Disease and Condition Overview
Peptic Ulcer is an open sore with distinct borders on the inside lining of the mucus layer of stomach and/or duodenal. The most common symptom is pain in the upper abdomen. In Chinese medicine, it is caused by a combination of external and/or internal factors. Internal factors include congenital deficiency and stomach and spleen deficiency, which cause the irregulation of qi and blood, and yin and yang. The external factors often include poor diet, excess drinking and cold pathogenic qi attacking spleen and stomach. Peptic ulcer can be caused by a combination of all of the reasons above.

The types of peptic ulcers include gastric ulcer, duodenal ulcer and esophageal ulcer. Endoscopy can aid accurate diagnosis.

Pair-point Treatment Combinations

(1) Pishu (BL 20), Weishu (BL 21) (Fig 23)
Spleen governs the transformation and ascending of nutrients while stomach governs the descending and harmonizing. This pair point combination, one exterior and one interior, one elevating and one lowering, strengthens spleen, harmonizes stomach and regulates the descending and ascending to facilitate qi and invigorate blood. This treatment is appropriate for many types of peptic ulcer.

Needling techniques:
1. Pishu (BL 20), Weishu (BL 21) towards spine oblique insertion about to a depth of 1 cun, after needling, apply moxa using moxa stick for 15 minutes.

(2) Zhongwan (RN 12), Zusanli (ST 36) (Fig 104)
Zhongwan (RN12): on the upper abdomen, on the anterior midline, 4 cun superior to the umbilicus.
Zusanli (ST 36): on the anteriolateral side of the lower leg, 3 cun inferior to Dubi (ST 35), one finger breadth (middle finger) lateral to the anterior crest of the tibia.

Zhongwan (RN 12) is the front-mu point of stomach. It harmonizes and regulates qi in the middle jiao and reduces distension. Zusanli (ST 36) is the lower he-sea point of stomach. It strengthens intestine and stomach and facilitates qi and blood. This pair point combination, one superior and one inferior, work in synergy to strengthen spleen, harmonize stomach qi, invigorate blood, reduce distension and stop pain. This treatment is appropriate for multiple types of peptic ulcer.

Needling techniques:
1. Zhongwan (RN 12) perpendicular insertion to a depth of 1 cun.
2. Zusanli (ST 36) perpendicular insertion to a depth of 2 cun.

(3) Shanzhong (RN 17), Juque (RN 14) (Fig 86)
Shanzhong (RN17) is qihui point-meeting point of the qi and the front-mu point of pericardium. It soothes the chest and the diaphragm, regulates qi and reverses the rising. Juque (RN14), the front-mu point of heart, stabilizes shen, harmonizes and regulates middle jiao, facilitates qi and stops pain. This treatment is appropriate for peptic ulcer accompanied by upper abdominal distension and rib pain.

Needling techniques:
1. Shanzhong (RN17) towards inferior direction, oblique insertion to a depth of 0.5-1 cun.
2. Juque (RN14) perpendicular insertion to a depth of 0.5 cun.

Commentaries
Acupuncture treatment is notably effective in treating peptic ulcer.
To treat pain brought on by peptic ulcer, select Shanzhong (RN 17). Juque (RN 14). Generally, Pishu (BL 20), Weishu (BL 21) and Zhongwan (RN 12), Zusanli (ST 36), these two pair-point combinations can be used to treat all types of peptic ulcer. Moxibustion is used on these above points in most eases, and it is important to continue treatment until symptoms improve.

The later stage of peptic ulcer may lead to bleeding. It is crucial to be careful during clinical treatment. Lastly, for patient suffering from peptic ulcer, it is essential to maintain a positive outlook and avoid stress.