The frequency of both H. pylori infection and NSAID in-gestion increases with age. It is unclear if eradication of H. py-lori results in a decrease in the frequency of NSAID-induced peptic ulcers. Nevertheless, patients with a history of prior peptic ulcer disease or its complications should be tested and treated for H. pylori, if present, before beginning NSAID therapy.

Maintenance Therapy Maintenance therapy with a chronic low dose (half strength)of any of the H2 blockers is now an obsolete concept. Maintenance therapy is now indicat-ed only for patients with H. pylori-positive peptic ulcer disease if eradication is unsuccessful.

Surgery Once central to the management of peptic ulcer disease, surgery now has a negligible role in the management of uncomplicated peptic ulcer disease, with the recognition that ulcers can be cured by elimination of H. pylori and NSAIDs. However, complications of peptic ulcer disease have not de-creased and surgery continues to play an important role in the management of complications.

Diagnosis in Traditional Chinese Medicine

Peptic Ulcer is categorized as "weiwan tong", "outu ", etc. in traditional Chinese medicine.

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 ¡¨² pain ¡¨² remission, while in duodenal ul-cer the rule is pain ¡¨² food intake ¡¨² remission. The pain oc-curs 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 3-4 cm. Ulcer in the posterior wall may have pain hypersensi- tive area on the back at T11--12 level.

3. Laboratory examinations:

(1)Fecal occult blood test (OB): OB positive reaction af-ter 3-day vegetarian meals reveals that the active ulcer exists. OB positive result may turn into negative if the patient is treat-ed 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 disformity of duodenal bulbar region may occur in duode-nal 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 in

Traditional Chinese Medicine

1. Insufficiency-cold Type :

Clinical manifestations: Latent pain in the upper abdomen with predilection for heat, and intolerance of cold which ag-gravates the pain, sallow complexion, lassitude and weakness, or loose stool, pale tongue with thin whitish fur, deep, slow and weak pulse.

Therapeutic method: Warming and invigorating middle-jiao .

Recipe: Modified Decoction of Astragalus for Tonifying middle-iiao.

Ingredients:

Radix Astragali seu Hedysari 30g

Ramulus Cinnamomi 9g

Radix Paeoniae Alba 18g

Os Sepiella seu Sepiae 30g

Radix Angelicae Dahuricae 30g

Radix Glycyrrhizae Praeparata 15g

Administration: All the above drugs are to be decocted in water for oral administration.

2. Qi-Stagnation Type:

Clinical manifestations: Epigastric distension and pain, distension and fullness in the hypochondria, belching, acid re-gurgitation, poor appetite, thin and whitish coating of the tongue, and taut pulse.

Therapeutic method: Soothing the liver, regulating the circulation of qi and regulating the function of stomach to re-lieve pain.

Recipe: Modified Powder for Treating Cold Limbs in combination with Sichuan Chinaberry Powder.

Ingredients:

Radix Bupleuri 9g

Radix Cyperi 12g

Radix Paeoniae Albe 9g

Fructus Aurantii 9g

Pericarpium Citri Reticulatae 9g

Fructus Meliae Toosendan 12g

Rhizoma Corydalis 12g

Radix Aucklandiae 9g

Caulis Perillae 12g

Concha Arcae 30g

Fructus Citri Sarcodactylis 9g

Radix Glycyrrhizae Praeparata 6g

Administration: All the above drugs are to be decocted in water to get 200-- 300ml of decoction. Take equal portions in the morning and in the evening.

3. Stagnated-heat type :

Clinical manifestations: Epigastric pain which is aggravate-ed after food intake, burning sensation in the stomach, dry mouth with bitter taste, fondness of cold drink, ocnstipation, deep-coloured urine, red tongue with yellow fur, taut and rapid pulse.

Therapeutic method: Clearing away pathogenic heat and regulating the function of stomach.

Recipe: Modified Two old Drugs Decoction in combina: tion with Decoction for Eliminating Pathogenic Heat from the Liver

Ingredients:

Rhizoma Coptidis 9g

Fructus Gardeniae 9g

Radix Scutellariae 9g

Rhizoma Anemarrhenae 10g

Radix Paconiae Alba 10g

Pericarpium Cirri Reticulatae 9g

Rhizoma Pinelliae 10g

Poria 10g

Fructus Cirri Sarcodactylis 10g

Herba Dendrobii 10g

Radix Glycyrrhizae Praeparate 6g

Administration: All the above drugs are to be decocted in water to get 200-- 300ml of decoction. Take equal portions in the morning and in the evening.

Modification: In case of 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 furor absence of fur and taut weak pulse, it is preferable to administer the Modified Decoction of Glehnia and Ophiopogon.

Its compositions are:

Radix Glehniae 10g

Radix Ophiopogonis 10g

Rhizoma Polygonati Odorati 10g

Semen Dolichoris Album 10g

Fructus Cirri Sarcodactylis 10g

Herba Dendrobii 10g

Radix Glycyrrhizae Praeparata 6g

Administration.. All the drugs in the above recipe are to be decocted in water to get 200- 300ml of decoction. Take e-qual portions both in the morning and in the evening.

Modification: In case of 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 un-smooth pulse, the modified Red Sage Drink in combination with Wonderful Powder for Relieving Blood Stagnation is preferable.

Ingredients:

Radix Salviae Miltiorrhizae 20g

Fructus Amomi 10g

Pollen Typhae 10g

Faeces Trogopterorum 10g

Fructus Meliae Toosendan 12g

Rhizoma Corydalis 12g

Radix Angelicae Sinensis 12g

Radix Paeoniae Rubra 10g

Radix Glycyrrhizae Praeparate 6g

All the above drugs are to be decocted in water for oral administration.

In case with hematemesis and tarry stools, add Radix Bletillae 6g and Radix Notoginseng 3g(administered orally of-ten 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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