing the underlying combination of inflammatory Heat and sticky Phlegm.
A gentle, time-tested formula for the uncomfortable, heavy feeling after overeating or consuming rich, greasy foods. It helps break down accumulated food, relieves bloating, acid reflux, nausea, and belching, and restores normal digestive movement. Often described as 'digestive first aid' in Chinese medicine, it works by clearing the blockage rather than masking symptoms.
A simple two-herb classical formula used to warm the stomach and move stagnant Qi, relieving cold-type stomach pain, bloating, acid regurgitation, and menstrual cramps. It is especially suited to pain that feels better with warmth and is triggered by cold exposure or emotional stress.
A classical formula designed to deeply nourish and moisten the Liver and Kidneys while gently restoring the smooth flow of Liver Qi. It is used for people experiencing rib-side or chest pain, acid reflux, bitter taste in the mouth, dry throat, and emotional tension that arise when the body's fluids and blood become depleted, leaving the Liver dry and unable to function smoothly.
A remarkably simple two-herb classical formula used to relieve muscle cramps, spasms, and cramping pain throughout the body. It works by nourishing the Blood and Yin fluids that keep muscles and tendons supple, while directly relaxing tense, spasming tissues. Originally created to treat leg cramps so effectively that it earned the nickname 'Cast Away the Walking Stick Decoction.'
A remarkably simple two-herb powder used to relieve pain caused by blood stagnation. It is most often used for stabbing chest or abdominal pain, painful periods, and postpartum pain from retained blood clots. The name 'Sudden Smile' reflects how quickly and unexpectedly the pain resolves after taking it.
A simple three-herb formula used to relieve chest and stomach pain caused by poor blood circulation and stagnant Qi. It works by promoting blood flow and easing Qi movement in the chest and abdomen. The source text notes it is especially effective for women.
Acute patterns like Cold invading the Stomach or Food Stagnation often resolve within days to a week with herbs and dietary adjustment. Liver Qi Stagnation and Damp-Heat patterns typically improve within 2-4 weeks of consistent treatment. Deficiency patterns - Stomach Yang or Yin Deficiency - require longer, often 2-3 months, to rebuild the stomach's reserves and prevent recurrence. Blood Stagnation takes the longest, as moving congealed Blood is a gradual process, but pain relief can still begin within a few weeks.
Treatment principles
The overarching principle in treating peptic ulcers is to restore the Stomach's normal downward movement and heal the mucosal lining. This is achieved by addressing the specific pathogenic factor - whether it's moving stagnant Liver Qi, warming Cold, clearing Damp-Heat, dispersing Food, or nourishing Yin. Many patients have mixed patterns, so treatment often combines strategies: for example, soothing the Liver while also warming the middle burner. Acupuncture and herbs work together to regulate Qi, reduce inflammation, and promote tissue repair.
What to expect from treatment
Most patients notice a reduction in pain and bloating within the first 1-2 weeks of herbal treatment, and acupuncture can provide immediate relief during a session. Weekly acupuncture sessions are typical for the first 4-6 weeks, along with daily herbal formulas. As symptoms improve, session frequency decreases. Dietary adjustments and stress management are essential for lasting results. The ulcer itself can heal within 4-8 weeks in many cases, but constitutional work continues to prevent recurrence.
General dietary guidance
Eat warm, cooked, easily digestible foods like congee, soups, and steamed vegetables. Avoid raw, cold, and icy foods and drinks, which constrict the stomach and impair digestion. Greasy, fried, spicy, and overly sweet foods create Dampness and Heat and should be minimized. Eat at regular times, chew thoroughly, and stop when 70% full. Avoid eating late at night or while stressed. Ginger tea can be helpful for cold-type pain, but avoid it if you have burning sensations.
Combining TCM with conventional treatment
TCM treatment can safely complement conventional ulcer therapy. If you are taking antibiotics for H. pylori, continue them as prescribed; herbs can support digestion and reduce side effects. For patients on PPIs, TCM may help reduce dependency over time, but never stop PPIs abruptly - work with your doctor to taper. Certain herbs like Gan Cao (licorice) can raise blood pressure with prolonged use, so monitor if you have hypertension. Always inform both your TCM practitioner and your doctor about all medications and supplements you are taking.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Safety & special considerations
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Sudden, severe abdominal pain that is unlike your usual ulcer pain — Could indicate a perforated ulcer, which is a medical emergency.
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Vomiting blood or material that looks like coffee grounds — Sign of active bleeding in the stomach that needs immediate evaluation.
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Black, tarry stools — Indicates digested blood from an upper gastrointestinal bleed.
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Unexplained weight loss — May signal a more serious underlying condition requiring investigation.
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Difficulty swallowing or feeling that food is getting stuck — Could point to a stricture or other complication that needs endoscopy.
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Rigid, board-like abdomen with severe pain and fever — Suggests peritonitis from a perforated ulcer - seek emergency care immediately.
Audience-specific guidance — open what applies to you
During pregnancy, the growing fetus can press on the Stomach and the emotional shifts often exacerbate Liver Qi stagnation, making this pattern more prominent. However, many of the potent Qi-moving and blood-invigorating herbs used for peptic ulcer - such as Chuan Xiong, Zhi Ke in large doses, and Wu Ling Zhi - are restricted or used with extreme caution during pregnancy. Practitioners typically modify formulas like Chai Hu Shu Gan San by removing or reducing these ingredients and relying more heavily on gentle herbs like Bai Shao and Gan Cao to soothe the Liver without risking the pregnancy.
Acupuncture is often the preferred first-line treatment in the first trimester, with careful avoidance of points known to stimulate uterine contractions, such as Hegu LI-4 and Sanyinjiao SP-6. Points like Neiguan PC-6 and Zusanli ST-36 are safe and effective for harmonising the Stomach and calming the mind. Any herbal treatment should be prescribed only by a practitioner experienced in pregnancy care.
Most herbs used for peptic ulcer are considered safe during breastfeeding, but bitter-cold substances like Huang Lian can pass into breast milk and may cause loose stools or colic in the infant. For a Damp-Heat pattern, a practitioner might substitute milder heat-clearing herbs or rely primarily on acupuncture and dietary therapy. Formulas that strongly move Qi or invigorate Blood are also used cautiously to avoid drying up milk supply or affecting the baby. Acupuncture remains an excellent, drug-free option throughout breastfeeding.
Peptic ulcer is less common in children but can occur, often presenting as vague abdominal pain, poor appetite, or irritability after eating. The Food Stagnation pattern is far more frequent than in adults, as children’s immature digestive systems are easily overwhelmed by overeating or rich snacks. A modified Bao He Wan at a fraction of the adult dose - usually one-quarter to one-half, depending on age and weight - is often the key to resolving the discomfort and protecting the developing Stomach lining.
Diagnosis relies heavily on parental observation of eating habits, bowel movements, and sleep, since young children cannot articulate the quality of their pain. Tongue examination is especially valuable: a thick, greasy coating points to food stagnation, while a pale, puffy tongue suggests underlying Spleen deficiency that predisposes the child to the condition. Pediatric treatment is generally gentler and shorter in duration, with a strong emphasis on dietary correction.
In older adults, peptic ulcer is almost always rooted in deficiency - either Stomach Yang Deficiency with its dull, cold pain, or Stomach Yin Deficiency with its burning, hungry discomfort. The body’s ability to repair the stomach lining weakens with age, so treatment timelines are longer and herbal dosages are typically reduced to about two-thirds of the standard adult dose to avoid burdening a slower metabolism. Polypharmacy is a real concern, and TCM practitioners must coordinate with the patient’s medical team to avoid herb-drug interactions, especially with blood thinners and acid-suppressing medications.
Acupuncture and moxibustion are particularly well-tolerated in the elderly. Warming techniques on points like Zhongwan REN-12 and Zusanli ST-36 can gently restore digestive fire without the side effects of oral medication. Lifestyle adjustments - small, warm, easy-to-digest meals and regular rest - are just as important as the treatment itself.
Evidence & references
Acupuncture for peptic ulcer has been studied in several randomized controlled trials, with evidence suggesting it can reduce pain and promote ulcer healing, especially when combined with conventional medication. A 2016 systematic review and meta-analysis found that acupuncture was superior to standard drug therapy in improving the total effective rate and reducing recurrence, though the authors noted that many included studies were of low methodological quality and at high risk of bias.
Chinese herbal medicine also shows promise. Formulas like Chai Hu Shu Gan San and Huang Qi Jian Zhong Tang have been investigated in Chinese-language trials, often demonstrating high rates of symptom relief and Helicobacter pylori clearance. However, the evidence base is limited by small sample sizes and a lack of rigorous placebo controls. More high-quality, multi-center trials are needed before definitive conclusions can be drawn for a Western medical audience.
Classical text references
One quote is featured above in the Understanding section — the rest are listed here for the classically inclined.
「胃脘当心而痛，上支两胁，膈咽不通，食饮不下。」
"The stomach duct causes pain right at the heart area, with distension radiating to both flanks, blockage of the diaphragm and throat, and inability to swallow food or drink. This is one of the earliest classical descriptions of epigastric pain resembling peptic ulcer, linking it to Stomach Qi obstruction."
Ling Shu (The Spiritual Pivot)
Chapter 4: The Evil Qi and the Form of the Zang-Fu Organs
Frequently asked questions
Common questions about using Traditional Chinese Medicine for peptic ulcer.
If your ulcer is caused by H. pylori, antibiotics are the standard of care to eradicate the infection. TCM can support this process by reducing inflammation, protecting the stomach lining, and alleviating side effects like nausea and diarrhea. In cases where ulcers are primarily due to NSAID use or stress, TCM alone can often heal the ulcer by addressing the root imbalance. Always complete any prescribed antibiotic course, and discuss integrating herbs with your doctor.
Acupuncture works by regulating the nervous system and improving blood flow to the stomach lining, which promotes healing and reduces pain. Specific points on the abdomen, legs, and arms are used to calm the Stomach, move stagnant Qi, and harmonize the Liver. Many patients feel immediate relief from bloating and cramping during a session. Regular treatments also help manage stress, a key trigger for ulcer flares.
Yes, dietary adjustments are a cornerstone of TCM ulcer treatment. The general rule is to eat warm, cooked, easy-to-digest foods and avoid raw, cold, greasy, and spicy items that burden the Stomach. Specific recommendations depend on your pattern - for example, ginger tea may help Cold patterns but aggravate Heat patterns. Your practitioner will give you tailored guidance, but even basic changes often bring rapid relief.
Generally, yes. Many patients use herbs alongside acid-suppressing medications without issue. However, some herbs like licorice root (Gan Cao) can affect blood pressure and potassium levels with prolonged use, so monitoring is important. Always tell both your TCM practitioner and your doctor about all medications and supplements you're taking. Never stop PPIs abruptly - work with your doctor to taper if you wish to reduce dependency.
Most people notice a reduction in pain and bloating within the first 1-2 weeks of herbs and acupuncture. Acute patterns like Food Stagnation or Cold Invasion may resolve in days. Chronic patterns, especially those involving deficiency or Blood stasis, take longer - often 2-3 months for lasting change. The ulcer itself can heal in 4-8 weeks, but continued treatment strengthens the stomach to prevent recurrence.
From a TCM perspective, absolutely. Stress and unexpressed emotions cause the Liver Qi to stagnate, which then disrupts the Stomach's function - a classic 'Liver invading Stomach' pattern. This leads to the distending pain, acid reflux, and bloating that many ulcer patients know well. Managing stress through acupuncture, herbs, and mind-body practices is often just as important as dietary changes.
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