Exploring the Mechanisms and Research Progress of Traditional Chinese Medicine in the Treatment of Ulcerative Colitis from the Perspective of the Gut Microbiome

Abstract

Ulcerative colitis (UC) is one of the major types of inflammatory bowel disease (IBD). It is characterized by a prolonged course, a tendency to recur, and the need for long-term management. In recent years, dysbiosis of the gut microbiota and the resulting damage to the mucosal barrier, immune and inflammatory dysregulation, and metabolic abnormalities have become key factors that cannot be overlooked in explaining the onset and progression of UC. Traditional Chinese medicine (TCM) treatment for UC is characterized by holistic regulation that addresses both internal and external factors, and by the synergistic action of multiple components. It has demonstrated potential to improve clinical symptoms, regulate the intestinal microbiome, promote mucosal repair, and reduce the risk of recurrence. Research on interventions such as TCM compound formulas, active ingredients of TCM, TCM enemas, and the combination of acupuncture and herbal medicine suggests that these methods may exert their effects by modulating the microbial community structure, influencing metabolites such as short-chain fatty acids and bile acids, improving intestinal epithelial barrier function, and alleviating excessive inflammatory responses. However, current evidence largely comes from animal experiments, small-sample clinical studies, and systematic reviews, and significant differences remain among studies in syndrome classification, intervention protocols, outcome measures, and mechanisms of action. This study focuses on the gut microbiota to review the pathogenesis of UC, the limitations of Western medical treatment, and research progress in TCM—particularly TCM enemas—with the aim of providing more targeted guidance for the comprehensive treatment of UC and future research.