Mechanism of Morbidity Based on Ulcerative Colitis: A Review of Traditional Chinese Medicine Treatment of Ulcerative Colitis.

Abstract

Ulcerative colitis (UC) is a chronic inflammatory disease of the colon and rectum that has become an increasing global health concern. Its pathogenesis is multifactorial, involving genetic susceptibility, environmental triggers, epithelial barrier dysfunction, gut microbiota imbalance, and immune dysregulation. Clinically, UC is characterized by bloody diarrhea, mucosal inflammation, and a relapsing-remitting course, with diagnosis typically confirmed by clinical, endoscopic, histological, and laboratory findings. Despite the increasing number of therapeutic options, including corticosteroids, immunosuppressants, and biologics, many patients still experience suboptimal responses or adverse events, and some ultimately require colectomy. In this context, Traditional Chinese Medicine (TCM) has attracted attention as a complementary approach due to its multi-target mechanisms and historical use in gastrointestinal diseases. This review summarizes recent evidence on the application of TCM in UC, including its theoretical foundations, active compounds, and modulation of key signaling pathways such as TLR4/NF-κB, NLRP3, JAK/STAT3, PI3K/Akt, Notch, and AMPK/mTOR. Additionally, we highlight clinical data from randomized controlled trials (RCTs) evaluating TCM formulas either as monotherapy or in combination with conventional treatments. Some studies report improvements in symptom scores, inflammatory markers, and endoscopic healing when TCM is combined with agents like mesalazine. However, these findings must be interpreted with caution. Most RCTs are single-center with small sample sizes, lack placebo control, and show considerable heterogeneity in intervention protocols and outcome assessments, making quantitative comparisons to standard therapies, such as remission rates or adverse event frequencies relative to mesalazine or biologics, being limited. Therefore, while TCM demonstrates therapeutic potential in UC management, more rigorous evidence is needed to establish its comparative efficacy and safety. Future studies should include large-scale, multicenter, placebo-controlled RCTs with standardized endpoints, and consider integrating TCM syndrome differentiation with modern pathophysiological frameworks to enhance clinical relevance and translational value.