Peptic Ulcer

What is Peptic Ulcer?

A peptic ulcer is a break in the inner lining of the stomach or the first part of the small intestine (the duodenum), caused by damage from stomach acid and the digestive enzyme pepsin.^[1] It can also occur in the lower esophagus, though less often. An ulcer in the stomach is a gastric ulcer, and one in the duodenum is a duodenal ulcer.^{[1, 2]}

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Common symptoms

The main symptom is upper abdominal pain, often burning or gnawing. With a gastric ulcer it tends to start 15 to 30 minutes after eating, and with a duodenal ulcer it often comes 2 to 3 hours after a meal.^[1] Some people also have:

• Bloating, nausea or loss of appetite
• Weight loss
• Black, tarry stools or vomiting blood, which signal bleeding^[3]

Many ulcers cause only vague dyspepsia (upper abdominal discomfort), so symptoms alone cannot confirm one.^[2]

Causes and risk factors

The two main causes are infection with Helicobacter pylori and the use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). In one review, H. pylori was found in about 42% of people with peptic ulcer disease and NSAID or aspirin use in about 36%.^[3] Severe illness in hospital (stress-related ulcers) and unexplained cases also occur.^[4]

Spicy food and stress are popularly blamed, but the established causes are infection and medicines.^{[3, 4]}

How it is diagnosed and treated conventionally

Endoscopy, a camera test of the upper digestive tract, confirms an ulcer, and testing for H. pylori is recommended in everyone with peptic ulcer disease.^{[1, 3]}

Treatment is directed at the cause. Acid-blocking medicines such as proton pump inhibitors heal most ulcers within about 4 weeks, with larger gastric ulcers sometimes needing 8 weeks. Treating H. pylori lowers the chance of the ulcer returning, and stopping NSAIDs heals most NSAID-related ulcers.^[3] Bleeding and perforation are complications that need urgent hospital care.^{[3, 4]}

Why Peptic Ulcer calls for a whole-person approach

An ulcer forms when the stomach's defenses are outweighed by the forces that damage it, so more than one factor is usually at work. Infection, medicines, acid and the strength of the lining all matter.^{[1, 4]}

Supportive care can address symptoms and the person around the ulcer, while physicians treat the ulcer itself.

Infection with H. pylori

The bacterium is a leading cause of ulcers, and clearing it with antibiotics sharply lowers recurrence.^[3] Testing and antibiotic treatment are medical tasks that complementary care does not replace.

Pain medicines

Long-term NSAID or aspirin use is the other major cause. When an NSAID cannot be stopped, physicians may change it, add acid protection, or treat H. pylori.^{[3, 5]} Tell your physician about every pain reliever you take, including over-the-counter ones. This is one reason a non-drug option for pain, such as acupuncture, is sometimes of interest.

Acid and the lining of the stomach

Acid and pepsin injure a lining that has lost its protection, which is why acid-lowering medicine is the main treatment.^{[1, 4]} Smoking and heavy alcohol use are commonly advised against.

Stress and the brain-gut connection

Researchers studying acupuncture for ulcers describe an interaction between the brain and the gut, and much of this work uses animal models of stress ulcer.^[6] The place of everyday psychological stress in human ulcers is less clear, since infection and medicines account for most cases.^[3]

Acupuncture for Peptic Ulcer

What the research shows

Acupuncture may help as an add-on to standard treatment, but the evidence is limited and of low quality. A meta-analysis of 16 randomized trials with 1,570 patients found no significant difference between acupuncture alone and Western medicine for effective rate, ulcer healing or H. pylori clearance, while recurrence was lower with acupuncture.^[7]

Acupuncture added to Western medicine did better than Western medicine alone for effective rate, healing and recurrence. The authors graded the evidence as low or extremely low grade, and called for larger, higher-quality trials.^[7]

A 2023 expert consensus on acupuncture for gastric ulcer found a lack of definitive guidelines and said the clinical evidence is limited, so the points it recommends reflect expert agreement rather than trial results.^[8]

How acupuncture may work

Researchers propose several actions, mostly from animal models of stress-induced gastric ulcer. A 2025 review describes anti-inflammatory and antioxidant effects, repair of the stomach lining and effects on brain-gut signaling when points such as Zusanli (ST36) are stimulated.^[6] These are proposed explanations from laboratory work, not proof of how it works in people.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. A course is several visits, and we reassess to see whether it is helping with symptoms.

Serious problems from acupuncture are rare. In prospective studies about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[9] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Peptic Ulcer

The Ayurvedic view

In Ayurveda, burning upper abdominal pain after eating is described under conditions such as Amlapitta (acid-related disorder) and Parinama Shula (pain related to digestion). These are traditionally seen as an excess of Pitta, the principle linked to heat and digestion, with weakened agni (digestive fire). These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Regular meals at steady times, and a diet that avoids very sour, spicy or fried foods, which Ayurveda sees as aggravating Pitta
• Calming practices such as breathing exercises and a steady sleep routine
• Individually prescribed herbs, from tested sources, since about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic^[10]

Panchakarma procedures, especially emetic or purgative therapies, are not appropriate with an active ulcer, bleeding, pregnancy, acute illness or frailty, and we would not use them while an ulcer is untreated.

What the research shows

We found no clinical trials of Ayurvedic medicine, including Panchakarma, in peptic ulcer, and no systematic reviews. The benefit is therefore unknown, and Ayurvedic care here is supportive, aimed at diet, routine and stress, and not at healing the ulcer. Healing depends on acid-lowering medicine and treatment of H. pylori or NSAID use.^[3]

Herbal medicine for Peptic Ulcer

Herbs and formulas that have been studied

Most research comes from China, where classical formulas and patent medicines are used alongside standard drugs. Studied examples include Jianzhong decoction, Kangfuxin (made from the American cockroach, Periplaneta americana) and patent medicines such as Pingwei capsule, Weifuchun tablet and Wenweishu capsule.^{[11, 12, 13]}

What the research shows

Evidence suggests possible benefit when Chinese preparations are added to standard drugs, but it is limited by study quality. A meta-analysis of 58 trials with 5,192 patients found Jianzhong decoction gave better effective rates, H. pylori eradication and recurrence rates than conventional Western treatment, with fewer adverse reactions reported.^[11]

A meta-analysis of 25 trials with 2,555 patients found Kangfuxin plus rabeprazole improved ulcer healing and reduced recurrence compared with rabeprazole alone.^[12] A network meta-analysis of 35 studies with 4,667 patients found patent medicines plus Western medicine more effective than Western medicine alone for H. pylori-related gastric ulcer, but called for larger multicenter trials.^[13]

These reviews drew mainly on trials from Chinese databases, and the Jianzhong result is unusually large, so we treat all of it with caution. For Western herbs such as licorice and turmeric, we found no peptic ulcer trials that support a claim.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe serious bleeding, including vomiting blood and black stools, when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^[14] This matters for people with an ulcer, who already have a risk of bleeding. A broader review documents interactions with drugs including blood thinners, immunosuppressants and antidepressants.^[15]

Herbal supplements are also a recognized cause of liver injury.^[16] Tell us about pregnancy, breastfeeding, and liver or kidney disease, and give us a full list of your medicines, including NSAIDs, aspirin and acid reducers.

Translating traditional medicine into modern biological language

These links are interpretation, not equivalence. Chinese medicine may describe ulcer pain as stagnation of liver qi attacking the stomach or as stomach cold or deficiency. Researchers studying acupuncture look at inflammation, antioxidant activity, repair of the stomach lining and brain-gut signaling as possible parallels.^[6]

Ayurveda's excess Pitta and weak agni describe burning pain and poor digestion. Modern medicine attributes ulcer burning to acid and pepsin injuring the lining, and finds the cause in H. pylori or NSAIDs.^{[1, 3]} No study has shown that a dosha or pattern corresponds to a specific biological process.

How this care fits with your medical care

This care is complementary. We do not diagnose ulcers, test for H. pylori or prescribe medicines. Keep your physician or gastroenterologist, finish any antibiotic course exactly as prescribed, and do not stop or change acid-lowering medicines without your prescriber.

Please bring your diagnosis, endoscopy and H. pylori test results, and a full list of medicines and supplements, especially NSAIDs, aspirin and blood thinners. New or changing upper abdominal pain should be evaluated by a physician.

When to seek urgent medical care

A bleeding or perforated ulcer is an emergency.^[3]

• Vomiting blood or material that looks like coffee grounds
• Black, tarry or bloody stools
• Sudden, severe abdominal pain that does not ease
• Fainting, dizziness, a racing heart or looking very pale
• Repeated vomiting, or being unable to keep food down
• Unplanned weight loss or trouble swallowing

If any of these occur, call 911 or go to the nearest emergency department.