Gastric Ulcer
胃疡 · wèi yáng+4 other namesHide other names
Also known as: Gastric Ulcers, Stomach Ulcer, Stomach Ulcers, Ulceration In The Stomach
Not all stomach ulcers are the same. The stress-triggered ulcer with distension and belching, the cold-type ulcer that feels better with a hot water bottle, and the gnawing, dry-mouth ulcer from depleted stomach fluids are three fundamentally different patterns - each with its own treatment. Most patients see significant pain relief within 2-4 weeks and sustained healing within 6-12 weeks when the correct pattern is addressed.
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 gastric 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.
Stomach ulcers aren't a single condition in TCM - they're a family of distinct patterns, each with its own cause, its own characteristic pain, and its own treatment.
Some are driven by stress and emotional tension, others by weak digestion and cold, and still others by heat and dampness from rich foods. This is why two people with the same Western diagnosis can need completely different herbal formulas and acupuncture strategies. Below, we walk through the patterns a TCM practitioner looks for, so you can understand the root of your ulcer and what real healing looks like.
A gastric ulcer is an open sore in the lining of the stomach. In conventional medicine, it's most commonly caused by infection with Helicobacter pylori bacteria or long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. The hallmark symptom is a burning or gnawing pain in the upper abdomen, often occurring between meals or at night, and sometimes relieved by eating or antacids.
Diagnosis is typically made through endoscopy, where a camera is passed down the throat to directly view the ulcer and take biopsies. While acid-suppressing medications can heal the ulcer, the underlying vulnerability of the stomach lining often remains.
Conventional treatments
Standard treatment includes proton pump inhibitors (PPIs) like omeprazole to reduce stomach acid, along with antibiotics if H. pylori is present. Antacids or H2 blockers may provide symptom relief. Patients are advised to avoid NSAIDs, alcohol, and spicy foods. Treatment usually lasts 4-8 weeks, and repeat endoscopy may be done to confirm healing.
Where conventional treatment falls short
While PPIs are effective at healing ulcers, they do not address the underlying susceptibility that allowed the ulcer to form. Recurrence is common after stopping medication, especially if the root triggers - stress, dietary habits, or constitutional weakness - remain unchanged. Long-term PPI use has been linked to nutrient malabsorption, gut flora disruption, and increased risk of certain infections. Crucially, the conventional approach treats all ulcers as fundamentally similar, whereas TCM recognizes that a stress-driven ulcer with distension and belching requires a different approach than a cold-type ulcer that improves with warmth, or a burning ulcer from damp-heat.
How TCM understands gastric ulcer
In TCM, the Stomach is seen as a pot that cooks and breaks down food, relying on a steady downward flow of Qi to move its contents through the digestive tract. When this downward movement is disrupted - by emotional stress, poor diet, or constitutional weakness - Qi stagnates, heat builds, or the lining becomes undernourished, and an ulcer can form. The location of the ulcer is in the Stomach, but the root cause often lies in the Liver or Spleen.
The Liver is responsible for the smooth flow of Qi throughout the body. When stress, frustration, or anger cause Liver Qi to stagnate, it often 'invades' the Stomach horizontally, disrupting its normal downward rhythm. This leads to distending pain, belching, and acid reflux - the classic stress-triggered ulcer pattern. This is why emotional regulation is a central part of TCM treatment for many ulcer patients.
The Spleen, on the other hand, is the digestive engine that transforms food into Qi and Blood. When Spleen Qi is weak - from overwork, irregular eating, or chronic illness - the Stomach lining doesn't receive enough nourishment to repair itself. This creates a dull, chronic ache that worsens after meals and is accompanied by fatigue and bloating. Over time, this deficiency can deepen into a cold pattern where the pain is relieved by warmth and pressure, or a dryness pattern where the stomach lacks its protective Yin fluids.
Other patterns include damp-heat from rich, greasy foods and alcohol, which creates a burning, heavy sensation, and blood stasis from long-standing ulcers, where the pain becomes fixed and stabbing. Because each pattern has a different root, TCM treatment is never one-size-fits-all. A practitioner will differentiate based on the pain quality, tongue and pulse, and accompanying symptoms to select the right combination of herbs and acupuncture.
「清气在下，则生飧泄；浊气在上，则生䐜胀。」
"When clear Qi is in the lower burner, it gives rise to undigested food diarrhea; when turbid Qi is in the upper burner, it gives rise to epigastric distention and fullness. This describes the basic mechanism of Stomach Qi failing to descend, which underlies many gastric ulcer patterns."
How a TCM practitioner diagnoses gastric ulcer
Inside the consultation
A TCM practitioner starts by listening to exactly how the stomach ulcer (胃疡, wèi yáng) pain feels and what makes it better or worse. The nature of the discomfort - whether it is sharp, dull, burning, or stabbing - is the first big clue that points toward one pattern rather than another. Timing, triggers, and the symptoms that come along with the pain all help to narrow the picture.
When stress and mood swings are the main trigger and the pain feels distending or moves around, Liver Qi Stagnation invading the Stomach is likely. The person often belches frequently, feels a tightness under the ribs, and the tongue may look normal with a thin white coat while the pulse has a wiry, tight quality that reflects the stuck energy.
If the pain is dull, comes on after meals, and is accompanied by bloating and a feeling of heaviness, the pattern shifts toward Spleen and Stomach Qi Deficiency. Fatigue and a pale tongue with a thin white coating are common, and the pulse feels weak and thready. This pattern often underlies chronic ulcers in people who skip meals or overwork.
Pain that feels better with warmth, pressure, or eating, and worse on an empty stomach or after cold food, points to Stomach Yang Deficient and Cold. Cold hands and feet, a preference for warm drinks, and a slow, weak pulse support this picture. The tongue is pale and may look puffy with a slippery white coat.
A burning, gnawing pain that comes with a bitter taste in the mouth and sticky bowel movements suggests Damp-Heat in the Stomach and Spleen. The tongue coating is thick, greasy, and yellow, and the pulse is rapid and slippery. This pattern is often seen when there is an infection like Helicobacter pylori or after a period of rich, greasy eating.
When the pain is a subtle, gnawing hunger sensation but there is no real desire to eat, and the mouth feels dry, Stomach Yin Deficiency is at play. The tongue is red with little or no coating, and the pulse is thin and rapid. This pattern tends to develop after long-standing heat or a chronic illness that has drained the body’s fluids.
If the pain is fixed in one spot and feels stabbing rather than dull or burning, Stomach Blood Stagnation is suspected. The tongue may be purplish or show dark spots, and the pulse is choppy. This pattern indicates that the ulcer has been present for a long time and has led to deeper tissue damage.
TCM Patterns for Gastric Ulcer
In TCM, the aim is to address the root cause, not just the symptom — it calls that root cause a “pattern.” The same gastric 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 bit of yourself in more than one pattern, because these patterns are snapshots of a process that can shift and overlap. For instance, long-standing Spleen Qi Deficiency can gradually cool down into Stomach Yang Deficiency, or stagnant Liver Qi can generate heat that combines with dampness to create a mixed Damp-Heat picture.
To narrow things down, focus on the pain quality and the one or two features that feel strongest. A dull ache that improves with food but worsens with exhaustion leans heavily toward Qi or Yang deficiency, while a burning or stabbing pain that flares with stress or rich food points toward heat, stagnation, or stasis. Notice what brings relief - warmth versus cool drinks, rest versus movement - as this often separates cold from heat patterns.
Because these patterns can exist side by side, and because the tongue and pulse give a level of detail that is hard to read on your own, a professional diagnosis is valuable. A TCM practitioner can feel the pulse and inspect the tongue to confirm whether the root is deficiency, excess, cold, or heat, and then tailor herbs and acupuncture precisely.
If the pain is severe, comes on suddenly, or is accompanied by vomiting blood, black tarry stools, or unexplained weight loss, see a doctor promptly. These are not signs to self-treat. Otherwise, working with a practitioner who can track your pattern over time is the safest way to address a gastric ulcer with Chinese medicine.
Liver Qi Stagnation invading the Stomach
Damp-Heat in Stomach and Spleen
Stomach Yin Deficiency
Stomach Blood Stagnation
Treatment
Four ways to address gastric ulcer in TCM — explore each, or take the quiz to see what fits you first.
Formulas traditionally used for gastric ulcer
7 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 classical formula designed to strengthen weak digestion and relieve bloating, nausea, and abdominal discomfort caused by a weak Spleen and Stomach with dampness and stagnation. It builds upon the foundational Si Jun Zi Tang (Four Gentlemen Decoction) by adding herbs that move Qi and resolve phlegm, making it especially suited for people whose digestive weakness is accompanied by a feeling of fullness, poor appetite, and loose stools.
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 gentle formula designed to replenish the fluids of the Stomach when they have been depleted by heat or chronic illness. It is commonly used for dry mouth and throat, poor appetite despite feeling hungry, and a red tongue with little coating. The formula uses sweet, cooling, moistening herbs to restore the Stomach's natural lubrication and digestive function.
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.
Excess patterns like Liver Qi Stagnation invading the Stomach or Damp-Heat often respond quickly, with pain reduction in 2-4 weeks. Deficiency patterns such as Spleen Qi Deficiency or Stomach Yin Deficiency typically need 6-12 weeks to rebuild the stomach lining's integrity, though comfort often improves sooner. Chronic Blood Stagnation may require 3-6 months for full resolution. Herbal treatment is usually combined with weekly acupuncture for the first 4-8 weeks, then tapered.
Treatment principles
The overarching goal in TCM is to harmonize the Stomach and restore its proper downward movement of Qi, while protecting and healing the ulcerated tissue. Because the root cause varies, treatment is tailored to the pattern: soothing the Liver and regulating Qi for stress-related ulcers, strengthening the Spleen and warming the middle for deficiency-cold types, clearing heat and drying dampness for damp-heat, nourishing Yin for dry-type ulcers, and invigorating blood for chronic stasis pain. Herbal formulas are the primary tool, supported by acupuncture to regulate the nervous system and local blood flow.
What to expect from treatment
Most patients begin with weekly acupuncture sessions and a daily herbal decoction or granule formula. Pain and bloating typically start to ease within the first 1-2 weeks. After 4-6 weeks, if symptoms are much improved, acupuncture frequency may reduce to biweekly, and herbal formulas may be adjusted to focus more on strengthening the constitution. A follow-up endoscopy after 8-12 weeks often shows significant healing. For chronic or recurrent ulcers, a longer course of 3-6 months may be needed to fully rebuild digestive strength and prevent relapse.
General dietary guidance
Eat warm, cooked, and easily digestible foods. Congee (rice porridge), steamed vegetables, soups, and lean proteins are ideal. Eat small, frequent meals rather than large ones. Avoid raw, cold, spicy, greasy, and deep-fried foods. Eliminate alcohol, coffee, and acidic drinks until healing is well underway. Chew food thoroughly and eat in a calm, unhurried environment. These general principles support the Stomach's healing across all TCM patterns.
Combining TCM with conventional treatment
TCM ulcer treatment can be safely combined with conventional medications, and many patients use both while healing. If you are taking PPIs, do not stop them abruptly - work with your doctor to taper once your symptoms are stable. Certain herbs, such as Gan Cao (licorice root), can affect potassium levels if used in high doses long-term, especially with diuretics, but typical formula doses are safe. If you are taking blood thinners like warfarin, inform your TCM practitioner, as some blood-moving herbs (like San Qi or Dan Shen) may increase bleeding risk. Always bring a complete list of your medications to your TCM consultation.
*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 feels like a knife — Could indicate a perforated ulcer - a medical emergency.
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Vomiting blood or material that looks like coffee grounds — Sign of active bleeding in the stomach.
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Black, tarry stools — Indicates digested blood from an upper GI bleed.
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Feeling faint, dizzy, or short of breath — May signal significant blood loss and anemia.
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Sharp pain that radiates to the back and doesn't let up — Could be a sign of a penetrating ulcer or pancreatitis.
Audience-specific guidance — open what applies to you
During pregnancy, Spleen and Stomach Qi Deficiency becomes the most common pattern underlying gastric ulcer, as the growing fetus draws heavily on the mother's Qi and Blood. Morning sickness can exacerbate stomach irritation, and the rising Stomach Qi from Liver Qi stagnation is also more frequent due to emotional changes. Treatment must prioritize the safety of both mother and baby.
Many herbs that move Qi or invigorate Blood are contraindicated in pregnancy, including San Qi, Yan Hu Suo, and strong Qi-moving herbs like Qing Pi or Zhi Shi. Chai Hu is generally used with caution and only in small doses under professional guidance. Safer alternatives for Liver Qi stagnation include gentle aromatic herbs like Chen Pi and Fo Shou. For Spleen deficiency, Xiang Sha Liu Jun Zi Tang is often preferred, as it gently strengthens digestion without dispersing Qi. Acupuncture is an excellent option: points like Neiguan PC-6 and Zusanli ST-36 are safe and effective, while abdominal points are needled shallowly or avoided in the first trimester. Always consult a practitioner experienced in pregnancy care.
Breastfeeding mothers with gastric ulcer need careful herbal selection to avoid substances that pass into breast milk and affect the infant. Bitter-cold herbs like Huang Lian and Da Huang can cause diarrhea in the newborn and should be avoided. Similarly, strong Qi-moving or blood-invigorating herbs may alter milk supply or cause irritability in the baby.
Gentle, nourishing formulas are preferred. For Spleen and Stomach Qi Deficiency, Dang Shen and Bai Zhu are safe and can even support milk production. If Damp-Heat is present, mild heat-clearing herbs like Lu Gen are acceptable. Acupuncture remains a safe, drug-free option, with points like Zusanli ST-36 and Neiguan PC-6 offering relief without any risk to the infant. As always, inform your practitioner that you are breastfeeding so they can tailor the formula accordingly.
Gastric ulcer is uncommon in children, but when it occurs, it usually stems from irregular eating habits, food stagnation, or a constitutional Spleen and Stomach Qi Deficiency. Children cannot always articulate their symptoms clearly, so a TCM practitioner will observe behavior: refusal to eat, irritability after meals, a pale or greasy tongue, and a weak or slippery pulse.
Herbal dosages are significantly reduced-typically one-quarter to one-half of the adult dose, depending on age and weight. Bitter or harsh herbs are avoided. Gentle formulas like Bao He Wan for food stagnation or Xiang Sha Liu Jun Zi Tang for Spleen deficiency are commonly used. Pediatric tuina (massage) and acupuncture (often with fewer needles and shorter retention times) are highly effective and well-tolerated. Dietary adjustments-warm, cooked, easily digestible foods-are the cornerstone of treatment.
In the elderly, gastric ulcer is almost always rooted in deficiency-most commonly Spleen and Stomach Qi Deficiency or Stomach Yang Deficiency and Cold. The digestive fire has waned over decades, and the stomach lining is less resilient. Pain is typically dull and chronic, with a pale, puffy tongue and a weak, deep pulse.
Herbal dosages should be lower than standard adult doses (often two-thirds) to avoid overwhelming a weakened digestive system. Warming, nourishing formulas like Huang Qi Jian Zhong Tang are preferred. Caution is needed with polypharmacy: many elderly patients take Western medications for hypertension, diabetes, or blood thinning, and some herbs can interact-for example, San Qi has antiplatelet effects. Acupuncture is an excellent adjunct, as it has no drug interactions and can gently strengthen the Spleen and Stomach. Treatment timelines are longer, and the focus is on gradual, sustained improvement rather than rapid resolution.
Evidence & references
The evidence base for TCM treatment of gastric ulcer is growing, though it remains dominated by Chinese-language studies. A 2024 review published in Medicine concluded that traditional Chinese medicine, particularly Ban Xia Xie Xin Tang, is frequently prescribed and shows promise in regulating gastric acid, reducing inflammation, and promoting mucosal repair. The review highlights that TCM approaches may offer a better choice for long-term management, with fewer side effects than conventional proton pump inhibitors.
Acupuncture has also been studied, with several small RCTs suggesting it can alleviate epigastric pain and improve quality of life in peptic ulcer patients. However, many trials suffer from methodological limitations, and high-quality, double-blind, placebo-controlled studies are still needed. The current evidence supports TCM as a safe and potentially effective complementary therapy, especially when tailored to the individual pattern, but it should not replace urgent medical care for complicated ulcers.
Key clinical studies
A narrative review examining the use of traditional Chinese medicine for gastric ulcer, highlighting Ban Xia Xie Xin Tang as the most frequently prescribed formula. The review discusses mechanisms including regulation of gastric acid, anti-inflammatory effects, and promotion of mucosal repair, and suggests TCM offers advantages in long-term management with fewer side effects.
Treatment of gastric ulcer, traditional Chinese medicine may be a better choice
Li X, et al. (2024). Treatment of gastric ulcer, traditional Chinese medicine may be a better choice. Medicine, 103(4), e38266.
https://pubmed.ncbi.nlm.nih.gov/38278376Classical text references
One quote is featured above in the Understanding section — the rest are listed here for the classically inclined.
「伤寒，阳脉涩，阴脉弦，法当腹中急痛，先与小建中汤。」
"In cold damage, when the yang pulse is choppy and the yin pulse is wiry, there is acute abdominal pain; first give Xiao Jian Zhong Tang. This classic formula for Spleen and Stomach deficiency with cold remains a cornerstone for treating chronic gastric ulcer with dull, hungry pain."
Shang Han Lun
Clause 100
「按之心下满痛者，此为实也，当下之，宜大柴胡汤。」
"If there is fullness and pain below the heart upon pressure, this is an excess condition; one should drain it downward, and Da Chai Hu Tang is suitable. This illustrates the differentiation between excess-type epigastric pain (often seen in Liver-Stomach disharmony with heat) and deficiency-type pain, guiding treatment choices for ulcer patients."
Jin Gui Yao Lue
Chapter 10, Abdominal Fullness, Cold and Food Stagnation
Frequently asked questions
Common questions about using Traditional Chinese Medicine for gastric ulcer.
Yes, TCM can heal ulcers by restoring the stomach's self-repair mechanisms, even when H. pylori is present. Herbs like Huang Lian (Coptis) have natural antibacterial properties, but the primary goal is to change the environment in the stomach so the bacteria can't thrive. Many patients heal without antibiotics, though severe or complicated cases may still need conventional treatment. Always discuss with your doctor if you've been diagnosed with H. pylori.
Most people notice less pain and bloating within the first 1-2 weeks of herbs and acupuncture. Complete healing of the ulcer, confirmed by endoscopy, typically takes 6-12 weeks. The timeline depends on the pattern: stress-related ulcers often respond faster than those rooted in long-standing digestive weakness.
Yes, TCM can be safely combined with proton pump inhibitors. Many patients start TCM while still on their prescribed medication. As your symptoms improve, you can work with your doctor to gradually taper the PPI - never stop suddenly, as this can cause rebound acid. Inform both your TCM practitioner and your doctor about all treatments you're using.
TCM aims to correct the underlying imbalance that made you susceptible to ulcers in the first place. When the root pattern - whether it's Liver Qi stagnation, Spleen deficiency, or damp-heat - is fully addressed, recurrence is much less likely than with acid suppression alone. However, long-term dietary and lifestyle habits play a big role in staying well, and occasional maintenance treatments may be recommended.
Yes, diet is a cornerstone of TCM ulcer treatment. Across all patterns, we recommend warm, cooked, easily digestible foods like congee, steamed vegetables, and soups. Avoid raw, cold, spicy, and greasy foods, as well as alcohol and coffee. Small, frequent meals are better than large ones. Your practitioner will give you specific advice based on your pattern - for example, someone with a cold-type ulcer benefits from warming spices like ginger, while someone with damp-heat should avoid them.
Acupuncture for digestive issues uses points on the abdomen, legs, and arms. The needles are hair-thin and most people feel only a slight pinch or a dull ache. Many patients find the sessions deeply relaxing, which itself helps reduce stress-related ulcer patterns. Points like Zusanli (ST-36) on the lower leg are especially effective for strengthening the Stomach and Spleen.
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