The insights of Donguibogam align surprisingly well with modern understanding of gastrointestinal disease. In modern medicine, gastric ulcer and duodenal ulcer develop when the balance breaks down between aggressive factors, such as gastric acid and pepsin, and defensive factors protecting the gastric mucosa. The most common causes are Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs, but chronic stress also plays an exceptionally important role.
Helicobacter pylori colonizes the gastric mucosa, causing inflammation and weakening mucosal defenses, which greatly raises ulcer risk. Nonsteroidal anti-inflammatory drugs cause ulcers by inhibiting the production of prostaglandin, a substance essential for protecting the gastric mucosa. Beyond these two causes, chronic stress and irregular lifestyle habits can act as powerful factors that aggravate or even directly induce a gastric ulcer.
Here, the hwa-byung of the stomach described in Donguibogam converges with the modern concept of the gut-brain axis. Our brain and gut communicate constantly through the nervous system, endocrine system, and immune system. Under stress, the brain activates the hypothalamic-pituitary-adrenal axis, increasing secretion of the stress hormone cortisol. This cortisol increases gastric acid secretion and reduces blood flow volume to the gastric mucosa. It also impairs the regenerative capacity of the gastric mucosa and promotes inflammatory responses, creating an environment vulnerable to ulcers. This closely mirrors the Donguibogam explanation of a weakened stomach coupled with exuberant fire.
Furthermore, stress alters the gut microbiota. When beneficial bacteria decrease and harmful bacteria increase, intestinal mucosal permeability rises, making inflammation more likely to occur and spread systemically to affect the stomach. Excessive activation of the sympathetic nervous system from chronic stress suppresses the parasympathetic nervous system responsible for digestive function, leading to dyspepsia and decreased gastric motility, which exposes the gastric mucosa to gastric acid for longer periods. In short, defensive barriers weaken while aggressive factors, including gastric acid, grow more active.
Common symptoms of a gastric ulcer include burning pain in the upper abdomen, heartburn, nausea, and dyspepsia. Pain often worsens on an empty stomach or at night because gastric acid irritates the gastric mucosa further. Dismissing these symptoms as simple gastritis can eventually lead to hematemesis or melena, matching the hematemesis described in Donguibogam. In severe cases, it increases the risk of gastric perforation, pyloric stenosis, and even gastric cancer, meaning it should never be ignored. If gastrointestinal discomfort persists, undergoing an endoscopy for an accurate diagnosis and treatment is essential.
