Considerations of traditional Chinese medicine as adjunct therapy in the management of ulcerative colitis

Ulcerative colitis (UC) has been treated with traditional Chinese medicine (TCM) for literally thousands of years. This paper gives an overview of TCM in the management of UC, provides an account of the state of the evidence, identifies gaps in the research base, and makes recommendations for future research. TCM is based on patterns and this influences the selection of the type of herbal medication or manipulation technique used for treatment. The majority of clinical studies on the efficacy of Chinese herbal medicine and acupuncture in the treatment of UC have methodological shortcomings. The extent of heterogeneity in many of these clinical trials, poor design quality of past studies prevent meaningful systematic reviews (SRs) or meta-analysis, although there are positive signs that TCM may be useful in relieving abdominal pain and reducing inflammation. Many unknowns still exist, including the active ingredients within Chinese herbal medicine and the potential for interaction with other drugs or western medications. While there may be a potential role for utilizing TCM in the treatment of UC patients relying on both traditional concepts and modern developments, it should be recognized that there are no studies that irrefutably support the use of TCM in the treatment of UC. Further basic or translational research must be done to elucidate mechanisms of action of these agents, and well-designed and well-conducted clinical studies must also be done to determine efficacy and safety of these agents.