PLANT-BASED INTEGRATIVE MEDICINE FOR ULCERATIVE COLITIS

First-line treatments for ulcerative colitis (UC) usually consist of medications containing 5-aminosalicylic acid (5-ASA). However, approximately 50% of patients do not respond to 5-ASAs, so they move on to immunosuppressant drugs or biologic treatments such as anti-TNF. But even these have limited efficacy (they do not work in every patient) and are associated with adverse effects, some of them serious.

It is understandable that both patients and doctors look for more natural and integrative solutions to treat IBD. This clinical interest in natural compounds has given rise to what some call a renaissance of phytotherapy within conventional healthcare.

The herbs used in Traditional Chinese Medicine (TCM) have attracted great clinical interest for their efficacy in ulcerative colitis and have been the subject of significant research. Notable among these herbs are aloe vera, Andrographis paniculata extract, Boswellia, xilei-san enema, Qing dai and curcumin.

The efficacy of these agents has been studied as a single therapy or used in combination with standard medication as a comprehensive treatment for UC. This is the meaning of integrative medicine: one that combines the efficacy of conventional modern medicine with traditional or alternative medicine to treat the patient holistically, considering not only physical but also emotional aspects.  This approach is especially useful for patients with chronic diseases, as it enhances outcomes by combining the efficacy of both approaches.

After analysing all the existing research and clinical trials, the team of Nir Salomon, from Israel, focused on the most promising agents and continued their development into innovative formulas that could be used safely and effectively in the treatment of IBD, achieving considerable success with an integrative approach in clinics and hospitals in Israel, as illustrated in the following clinical case.

Plant-based products to treat UC: a case report

Several years ago, a 25-year-old patient with extensive UC (pancolitis) was referred by her gastroenterologist to the integrative medicine unit of the Sheba Medical Center in Israel, one of the 10 best hospitals in the world according to Newsweek magazine. She had been diagnosed with UC 8 years earlier, at the age of 17, and had been treated with oral and topical 5-ASA medication, as well as azathioprine (an immunosuppressant drug). However, she continued to suffer periodic flare-ups.

Her colonoscopy showed severe inflammation of the entire colon, an increase in C-reactive protein (CRP) and platelet count. After an increase in the azathioprine dose failed to improve her condition, she was started on infliximab (a biologic drug used in UC and other autoimmune diseases) combined with azathioprine and mesalazine (5-ASA).

Initially she responded well, except for two flare-ups that were attributed to “opportunistic infections” (infections to which those with an immune system weakened by the use of immunosuppressant treatments are more vulnerable). She stopped infliximab after 15 months of treatment and continued with azathioprine and mesalazine with a good clinical response.

After 1 year, a new flare-up required the reintroduction of infliximab. The patient responded initially, but after the first infusion she lost her response to the treatment, even when her infliximab dose was doubled.

At this point she was referred to the integrative medicine unit of the Sheba Medical Center. The patient was suffering 6 to 8 bowel movements a day, with notable bleeding, severe urgency and crampy abdominal pain. She had discontinued azathioprine and infliximab, and was only still taking mesalazine. Her CRP level was 7.42, platelets 531 and haemoglobin 11.5. Her most recent sigmoidoscopy, a month earlier, showed moderate-to-severe inflammation of the sigmoid colon with a Mayo endoscopic score of 2.

She was started on Qing dai (QD) capsules and a new curcumin composition (Qura®, 3 g/day). After 2 weeks, she showed significant improvement in symptoms. After 6 weeks, she reported complete resolution of symptoms and was advised to take a faecal calprotectin test to assess mucosal healing. At 12 weeks of treatment, her faecal calprotectin level was 30 µg/g, indicating inactive inflammation. After 6 months of treatment, she underwent a full colonoscopy that showed significant improvement, with most of the colon showing mucosal healing.

This case demonstrates that moderate-to-severe UC can be treated effectively with an integrative model, but it is only one of many. There is growing evidence of the efficacy of plant-based compounds and formulas.

Qing Dai to treat UC

Qing dai (indigo tinctoria) has been used to treat many haemorrhagic conditions, including colitis. It has recently been studied for the treatment of various inflammatory diseases. In vivo, Xiao et al. showed that Qing dai powder could improve inflammatory responses in an experimental model of colitis.

In 2019, Suzuki et al. published a case series of UC patients who were treated concomitantly with QD with promising results. Earlier, an open-label pilot clinical study by Sugimoto et al. showed that QD was effective in reducing both clinical and endoscopic activity in patients with mild-to-moderate UC.

Curcumin to treat UC

Curcumin is an active phytochemical compound derived from the common spice: turmeric (Jiang huang). For decades this compound has been the subject of numerous studies as a treatment against cancer, wound healing, neurodegenerative diseases and, more recently, IBD.

The first randomised controlled trial investigated curcumin as a treatment added to mesalazine for patients with UC in clinical remission. During the initial 6-month treatment, only 2 of the 43 patients treated with curcumin experienced a relapse of the disease, compared with 8 of the 39 patients treated with placebo (p=0.040).

In 2014, Nir Salomon’s team conducted a randomised placebo-controlled trial using an integrative model with add-on curcumin therapy to optimise 5-ASA treatment. Patients with mild-to-moderate active UC who were not receiving 5-ASA were treated with 3 g/day of curcumin or placebo for 4 weeks. Curcumin proved superior to placebo in inducing clinical and endoscopic remission.

With increasing evidence from clinical trials and real-world clinical practice, a systematic integrative clinical model of these herbal therapies alongside conventional medicine is clearly warranted.

References:

  • Integrative Herb-Drug Therapies for Ulcerative Colitis | Evinature
  • Xiao HT, Peng J, Hu DD, Lin CY, Du B, Tsang SW, Lin ZS, Zhang XJ, Lueng FP, Han QB, Bian ZX. Qing-dai powder promotes recovery of colitis by inhibiting inflammatory responses of colonic macrophages in dextran sulfate sodium-treated mice. Chin Med. 2015 Oct 13;10:29.
  • Suzuki H, Kaneko T, Mizokami Y, Narasaka T, Endo S, Matsui H, Yanaka A, Hirayama A, Hyodo I. Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis. World J Gastroenterol. 2013 May 7;19(17):2718-22. 
  • Shinya Sugimoto, Makoto Naganuma, Hiroki Kiyohara, et al.; Clinical Efficacy and Safety of Oral Qing-Dai in Patients with Ulcerative Colitis: A Single-Center Open-Label Prospective Study. Digestion 8 June 2016; 93 (3): 193–201.
  • Lang A, Salomon N, Wu JC, Kopylov U, Lahat A, Har-Noy O, Ching JY, Cheong PK, Avidan B, Gamus D, Kaimakliotis I, Eliakim R, Ng SC, Ben-Horin S. Curcumin in Combination With Mesalamine Induces Remission in Patients With Mild-to-Moderate Ulcerative Colitis in a Randomized Controlled Trial. Clin Gastroenterol Hepatol. 2015 Aug;13(8):1444-9.e1. 
  • Lin Y, Liu H, Bu L, Chen C, Ye X. Review of the Effects and Mechanism of Curcumin in the Treatment of Inflammatory Bowel Disease. Front Pharmacol. 2022
  • Sharifi-Rad J, Rayess YE, Rizk AA, Sadaka C, et al.; Turmeric and Its Major Compound Curcumin on Health: Bioactive Effects and Safety Profiles for Food, Pharmaceutical, Biotechnological and Medicinal Applications. Front Pharmacol. 2020 Sep 15;11:01021. 

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January 15, 2026
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