SEARCHNARRATIVE_REVIEWgastroenterology, traditional Chinese medicine

narrative_review·gastroenterology, traditional Chinese medicine, immunology, microbiology, pharmacology·PMC10230642

Chinese herbal medicines for treating ulcerative colitis via regulating gut microbiota-intestinal immunity axis

Chinese Herbal Medicines · 16 authors, 6 centres

AI SUMMARY

FIDELITY 100%

POPULATIONRodents with DSS- or TNBS-induced experimental colitis; human patients with active or quiescent UC

INTERVENTIONChinese herbal formulas (e.g., Huaihua Powder, Huangqin Decoction, Qingchang Huashi Formula), single herbs (e.g., Indigo naturalis, Abelmoschus manihot), or derived constituents (e.g., berberine, curcumin, baicalin, polysaccharides from Codonopsis pilosula, Ganoderma lucidum)

COMPARISONPlacebo, no treatment, or standard-of-care (e.g., mesalazine, sulfasalazine, 5-ASA, azathioprine)

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

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TL;DR

This review summarizes how Chinese herbal medicines (single herbs, formulas, and derived constituents like polysaccharides, alkaloids, flavonoids, and polyphenols) protect against ulcerative colitis by modulating the gut microbiota-intestinal immunity axis. The key mechanisms include restoring beneficial bacteria (e.g., Lactobacillus, Bifidobacterium), increasing short-chain fatty acid production, and rebalancing pro-inflammatory (Th17) and anti-inflammatory (Treg) immune pathways. Clinical evidence, though limited, suggests several Chinese herbal medicines show promising efficacy with fewer adverse effects compared to conventional therapies.

Full summary

4,720 CHARS

**Background:** Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease characterized by diarrhea, abdominal pain, and bloody stools. Its pathogenesis involves genetic susceptibility, environmental factors, immune dysfunction, and gut microbiota dysbiosis. Current treatments (biologics, corticosteroids, immunomodulators) have limitations including high cost and adverse effects. Chinese herbal medicines have been used for UC in China for millennia and offer advantages of wide availability, low cost, and multi-target mechanisms. This review focuses on how Chinese herbal medicines treat UC by regulating the gut microbiota-intestinal immunity axis.

**Methods:** The authors conducted a narrative review of published preclinical and clinical studies examining Chinese herbal formulas, single herbs, and derived constituents for UC treatment. Preclinical studies used dextran sulfate sodium (DSS) or trinitrobenzene sulfonic acid (TNBS) to induce experimental colitis in rodents. Outcomes assessed included disease activity index (DAI), colon length, body weight, colonic histology, inflammatory cytokine levels, gut microbiota composition (via 16S rRNA sequencing), short-chain fatty acid (SCFA) production, and immune cell profiling (Th17/Treg balance). Clinical trials included randomized controlled trials (RCTs), open-label studies, and multicenter trials.

**Key Results:** The review covers 10 herbal formulas, 7 single herbs, and 14 derived constituents. Key findings include: - **Herbal formulas:** Huaihua Powder (5.76 g/kg/d) reduced Bacteroidetes/Firmicutes ratio and Verrucomicrobia while preventing Proteobacteria overgrowth in DSS mice. Huangqin Decoction (9.1 g/kg/d) suppressed TNF-α, IL-6, IL-1β, and COX-2 while inhibiting Desulfovibrio and Helicobacter. Lizhong Decoction (1.365–12.285 g/kg/d) increased Muribaculaceae_norank and PrevotellaceaeUCG001 while reducing Escherichia_Shigella. Qingchang Huashi Formula (36 g/kg/d) decreased Firmicutes/Bacteroidetes ratio, inhibited NLRP3/IL-1β pathway, and reduced IL-1β, IL-6, and TNF-α. Rhubarb Peony Decoction (5–20 g/kg/d) promoted Butyricicoccus pullicaecorum and restored Th17/Treg homeostasis. - **Single herbs:** Abelmoschus manihot (0.25–1 mg/g/d) increased Lachnospiraceae, Alistipes, and Lactobacillus while reducing Bacteroidetes. Indigo naturalis (200 mg/kg) reversed the Bacteroidetes/Firmicutes ratio increase and reduced IL-6, IL-8, and TNF-α while elevating IL-10. Hypericum attenuatum Choisy (200 mg/kg) suppressed NF-κB and MAPK signaling and increased Firmicutes, Clostridiales, and Lachnospiraceae. - **Derived constituents:** Codonopsis pilosula polysaccharides (300 mg/kg/d) reduced IL-17A, IL-17F, IL-6, IL-22, and TNF-α while increasing TGF-β and IL-10, and enhanced Bifidobacterium and Lactobacillus. Berberine (100 mg/kg/d) increased lactic acid-producing bacteria and decreased Mucispirillum and Oscillospira. Oxyberberine (50 mg/kg/d) inhibited TLR4-MyD88-NF-κB signaling and increased Prevotella and Anaeroplasma. Baicalin (100 mg/kg) reduced Firmicutes/Bacteroidetes ratio and promoted butyrate-producing species (Butyricimonas, Roseburia, Subdoligranulum, Eubacterium). Curcumin (0.2% in diet) increased Clostridium cluster IV and XIV, Lactobacillales, and fecal butyrate. - **Clinical trials:** Hudi enteric-coated capsules (HEC) showed 91.09% efficacy vs. 84.62% for mesalazine in 240 patients with mild UC. Curcumin (2 g/d) plus sulfasalazine or mesalamine significantly prevented relapse in 89 patients with quiescent UC. Indigo naturalis (0.5–2.0 g/d) showed clinical efficacy in 86 patients with active UC, though mild liver dysfunction occurred in 10 patients. Fufangkushen Colon-coated Capsule (FCC) showed superior effect for left hemicolon UC compared to mesalazine in 320 patients.

**Clinical Implications:** Chinese herbal medicines offer a multi-target therapeutic approach for UC by simultaneously modulating gut microbiota composition, enhancing SCFA production, and rebalancing Th17/Treg immune responses. Several agents (curcumin, berberine, Indigo naturalis) have entered clinical trials with promising efficacy and safety profiles. However, most clinical studies lack rigorous double-blind, randomized controlled designs. The review highlights that targeting the gut microbiota-intestinal immunity axis is a promising strategy for UC treatment, and Chinese herbal medicines are well-positioned to exploit this approach due to their inherent multi-component, multi-target characteristics. Future research should employ antibiotic treatment, fecal transplantation, and germ-free animal models to establish causality, and large-scale evidence-based clinical trials are urgently needed.

PICO

PPOPULATION

Rodents with DSS- or TNBS-induced experimental colitis; human patients with active or quiescent UC

IINTERVENTION

Chinese herbal formulas (e.g., Huaihua Powder, Huangqin Decoction, Qingchang Huashi Formula), single herbs (e.g., Indigo naturalis, Abelmoschus manihot), or derived constituents (e.g., berberine, curcumin, baicalin, polysaccharides from Codonopsis pilosula, Ganoderma lucidum)

OOUTCOME

Disease activity index (DAI), colon length, body weight, colonic histology, inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-10), gut microbiota composition (16S rRNA), SCFA levels, Th17/Treg balance, clinical remission and mucosal healing in human trials

STUDY TYPE

narrative_review

SPECIALTY

gastroenterology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10230642

Chinese herbal medicines for treating ulcerative colitis via regulating gut microbiota-intestinal immunity axis

Chinese Herbal Medicines

READ THE FULL PAPER

ABSTRACT

Ulcerative colitis (UC) is one of types of inflammatory bowel disease with high recurrence. Recent studies have highlighted that microbial dysbiosis as well as abnormal gut immunity are crucial factors that initiate a series of inflammatory responses in the UC. Modulating the gut microbiota-intestinal immunity loop has been suggested as one of key strategies for relieving UC. Many Chinese herbal medicines including some of single herb, herbal formulas and the derived constituents have been reported with protective effect against UC through modulating gut microbiome and intestinal immunity. Some clinical trials have shown promising results. This review thus focused on the current knowledge on using Chinese herbal medicines for treating UC from the mechanism aspects of regulating intestinal homeostasis involving microbiota and gut immunity. The existing clinical trials are also summarized.

CITATION EXPORT

Yifei Yang, Yi Wang, Long Zhao et al.. Chinese herbal medicines for treating ulcerative colitis via regulating gut microbiota-intestinal immunity axis. Chinese Herbal Medicines. (2023). https://doi.org/10.1016/j.chmed.2023.03.003

AUTHORS

16 · 6 CENTRES

Yifei Yang, Yi Wang, Long Zhao, Fang Wang, Mingxing Li, Qin Wang, Haoming Luo, Qianyun Zhao, Jiuping Zeng, Yueshui Zhao, Fukuan Du, Yu Chen, Jing Shen, Shulin Wei, Zhangang Xiao, Xu Wu

aLaboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou 646000, China
bLuzhou Key Laboratory of Cell Therapy & Cell Drugs, Luzhou 646000, China
cSichuan Fifth People’s Hospital, Chengdu 610015, China
dDepartment of Spleen and Stomach Diseases, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China
eSouth Sichuan Institute of Translational Medicine, Luzhou 646000, China
fState Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macao 999078, China