Gastric Ulcer

Licorice is the classic herbal ulcer remedy, and it produced a pharmaceutical drug. Deglycyrrhizinated licorice (DGL) — the root with its blood-pressure-raising glycyrrhizin removed — was tested in controlled trials for gastric and duodenal ulcer from the late 1960s, with endoscopic healing reported and efficacy comparable to the acid-suppressing drugs of the day ^{1,3Reference 1Turpie et al. · 1969Clinical trialClinical trial of deglycyrrhizinized liquorice in gastric ulcer — controlled trialView study →Reference 3D’Imperio et al. · 1978RCTDouble-blind trial in duodenal and gastric ulcers: cimetidine and deglycyrrhizinized liquorice — randomised controlled trialView study →}; DGL also reduced aspirin-induced gastric mucosal bleeding ^{2Reference 2Rees et al. · 1979Effect of deglycyrrhizinated liquorice on gastric mucosal damage by aspirinView study →}.

The mechanism is well characterised and protective rather than acid-blocking: glycyrrhetinic acid inhibits 15-hydroxyprostaglandin dehydrogenase, raising mucosal prostaglandins and increasing mucus secretion and cell proliferation — the same logic that produced the semi-synthetic ulcer drug carbenoxolone.

More recently, adding licorice to standard H. pylori triple therapy improved eradication rates in two randomised trials ^{4,5Reference 4Hajiaghamohammadi et al. · 2016RCTTo evaluate of the effect of adding licorice to the standard treatment regimen of Helicobacter pylori — randomised controlled trialView study →Reference 5Momeni et al. · 2014RCTEffect of licorice versus bismuth on eradication of Helicobacter pylori in patients with peptic ulcer disease — randomised controlled trialView study →}, consistent with in-vitro work showing licorice polysaccharides block H. pylori adhesion to gastric tissue ^{6Reference 6Wittschier et al. · 2009In vitroAqueous extracts and polysaccharides from liquorice roots (Glycyrrhiza glabra L.) inhibit adhesion of Helicobacter pylori to human gastric mucosa — in vitroView study →}.

The strongest trials predate modern methodology and proton-pump inhibitors, and the whole-root-versus-DGL question is unresolved — one trial found DGL ineffective, which suggests the glycyrrhizin fraction contributes something. Preparation matters: DGL is the form with the ulcer evidence and it avoids the glycyrrhizin issue, while sustained high-dose whole root raises blood pressure and lowers potassium and is not intended for open-ended use.

Meadowsweet is a salicylate-bearing plant — it gave aspirin its name — and yet its decoctions protect the gastric lining rather than damaging it. Flower decoctions showed anti-ulcer activity including against acetylsalicylic-acid-induced gastric lesions ^{8Reference 8Barnaulov et al. · 1980AnimalAnti-ulcer action of a decoction of the flowers of Filipendula ulmaria — animal modelView study →}, and a modern study confirmed gastroprotection against ethanol-induced acute gastric injury using lyophilised flower infusions ^{7Reference 7Samardžić et al. · 2018AnimalAntioxidant, anti-inflammatory and gastroprotective activity of Filipendula ulmaria and Filipendula vulgaris — ex vivo and animal modelView study →}.

An isolated constituent and a whole herb are not the same thing: the plant’s tannins, flavonoids and mucilage accompany the salicylates and change the net effect on the stomach entirely. Traditional Western practice reached the same conclusion long before the pharmacology, using meadowsweet specifically for hyperacidity and gastric irritation. Animal evidence only, with no human trial.

The archetypal demulcent, and its action is physical rather than pharmacological. The inner bark is roughly 7% mucilage, a hydrophilic polysaccharide that swells in water into a viscous gel and coats mucosal surfaces ^{9,10Reference 9Watts et al. · 2012ReviewSlippery elm, its biochemistry, and use as a complementary and alternative treatment for laryngeal irritation — reviewReference 10Barnes et al. · 2007Herbal Medicines (3rd ed.), pp}. On an irritated stomach lining it forms a barrier that buys time for repair.

It is taken as a gruel or slurry rather than a tincture, because the mucilage has to be present in bulk to work; an alcohol extract leaves most of it behind. Slippery elm is a food-grade, exceptionally well-tolerated remedy with a long record in North American practice. There is no controlled trial for ulcer, and the mechanism points to symptomatic relief rather than healing.

U. rubra has come under harvest pressure, so sourcing matters.

The European counterpart to slippery elm, working by the same physical mechanism. The root is rich in a viscous polysaccharide mucilage — the original confection took its name from this plant, though today’s version contains none of it ^{11Reference 11Grieve · 1931A Modern Herbal — Mallow (Marsh)}. Traditional use runs through the whole length of the mucous membranes, with the root favoured for the digestive tract and the leaf for urinary and respiratory use ^{12Reference 12Barnes et al. · 2007Herbal Medicines (3rd ed.), pp}. Like slippery elm it is prepared as a cold infusion or gruel to preserve the mucilage, is essentially a food, and is among the gentlest options in the materia medica. There is no ulcer trial.

Better known as a nervine and aphrodisiac, damiana has a specific gastroprotective finding. Arbutin, one of its major hydroquinone glycosides, protected the gastric mucosa in both aspirin- and ethanol-induced rat ulcer models, reducing ulcer index and lipid peroxidation and modulating IL-6, IL-10 and TNF-α, with no observed toxicity ^{13Reference 13Taha et al. · 2012AnimalGastroprotective activities of Turnera diffusa Willd. ex Schult. revisited: role of arbutin — animal modelView study →}.

Gastric ulcer appears in damiana’s traditional indications across its range, and the named constituent gives that use a plausible basis. The work is in animals only.

The Asháninka of Peru have the longest recorded use of this vine, and gastric ulcers appear explicitly in their documented indications, alongside inflammation, arthritis and wound healing ^{14,15Reference 14Heitzman et al. · 2005ReviewEthnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae) — reviewView study →Reference 15Keplinger et al. · 1999ReviewUncaria tomentosa — ethnomedicinal use and new pharmacological, toxicological and botanical results — reviewView study →}. Cat’s claw’s modern evidence is good but sits elsewhere — anti-inflammatory activity in osteoarthritis and rheumatoid arthritis, and as an adjunct in chemotherapy-related neutropenia. Its anti-inflammatory pharmacology is consistent with the traditional gastric use.

The inner-leaf gel is a mucilaginous demulcent, and peptic ulcer is among its documented traditional uses in Ayurvedic and Thai practice ^{16Reference 16Bone · 2003A Clinical Guide to Blending Liquid Herbs: Herbal Formulations for the Individual Patient, pp}. The distinction that matters is between preparations: the inner-leaf gel is the soothing part, while whole-leaf preparations carry anthraquinone latex from just under the rind, which is a stimulant laxative and unhelpful for an irritated stomach. Decolourised, purified inner-leaf juice is the form intended for internal use. Its use for ulcer is traditional, though aloe’s demulcent action is well established in principle.

Greater celandine is primarily a bitter cholagogue — a liver and gallbladder herb — and gastric ulcer appears in both its European and Chinese traditional indications ^{17,18Reference 17Gilca et al. · 2010ReviewChelidonium majus — an integrative review: traditional knowledge versus modern findingsView study →Reference 18Bone et al. · 2013Principles and Practice of Phytotherapy, pp}. It is a strong-acting herb, used in small doses within formulas and best prescribed by a practitioner.

Rhubarb root acts in opposite ways depending on dose. At low doses the tannins dominate and rhubarb root is astringent and anti-haemorrhagic — which is the basis of its traditional use in gastrointestinal bleeding and in Chinese medicine for upper-GI haemorrhage. At higher doses its anthraquinones drive a purgative action, which is the opposite of what an irritated stomach needs. The dose decides the effect, so this is a herb for a practitioner’s formula rather than casual self-use.

Gastric ulcer sits among reishi’s long list of traditional Chinese indications. Its serious modern research concerns immune modulation and its triterpenes and polysaccharides, not the gastric mucosa, so the gastric use reflects the breadth of a tonic reputation rather than a specific anti-ulcer tradition.

In Russian and Siberian folk practice chaga was taken for stomach complaints and ulcers as well as for general debility, and that gastric use is among its best-documented traditional applications. Modern work focuses on its polysaccharides and antioxidant activity rather than on ulcer healing.

Best known in Ayurveda as a female reproductive tonic, shatavari is also used as a soothing demulcent for dryness and irritation of the digestive membranes, which is the reasoning behind its use for ulcer. That places it with marshmallow and slippery elm mechanistically, though with less direct evidence for the stomach specifically.

A berberine-bearing bitter used traditionally for inflamed and irritated mucous membranes throughout the digestive tract. Berberine’s activity against H. pylori gives a plausible thread, though goldenseal has not been tested for this. Goldenseal is seriously threatened by over-harvest, and Oregon grape is the usual sustainable substitute for its berberine content.

Manuka honey’s antibacterial activity is well established for wounds, and it has been investigated against H. pylori in vitro. Whether ingested honey reaches gastric mucosa at a meaningful concentration is a different question, and an untested one.

Neem bark extract has been studied for gastric acid secretion and ulcer healing in small preliminary work, and gastric complaints are among its very broad Ayurvedic indications. Its well-controlled human evidence is in oral health rather than the stomach.

Brazilian “para todo”, used as a general restorative with gastric complaints among a long list of indications. The gastric use reflects the breadth of a tonic reputation rather than a specific ulcer tradition.

An Amazonian nerve tonic and aphrodisiac whose traditional indications include gastrointestinal complaints. That use is broad rather than ulcer-specific, and the herb’s research attention has gone to its neuroprotective activity.

Hou Po is a major Chinese herb for stagnation, fullness and distension in the middle abdomen, the traditional territory its gastric use comes from. Its modern research concerns honokiol and magnolol for anxiety and sleep rather than the gastric mucosa.

A South American remedy used across a wide range of digestive complaints including gastric irritation. Its better-supported directions are antidiarrhoeal and antispasmodic.

The leaf and bark tea is used in Brazilian practice for dyspepsia and gastric complaints among many other indications. It has had no ulcer-specific testing.

A traditional alterative whose consistent uses across its range are skin disease, infection and rheumatic complaints; gastric use is peripheral to that pattern.

Used across the tropics for stomach irritation and ulcers alongside its better-known application to wounds and skin infection, usually as the fresh leaf.