Ulcers: Diagnosis, Treatment and Management

By: Darcy Hill   
California College of Ayurveda 

The Cleveland Clinic describes a stomach ulcer as something that occurs when stomach acid eats through your protective stomach lining, producing an open sore. Typical signs and symptoms include burning stomach pain and indigestion. Ulcers heal when the conditions causing them are removed.  

A stomach ulcer (or gastric ulcer) is an open sore in your stomach lining. It is a common cause of focal stomach pain, which is a pain that you feel coming from a particular spot-often with a burning or gnawing quality. Stomach ulcers are common and treatable, but they become serious if they go too long without treatment. Some ulcers bleed continuously, which can lead to significant blood loss over time. Some can continue to erode through your stomach wall until there is a hole.  

Sometimes a stomach ulcer is called a peptic ulcer. In the US, healthcare providers treat about 4 million stomach ulcers every year. Ulcers are common in our society because their main causes are also so common. These include use of over-the counter pain medications and a widespread bacterial infection called H.pylori.  

A stomach ulcer feels like a sore spot in your stomach, which is located in your upper abdomen, between your breastbone and your belly button. Typical ulcer pain feels like an acid burn in your stomach. Stomach acids, enzymes and other chemicals are eating away at the wound. 

Many people experience indigestion with stomach ulcers, which means burning stomach pain together with a feeling of fullness. People also report: Acid Reflux and Heartburn, Nausea and vomiting, bloating, belching and gas pain. These symptoms are also related to the conditions that caused your stomach ulcer.  

The two most common causes of stomach ulcers are the H. Pylori bacteria infection and the overuse of Nonsteroidal anti-inflammatory drugs. These two causes together account for about 99% of the stomach ulcers in US healthcare today.  

Lifestyle factors can include day to day stress levels, what you eat and drink, smoking, alcohol and spicy and acidic foods can all contribute to the issue. ¹

Your stomach lining will begin to heal when the cause of the ulcer goes away.¹ 

Introduction to Peptic Ulcers and Ayurveda from Ayurvedic.com

Peptic ulcers are sores that develop on the lining of the stomach, small intestine or esophagus, often causing symptoms like stomach pain, bloating, and nausea. They are commonly caused by factors such as H. Pylori infection, long term use of Non-steroidal anti-inflammatory and excessive acid production in the stomach. 

Ayurveda offers comprehensive treatments for peptic ulcers by addressing the root causes and promoting overall digestive health. Through a combination of herbal remedies, dietary adjustments, detoxification therapies and lifestyle modifications, Ayurveda treatments aim to heal ulcers, reduce symptoms and prevent recurrence.  

Understanding Ayurvedic approaches to treating ulcers can empower individuals to manage their condition naturally and effectively, enhancing their quality of life and digestive well-being. 

Ayurveda emphasizes the balance of three doshas-Vata-Pitta-Kapha-to maintain health and prevent disease. Ulcers are primarily associated with an imbalance in the Pitta dosha, which governs metabolism and digestion. 

In classical Ayurvedic texts, conditions like ulcers are described under the category or Agni (digestive fire) imbalance and Ama (toxic) accumulation. Ayurvedic treatments focus on pacifying Pitta, detoxifying the body and restoring digestive health through a holistic approach. Modern Ayurvedic practices continue to utilize these traditional remedies, integrating them with contemporary health needs to provide effective solutions for managing peptic ulcers and promoting overall digestive wellness.  

The Key Ayurvedic Treatments for Ulcers include: 

Herbal Remedies 

Ayurveda utilizes a variety of herbs known for their soothing, anti-inflammatory, and healing properties to treat ulcers Some key herbal remedies include: 

• Licorice Root: Promotes mucosal healing and reduces inflammation.  
• Aloe Vera: Soothes the digestive tract and supports tissue repair.  
• Turmeric: Possesses anti-inflammatory and antioxidant properties that aid in healing ulcers. 
• Triphala: A combination of Haritaki, Amalaki and Bibhitaki that detoxifies the digestive system and supports all- over gut health.  
• Amla: Rich in Vitamin C and antioxidants, Amla strengthens the immune system and promotes healing.  

Dietary Modifications 

A balanced diet is crucial in managing ulcers. Ayurvedic dietary recommendations include: 

• Cooling Foods: Incorporate foods that pacify Pitta, such as sweet fruits, non-spicy vegetables and whole grains. 
• Avoid Irritants: Reduce the intake of spicy, acidic and fried foods that can aggravate ulcer symptoms.  
• Regular meals: Eat small, frequent meals to avoid overloading the digestive system.  
• Hydration: Maintain adequate hydration with herbal teas and warm water to support digestion and healing.  

Panchakarma Therapies 

Panchakarma, a cornerstone of Ayurvedic detoxification, consists of five therapeutic procedures aimed at cleansing the body of toxins and restoring the doshic balance. For ulcers the following therapies are beneficial: 

• Virechana: (Therapeutic Purgation): Cleanses the liver and reduces Pitta dosha by eliminating excess bile and toxins.  
• Basti: (Medical Enemas): Balances Vata dosha and detoxifies the colon, supporting overall digestive health.  
• Nasya: (Nasal Oils)-Enhances respiratory function and indirectly supports digestive health by clearing out the nasal passages and improving bodily functions. 

Yoga and Stress Management 

• Meditation: Calms the nervous system and mind. Reduce stress, helps to bring balance to Pitta dosha.  
• Pranayama (Breathing exercises): Enhances relaxation and improves oxygen flow to the body.  
• Gentle yoga poses: Support digestive function and reduce abdominal tension, aiding ulcer healing.  

 Lifestyle Changes 

Adopting healthy lifestyle habits is essential for preventing and managing peptic ulcers. Recommendations include: 

• Avoid Smoking and Alcohol. These substances can irritate the stomach lining and exacerbate ulcer symptoms.  
• Regular exercise: engage in moderate physical activity to support overall digestive health and reduce stress. 
• Adequate Sleep: Ensure sufficient and quality sleep to support the body’s healing process, maintain digestive health and reduce stress.  

How Ayurvedic Treatments Address Ulcers 

• Balancing Doshas: By pacifying Pitta dosha, Ayurveda addresses the root cause of ulcer formation and digestive fire. 
• Reducing Inflammation: Herbal remedies and therapies target inflammation in the stomach lining, alleviating pain and promoting tissue repair. 
• Enhancing healing: Herbs like licorice root and Aloe Vera provide a protective coating to the stomach lining, facilitating healing and preventing further irritation. 
• Detoxification: Panchakarma therapies cleanse the body of accumulated toxins, reducing the burden on the digestive system and promoting overall health. 
• Stress reduction: Yoga and meditation techniques help manage stress, which is a significant trigger for peptic ulcers, ensuring long-term relief and prevention. 

By addressing both the symptoms and the underlying causes, Ayurvedic treatments offer a comprehensive approach to managing peptic ulcers effectively. 

Choosing the right Ayurvedic treatment: 

Consulting with an Ayurvedic Practitioner 

Selecting the appropriate Ayurvedic treatment for ulcers begins with consulting a qualified Ayurvedic practitioner. A practitioner will assess your dosha balance, overall health, and specific condition to tailor a personalized treatment plan. This ensures that the chosen remedies and therapies are aligned with your unique health needs and promote optimal healing.  

Quality of Herbal Supplements 

When choosing herbal supplements as part of your Ayurvedic treatment, it is essential to prioritize quality. Look for supplements that are: 

• Standardized Extracts: Ensure consistent potency and efficacy 
• Certified Organic: Free from pesticides and fertilizers 
• Reputable Brands: Trusted manufacturers adhere to Good Manufacturing Practices and undergo rigorous testing for purity and safety. 

High quality herbal supplements enhance the effectiveness of Ayurvedic treatments and support your overall health. 

Recommended Dosage and Administration 

Herbal Remedies: 

• Licorice Root: 500 mg twice a day 
• Aloe Vera:200 mg twice a day or as a juice 
• Turmeric: 500 mg 3 times a day 
• Triphala: 1 tsp of powder mixed with warm water 2 times daily 
• Amla: 1-2 grams of Amla powder or as a juice 2 times daily. 

Always follow the recommended dosage of the supplement label or as advertised by your Ayurvedic practitioner. 

Panchakarma Therapies 

Panchakarma Therapies are typically administered under the supervision of trained Ayurvedic Practitioners. The frequent and duration of treatments depend on the severity of the condition and the individual health needs. A typical Panchakarma session may include Virechana and Basti, scheduled over several days or weeks to achieve optimal detoxification and healing.  

Some herbal remedies can cause mild side effects such as gastrointestinal discomfort or allergic reactions. Take things slowly and consult with your practitioner.  

Ayurvedic Treatments offer a holistic approach to managing ulcers by addressing the root causes and promoting overall digestive health. By utilizing powerful herbal remedies, detox therapies, dietary modifications and stress management techniques, Ayurveda provides comprehensive support for ulcer healing and prevention.  Incorporating these natural remedies into your daily routine, alongside a balanced diet and healthy lifestyle can significantly enhance your digestive well-being and promote long term health. 

Consult with a practitioner who can meet your specific needs and tailor a treatment plan to get optimal results^{. 2} 

Dr Marc Halpern discusses Ulcers (Grahani) in his textbook Clinical Ayurvedic Medicine. 

The western interpretation of Ulcers is defined as an ulceration of the mucosal surface of the stomach or duodenum that enters into the muscular layer below.  

Etiology 

Ulcers are caused by a malfunction of the lower esophageal sphincter at the junction of the esophagus and the stomach. The cause of the dysfunction is unknown.  

Signs and Symptoms 

Gastritis and ulcers have a similar presentation with upper abdominal pain (Gnawing, burning or aching) belching and loss of appetite. Nausea and vomiting are possible as well as weight loss. Gerd presents differently, with burning pain in the chest that begins suddenly and is intense. Because the pain is in the chest, it is often called heartburn. However, the heart is not involved. Gerd is usually worse when lying down.  

Complications  

Peptic ( stomach) and severe gastritis can lead to pernicious anemia as a result of parietal cell dysfunction. Parietal cells produce Intrinsic Factor, a substance necessary for B-12 absorption. Poor protein digestion is also possibly due to the effect of hypochlorohydria on pepsinogen . Chronic inflammation may increase the risk of stomach cancer. Ulcerations that continue to progress can lead to a perforated stomach resulting in peritonitis. Surgery is required to treat this condition^. 3  

Ayurvedic Discussion 

The role of Pitta is paramount in these conditions as burning is the predominant symptom. However, Vata can play an important role as well and should not be ignored. Vata dosha is responsible for drying the protective mucous membrane of the stomach. In this case, even normal or lower than normal acid levels result in burning gastritis.  

In order to adequately differentiate the two causes, it is important to consider the patient’s overall Vikruti and the etiological factors contributing to the condition. In patients who are affected by worry and anxiety, the condition is much more likely to be caused by Vata dosha. In patients who are affected by intensity and anger, the condition is much more likely to be caused by pitta dosha.  

Ulcers are a more severe condition than gastritis. Ulcers often produce blood that oxidized in the digestive tract and appears as black tarry stool. A stool analysis can be performed to try to detect the blood. It is a very useful diagnostic test and if present indicates ulcer. ₄ 

 The Classical Text Asthanga Hrdaya has the following points on Ulcers: 

• Ten Year old Ghee cleanses and heals ulcers. ⁵ 
• Triphala is a very good rejuvenator. It heals ulcers and dries up moisture in the ulcers. ⁶ 
• Kasaya Rasa Karma heals ulcers and scratches adhering material.⁷ 
• Both Priyangradi and Ambashthadi  Drugs mitigate Pitta and reduces ulcers. 
• Drugs that are useful for healing ulcers by absorbing water.⁸ 

Nyagrodha*Pippala*Arjuna*Plaksa*Nandi*Kola 

• Alcoholic Drinks, which are strong, hot and sour cause acute complications to the persons suffering from ulcers. ⁹ 
• Food substances, which cause constipation, burning sensation, having the qualities of cold and heavy, are also contraindicated as they are responsible for aggravation of doshas in the person suffering from ulcers. ¹⁰ 

In the Charaka Vrana Chikitsa-25^Th Chapter on Wounds and Ulcers deals with symptoms and treatment of internal and external wounds and ulcers. It is called Vrana Chikitsa Adhyaya.  

Prologue 

Finding an opportune moment, Agnivesha respectfully requested his preceptor, Lord Atryea who was well versed in the spiritual and physical sciences, and as free from the afflictions of self-pride as well as vanity, as follows: 

O! Lord. 2 types of Ulcers are enumerated in the chapter dealing it the complication of diseases (vide Sutra 19:4:7) O! Bestower of Happiness, your may kindly expound the signs and symptoms as well as the treatment of these 2 types of ulcers. ¹¹ 

The Guru’s reply: Having heard this query, The Preceptor replied as follows: 

O! Disciple, now listen about the Linga (signs and Symptoms including etiology) and Bheshaja (therapeutic measures) of both the types of ulcer, vix, nija (endogenous and Agantuja (Exogenous). ¹² 

The Nija or endogenous type of Vrana (Ulcer) is caused by a vitiation of Doshas in the body.  

The Pathogenesis of Endogenous Ulcers 

Vata, Pitta and Kapha being aggravated by their respective causative factors get lodged in the exterior of the body to give rise to the endogenous type of ulcer in human beings. ¹³ 

Vataja Vrana 

Vatiki type of ulcer is characterized by: 

• Stabdha-stiffness 
• Kathina samsparsha-hardness in touch 
• Manda Srava-scant discharge 
• Ati tivra ruk-excruciating pain 
• Tudyate-prickling sensation 
• Sphurana-throbbing 
• Shyava aruna maruta sambhava-bluish black coloration 

Treatment of Vatika Ulcer: 

The patient suffering from Vatika type of ulcer is treated with 

• Sampurna-filing buccal cavity of the ulcer 
• Snehapana-oleation therapy 
• Snigdha-fomentation 
• Upanaha-application of hot paste or drugs 
• Pradeha-applicaton of ointment 
• Pariseka-(affusion) which are of unctuous nature ¹⁴ 

Pittaja Vrana 

Signs and symptoms from Paittika type of ulcers: 

• Trishna-thirst 
• Moha-Unconsciousness 
• Jwara-fever 
• Sweda:Sweating 
• Daha-burning sensation 
• Dushti-putrification and 
• Avadarana-sloughing out of tissues 
• Vidyat gandhaih putika srava-Elucidation of foul smelling material (pus) form the ulcer 

Treatment of Paittika Ulcer: 

Paittika type of Ulcer is treated with 

• Pradeha-application of hot pasted of drugs and  
• Parisechana (affusion)  
• Sarpi pana-intake of medicated ghee 
• Virechana-purgation therapy prepared of cooling, sweet and bitter drugs ¹⁵ 

Kaphaja Vrana 

Signs and Symptoms of Kapahja Vrana: 

The Kaphaja type of Ulcer is characterized by 

• Bahu piccha-excessive slime exudation 
• Guru-heaviness 
• Snigdha-unctuousness 
• Stimita-numbness 
• Manda Vedana-mild pain 
• Pandu varna-pallor 
• Alpa sanklesha-loss of sloughing and 
• Chira kari-long duration

Treatment of Kaphaja Vrana:  

Kaphaja type of Ulcer is treated with 

• Pradeha (application of hot paste of drugs 
• Parisechana (affusion) prepared of drugs which are Kashaya (astringent), Katu (pungent), Ruksha (dry) and Ushna (hot. 
• The patient suffering from this type of Ulcer is given 
• Langhana (fasting) 
• Pachana (which helps in the metabolic transformation of uncooked material of the body. ¹⁶ 

In the beginning, the patient suffering from the ulcer should appropriately by given elimination therapies for the purification of the body and elimination of the morbid matter through the upward track (Vamana or emesis) and downward track (Virecana or purgation), by venesection with the help of sharp -edged instruments, and by medicated enema or basti. When the body becomes cleansed of the morbid matter, the ulcer gets healed up instantaneously. ¹⁷ 

  The following will describe brief summaries on some of the Classical Texts surrounding Ulcers. 

To understand the Indian Materia Medica’s approach to stomach Ulcers consider the following points: 

• Herbal Remedies: Utilize herbs like Aloe Vera and Licorice for their soothing properties to the stomach lining.  
• Dietary Adjustments: Incorporate a diet rich in fiber and low in spice foods to promote healing. 
• Ayurvedic Treatments: Explore Ayurvedic formulations such as Triphala and Ashwagandha for their digestive benefits.  
• Probiotics: Include probiotic rich foods like yogurt to restore gut flora balance. 
• Avoid Irritants: Steer clear of alcohol, caffeine, and NSAID’s that can exacerbate ulcer symptoms. 
• Consultation: Seek guidance from a qualified practitioner for personalized treatment plans. ¹⁸   

To understand the teachings of Yoga Vasistha on ulcers and inflammation, consider these insights: 

• Recognize that physical ailments stem from mental disturbances and ignorance 
• Cultivate a calm mind through meditation to alleviate stress-related inflammation.  
• Embrace a balanced diet rich in natural, anti-inflammatory foods.  
• Practice yoga postures that promote circulation and detoxification. 
• Use breath control (pranayama) to enhance the body’s healing processes. 
• Understand the importance of self-awareness and mindfulness in healing. ¹⁹ 

To understand Dravyaguna Vijnana’s approach to Ulcers consider the following points: 

• DV is the study of medicinal properties of herbs and their therapeutic applications. 
• Types of Ulcers: Recognize different types of Ulcers, such as peptic, gastric, and duodenal ulcers. 
• Herbal Remedies: Utilize herbs like Aloe Vera, Licorice and Turmeric known for their healing properties.  
• Dosage Forms: Administer herbs in various forms, including powders, decoctions, and pastes for effective treatment. 
• Dietary Considerations: Incorporate a balanced diet rich in antioxidants and anti-inflammatory foods to support healing.  
• Lifestyle Modifications: Encourage stress management and avoidance of irritants like alcohol and smoking to prevent ulcer aggravation. Eliminate spicy, acidic and fried foods. 
• Determine the Doshic imbalance: ie: whether Pitta, Vata or Kapha is predominant in the ulcer condition. 
• Promote healing with ashwagandha to support tissue regeneration and reduce stress related ulcers. Explore traditional formulations such as Triphala for overall digestive health. 
• Monitor Lifestyle Factors: Address major stress management and lifestyle habits that may contribute to ulcer formation. 
• Consult a practitioner and have regular follow ups. ²⁰ 

To summarize, Ulcers are often linked to an imbalance in the body’s doshas, particularly Pitta. Pitta is a source of heat, which can lead to inflammation and ulcer formation. A diet high in spicy, acidic or processed foods can aggravate ulcers. Stress and emotional factors can also contribute.  

The management from an Ayurvedic perspective could include: Herbal remedies such as licorice and aloe vera, stress reducing activities such as yoga and meditation, maintaining a balanced diet with cooling foods to soothe the digestive system. A regular detox program may help eliminate toxins that contribute to ulcer formation. Consulting with an Ayurvedic practitioner will help to guide those suffering from ulcers through this process.  

Overall, a holistic and Ayurvedic approach focusing on diet, lifestyle and mental wellbeing is essential for ulcer management.

1. Cleveland Clinic: https://myclevenandclinic.org/health/disease22314-stomach-ulcer    3-18-2024 

2. Ask Ayurveda.com: https://askayurveda.com/articles/309-pepticulcer-ayurvedic-treatment-natural-ways-to-heal-stomach-ulcers    November 2025 

3. Clinical Ayurvedic Medicine 
   Dr. Marc Halpern 
   Volume 1 8^th Edition    page 36   April 2020  

4. IBID pg 37 

5. Asthanga Hrdaya Classical Text from Web pg 108 

6. IBID pg 163 

7. IBID pg 210 

8. IBID pg 282 

9. IBID pg 283 

10. IBID pg 436 

11. Charaka Vrana Chikitsa-25^th Chapter Wounds and Ulcers 
    https://www.easyayurveda.com/2015/21/7charaka-vrana-chikitsa-25th-chapter
    Prologue pg 3-4 

12. IBID pg 5-6 

13. IBID pg 9-10 

14. IBID pg 11-12 

15. IBID pg 13-14 

16. IBID pg 15-16 

17. IBID pg 38-39 

18. Summary from Web on Indian Materia Medicas Approach 

19. Yoga Vasistha summary on ulcers 

20. Summary on Dravyaguna Vijnanas approach