Metabolic Reprogramming in Ulcerative Colitis: The Gut Microbiota–Metabolite–Immunity Axis and the Regulatory Role of Traditional Chinese Medicine

Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with unclear etiology, involving intestinal barrier dysfunction, immune dysregulation, gut microbiota imbalance, and host metabolic abnormalities. Multi-omics research has advanced the “gut microbiota–metabolite–host immunity” axis as a central framework for understanding UC pathogenesis. Short-chain fatty acids (SCFAs) and tryptophan metabolites—key microbiota-derived metabolites—play essential roles in maintaining intestinal immune homeostasis and regulating inflammation. Their disruption promotes persistent inflammation and disease progression. Traditional Chinese Medicine (TCM) offers advantages in UC treatment through holistic regulation and multi-target intervention. Evidence indicates that TCM formulas, individual herbs, and their bioactive constituents reshape gut microbiota composition and function, modulate SCFA production and tryptophan metabolism, and alleviate mucosal inflammation. This review systematically delineates key metabolic disruptions in UC, summarizes current understanding of TCM-mediated metabolic reprogramming, and evaluates TCM regulation of SCFA and tryptophan pathways, aiming to establish a theoretical foundation for integrating TCM with conventional UC management.