Ulcerative Colitis and Herbal Medicine: Pathophysiological Mechanisms, Preclinical Evidence, Clinical Evidence, and Therapeutic Opportunities

Abstract

Ulcerative colitis (UC) is a chronic inflammatory disease of the colon that usually starts in the rectum and is caused by genetic vulnerability, poor epithelial barrier function, microbial dysbiosis, and dysregulated immunological responses. Current pharmacological treatments relieve symptoms but are commonly linked with adverse effects, incomplete remission, and relapse, driving growing interest in herbal therapy as a multi-targeted, safer therapeutic option.This review synthesizes preclinical and clinical evidence on plant species with anti-colitic potential, such as Vitis vinifera, Cocos nucifera, Arctium lappa, Pimpinella candolleana, Ziziphus jujuba, Juglans regia, Terminalia chebula, Cordia dichotoma, and others, focusing on their mechanisms of action and translational relevance. Most species had preclinical investigations, but only a handful had clinical data.These plants exert anti-colitic effects via regulating nuclear factor kappa B, cyclooxygenase-2, tumor necrosis factor-alpha, interleukin-6, interleukin-13, and oxidative stress pathways. Flavonoids, polyphenols, terpenoids, and polysaccharides are bioactive ingredients that repair antioxidant defenses, promote mucosal healing, and regulate the gut flora. Preliminary clinical data and commercial herbal preparations provide additional support for translational potential.Herbal interventions offer a holistic approach to UC by addressing inflammation, oxidative stress, and microbial imbalance; however, clinical validation, extract standardization, and safety testing remain essential before mainstream integration.