Traditional Chinese medicine combined with biologic therapy for refractory severe ulcerative colitis: A case report

Background

Acute severe ulcerative colitis (UC) may show suboptimal early response to corticosteroids and biologics, with ongoing hematochezia and anemia increasing the risk of rescue failure and surgery. Traditional Chinese medicine (TCM) is used adjunctively in East Asia and may aid hemostasis, barrier repair, and symptom control; however, evidence for timing and integration with biologic induction remains limited.

Case summary

An 18-year-old man with extensive, severe UC (Mayo 12; endoscopic Mayo 3) had only partial improvement after intravenous steroids and two infliximab (IFX) infusions, with persistent hematochezia and a hemoglobin nadir of 59 g/L. A modified TCM regimen (Shen-Ling-Bai-Zhu San plus Ge-Gen-Qin-Lian Tang) was started, achieving a hemostatic “inflection” within 3–4 days; Huangtu Tang–intent herbs were added for recurrent bleeding. IFX was then accelerated with a third infusion at week 2. By discharge, symptoms remitted (Mayo 2; Lichtiger 2), and by day-14 endoscopy the mucosa improved (endoscopic Mayo 1). At two months, clinical indices were 0 with normalized C-reactive protein and sustained remission thereafter. No new serious adverse events occurred during combination therapy.

Conclusions

In steroid-refractory severe UC with inadequate early bleeding control during IFX induction, adjunctive TCM—combined with accelerated IFX—was temporally associated with rapid hemostasis, clinical improvement, and endoscopic healing without new safety signals. This case supports the feasibility of an integrative, treat-to-target strategy and highlights the need for standardized protocols and prospective trials to validate efficacy and clarify mechanisms.