Remedy Diagnosis In Duodenal Ulcers


Corresponding to the stage of nervous irritation we find, due to increased peristalsis, inclination to diarrhoea, which is painless and weakening. In the paralysed second stage we find constipation with stool thin as lead pencil. Phosphorus acts primarily on the accompanying duodenitis and hyperchlorrhydria in duodenal ulcers, but it also acts directly on the ulcer.


Trill / Arn / Mill / Sec.

Anacardium. Pain on empty stomach 4 to 5 hours after eating, but returns after some time. Nux vomica is similar to Anacardium; both remedies act primarily on the nervous system, both are irritable, are constitutional, have stomach symptoms and nausea, eructation and vomiting. However, in Nux vomica the pain in stomach is worst 2 to 3 hours after eating, gets better as the gastric digestion is completed, when Anacardium is worst. Here is an illustrative case: March, 1935, a woman of 45 came to me, complaining that she has had occasional stomach complaints for years.

The last few weeks pain when stomach is empty; eructation, heart burn; all symptoms disappear immediately upon eating. Stool normal. Examination showed a pale, nervous, loquacious patient. Heart and lungs negative; constant pressing pain to the right of midline, three inches above umbilicus, with tense abdominal wall causing increase of pain upon palpation.

Roentgenograms show painly niche in bulbous part of duodenum, visible in all four exposures also many gallstones. Physician previously consulted ordered immediate operation to which patient objected. I prescribed two weeks bed rest, mild diet, cataplasms and Anacardium 6. After two days painless. When I examined her on the seventh day, the spot painful upon pressure previously was now normal and abdominal walls were only slightly tensed, which vanished in a few days. Patient remained well.

Graphites. Has symptoms similar to hunger pains; patient awakens nights from restless sleep with cramp in stomach with desire for food. Generally his stomach feels full after eating; gases in stomach and rancid eructations. At other times pyrosis with burning and feeling of weight in stomach.

At the same time he has fermentation and irritation of mucous membranes. Dislikes meat, craves cold drinks, is constipated, with lumps of slimy stool and offensive flatus. Such patients are usually obese sad, sensitive to cold. In women all symptoms are aggravated at menstrual time. Generally speaking this remedy will perhaps not often be indicated in duodenal ulcer, but I mention it because it proved very valuable in one of may cases.

Kali carbonicum. Is often indicated and belongs partly to the group of hunger pain with aggravation from 2 to 4 a.m. But here eating does not relieve permanently, and larger amounts of food increase the pain; especially meat and beer cause burning and raw feeling in stomach, fullness and pressure in abdomen, nausea and hot eructation. It may develop to such a state that almost all food and drink cause acid, bitter, tenacious, stringy vomiting. Hot applications relieve immediately while cold aggravates. Nash call it the remedy for beer drinkers. Clarke recommends it very highly when duodenal ulcers are caused from burning. My potency choice is the 6.

Phosphorus. Is of a similar cachectic type, has also hunger pain, better temporarily from cold food and drink, but different from that of the other remedies, more like fainting bulimia with extreme weakness and empty feeling in abdomen. All stomach symptoms have the stigma of Phosphorus: irritable, nervous weakness. When cold food gets warm in stomach it causes burning and acid, empty eructations and finally it is vomited.

Warm in stomach it causes burning and acid, empty eructations and finally it is vomited. Corresponding to the stage of nervous irritation we find, due to increased peristalsis, inclination to diarrhoea, which is painless and weakening. In the paralysed second stage we find constipation with stool thin as lead pencil. Phosphorus acts primarily on the accompanying duodenitis and hyperchlorrhydria in duodenal ulcers, but it also acts directly on the ulcer.

Chelidonium. Hunger pain, gnawing pain, vomiting of bile and mucus, eructation, cramp of stomach, better from eating and hot drinks (especially coffee); nocturnal periodicity. Acts well when duodenal ulcer and duodenitis are associated with cholangitis. I so well remember a case in a colleague of the old school in which I had a striking result. The leading symptom in this case was a pain under the angle of the right scapula.

The symptoms of the digestive tract vanished immediately with normal bile secretion. Stauffer calls especial attention to the fact that “liver and gall bladder remedies” will act well in duodenitis, hence also in latent duodenal ulcers. We must admit that there is a certain relationship between function of the liver and many catarrhal processes of the digestive tract.

Nux vomica. Late pains in duodenal ulcers one to three hours after eating, while digestion is at its height; pain eases when stomach becomes empty, followed by hunger. It is the remedy for irritable, angry people of sedentary habits, which latter favours abdominal plethora; their well-being depends upon their stool and haemorrhoids. They think they need stimulants like coffee, alcohol, tobacco, spices, which again aggravate their physical and mental irritability, or the digestive tract trouble.

Characteristic symptoms for this remedy are: feeling of fullness in abdomen; bitter acid eructations; nausea and vomiting; sour astringent taste; periodicity of pain, especially in the early morning (also early vomiting). Spastic constipation. The Therapeutic action of the Nux vomica alkaloids: Strychnine and Bruicine is from the nervous system, both regulating the motor- secretory acts as also trophoneurotic in the healing process of duodenal ulcer.

Gratiola officinalis. It is the female Nux vomica has also the pressure as from a stone with fullness in stomach, nausea and vomiting, pyrosis, cramps in stomach, constipation with hard stool. But it has prominently vertigo during and after eating similar to Ignatia (which latter, however, has more hunger pain and amelioration from eating.) It is perhaps more indicated in catarrhal than ulcerous conditions.

Arsenicum album. Has also late pains. It is best suited to ulcers on the lesser curvature, but given suitable general symptoms it is also valuable in duodenal ulcers. In cachectic and exhausted patients with ulcers inclined to haemorrhage (bloody vomiting and bloody stool). From the beginning one is not sure whether or not malignancy is present. The pain is burning, a dry burning, which wants to be extinguished, but only small frequent swallows of fluid are tolerated. Ample food and drink aggravate all symptoms, while heat (hot applications or hot drinks) ameliorate.

Typical is furthermore the periodicity of the pains, around midnight. Diarrhoea with burning and tenesmus after defecation. The anus burns the mouth burns, all that lies between; here it resembles Capsicum, which, however, has entirely different symptoms.

Kreosotum. Has both hunger pains and late pains; troubles increase in the hours after eating and are: Acidity, eructation and stomach cramps. At the height of the digestive process-three to four hours after eating-vomiting of undigested food. It is suitable for obstinate cases of duodenal ulcers with suspicion of carcinoma; there is disposition to bleeding; better from warmth and motion, worse from cold and rest. Sometimes we find in duodenal ulcer also an early pain, or, as called by some authors, a quick pain. Still, this symptom belongs more to oesophagus disease and peptic jejunal ulcer. This pain comes on while eating, or immediately after.

Atropinum sulphuricum. Is typical for this early pain, though the remedy is oftener used than indicated. There is pyrosis, nausea, eructation with loss of appetite, attacks of stomach cramps with vomiting. Of course, eating aggravates all complaints.

Belladonna. Closely resembles Atropinum, but acts more transitory. Cramps in stomach always during or after meals, and is relieved by bending backward. The stomach does not tolerate slight pressure, is swollen and hypersensitive; aggravation from every motion. Characteristic is the shunning of al fluids. Waterbrash. Spastic condition of the pharynx with retching; violent vomiting with cold perspiration is found in some cases. Lack of appetite and disgust from spices. The Belladonna patient us usually robust, plethoric and mentally alert.

Galium bichromicum, Early and quick pains belong to it; hunger pain between 2 and 4 a.m., better from eating.

Uranium nitricum. Similar to Belladonna. Uranium and nitrate components act together to produce a severe cachectic mummy-like condition. Here also are stomach pain, eructations, nausea with vomiting and tympanitis soon after eating. In spite of bulimia and voracious appetite the patient loses weight constantly, contrary to Kali bichromicum. But later we find loss of appetite with disgust toward meat; stool hard and constipated. It is valuable remedy in duodenal ulcer.

Sometimes concomitant symptoms may lead to the similimum.

Iodum. Like Uranium nitricum has bulimia with burning pain and cramps; patient has to eat constantly in order to relieve pain, but he becomes more and more emaciated. Contrary to Uranium, there is diarrhoea. Complaints are better from cold, worse from warmth. Stauffer recommends it highly in ulcerous processes of the digestive organs.

The symptoms of pressure in stomach is present, aside from those remedies already mentioned, also in Arsenicum album, Nux vomica, Gratiola, etc.

Lycopodium. Patient feels tight in region of stomach, has bulimia, but is satiated and full after a few bites; clothes feel too tight, especially around the waist. Patient is sleepy after meals; flatulence, better from eructation or from passing of flatus. Acidity and pyrosis increase the subjective symptoms; constipation; worse time 4 to 6 p.m.

Carbo vegetabilis. Has pressure in stomach, like Lycopodium, but the patient is usually run down much more than in Lycopodium; has bulimia, which, if not satisfied, is followed by cramp in stomach; hyper-acidity with pyrosis, sour eructation, retching, worse from fatty food, milk and stimulants; better from eructations. Severe flatulence in upper abdomen (Lycopodium in lower abdomen), worse from cold. (Lycopodium worse from warmth}.

Vomiting as a concomitant symptom can be an aid in the selection of the remedy, often indicating (aside from Nux vomica):

Ipecacuanha. Which has bitter and mucous vomiting from an empty stomach with relief , accompanied by severe nausea; the tongue is absolutely clean; everything disgusts; stomach feels like an empty bag hanging in abdomen.

Lobelia. Deathly nausea with vomiting and salivation, but better from drinking cold water, which also relieves sensation of fullness and lump in stomach.

If full feeling in stomach becomes the leading symptom, then we remember, aside from Nux vomica, Lobelia, Gratiola, Carbo vegetabilis, Lycopodium, also:

Sulphur. Which is full after a few bites, easily satiated in spite of bulimia; nausea, pyrosis, acid stomach, weakness especially at 11 a.m.

Argentum nitricum. Stomach feels full to bursting; shotlike loud eructation which comes hard; meteorism and severe flatulence; stomach pain regularly around midnight, coming and going slowly; the pain is stitching, radiating in every direction better from pressure and doubling up, worse from deep breathing and slight pressure, situated in a small spot between umbilicus and xiphoid process; the upward pressure causes anxiety and dyspnoea, which are relieved in open air; desire for cold things, sweetmeats (especially sugar), which, however, do not agree. All symptoms aggravated by mental excitement.

Acidum nitricum. Is similar to Argentum nitricum; it also has the quickly satisfied appetite; fullness with distress, but it has aversion to sweet things and meat; craves fat food; stomach cramps are especially nights; severe nausea, vomiting of mucus (with retching), bile and blood; much thirst.

Acidum sulphuricum. Has hyperacidity as also: Atropia sulph., Carbo vegetabilis and Animalis, Lycopodium, Phosphor and Sulphur. The stomach is so weak and flabby that cannot keep anything down; spasmic singultus with acid distress; here we may also think of Natrum Phos., Natrum muriaticum Natrum carbonicum.

Natrum carbonicum. Has pressure and distress in abdomen after eating, aside from acidity troubles, eating makes patient sleepy and flatulent with palpitation of heat; vegetables and farinaceous food are poorly tolerated; usually the remedy has lack of appetite, feels better toward end of digestive period.

Natrum muriaticum. Much thirst with acidity and pyrosis nausea and salivation, vomiting of mucus and watery fluid; yet patient craves salt and spices; pressure and fullness of stomach after eating; constipation (dry faeces), emaciation, anorexia; aversion to rye bread.

Natrum phosphoricum. has sour taste, acid eructation, pyrosis, sour diarrhoea; everything connected with this remedy is sour.

Bismuthum. Stomach pain better from bending backward.

Briefly I shall mention the duodenal ulcer with bleeding, evidenced by tarry stools, more than by bloody vomiting. Here are important: Hamamelis and Erigeron canadense generally speaking.

Trillium pendulum. Is valuable when haemorrhage is so severe that collapse and heart weakness threaten.

Arnica. Has bruised feeling, anxiety, restlessness, flatulency with borborygmus.

Mellifolium. Vomiting of blood with stomach cramps and flatulency.

Secale Bleeding which does not cease.

In less severe haemorrhage we must not for get Phosphorus, Arsenicum, the mineral acids, etc. Threatening dangerous conditions may require Arsenicum. Carbo vegetabilis or Veratrum album.

The very variable symptoms of duodenal ulcer are found in a large list of our Materia Medica. It therefore is advisable to separate the cardinal symptoms: hunger pains (better from eating), which include night pains, late pains, early or quick pains, which point to a certain group of remedies. If this does not lead to one remedy, then we must consider as leading symptoms: bulimia, fullness, acidity, vomiting, etc., to bring out the indicated remedy.

Schwarzhaupt Cologne