Ulcerative Colitis

What is Ulcerative Colitis?

Ulcerative colitis is a lifelong inflammatory condition of the colon and rectum, in which inflammation starts in the rectum and extends upward in a continuous pattern.^{[1, 2]} It is the most common form of inflammatory bowel disease and has no cure, though it can be controlled with treatment.^[1]

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Common symptoms

The hallmark symptoms are chronic diarrhea with rectal bleeding and impaired quality of life.^[3] Many people also have:

• Abdominal pain and cramping, and a sudden urge to pass stool
• Fatigue, which is common in inflammatory bowel disease and can persist even when the disease is quiet^{[4, 5]}
• Inflammation outside the bowel, such as primary sclerosing cholangitis, which affects about 27% of people with ulcerative colitis^[3]

Symptoms come and go, with flares and periods of remission.^[2]

Causes and risk factors

The cause is not known. It is thought to occur in people with a genetic predisposition after environmental exposures, with a weakened gut barrier, the gut microbiota and an overactive immune response all implicated.^[2]

How it is diagnosed and treated conventionally

Diagnosis combines symptoms, blood and stool tests, and colonoscopy with biopsy.^{[2, 3]} People with the disease need regular monitoring of symptoms and inflammation markers and colonoscopy for dysplasia surveillance starting about 8 years after diagnosis.^[3]

Aminosalicylate (5-ASA) drugs are first-line for mild to moderate disease. Moderate to severe disease may need corticosteroids to start remission, followed by biologics or small-molecule medicines to maintain it.^{[2, 3]} Despite these options, about 20% of patients are hospitalized within 5 years of diagnosis and about 7% have their colon removed.^[3]

Why Ulcerative Colitis calls for a whole-person approach

Ulcerative colitis involves the gut lining, the immune system, the gut bacteria and the brain-gut connection at once, so medicines are only one part of living with it.^[2] Even good medical therapy leaves many people with symptoms: response rates to the best current treatments range from about 30% to 60% in trials.^[3]

Supportive care aims at the symptoms and burdens that medicines may not fully address, while your physicians control the inflammation.

Inflammation and the immune system

Researchers believe a dysregulated immune response is central to the disease.^[2] This is why treatment is directed by a gastroenterologist and why complementary options are studied only as add-ons.

Mood, stress and the brain-gut connection

Depression is common in inflammatory bowel disease, and a meta-analysis of 24 studies found that depression was linked to a higher risk of flares, hospitalization and surgery.^[6] Caring for mood and stress is therefore part of good overall care.

Fatigue

Fatigue is a common, burdensome symptom in inflammatory bowel disease, and managing it is difficult.^[4]

Nutrition

Chronic diarrhea and inflammation can interfere with nutrient absorption, so a physician or dietitian may check for deficiencies.^[2] Dietary changes during a flare should be guided by your treating team.

Acupuncture as supportive care in Ulcerative Colitis

What the research shows

Acupuncture may help symptoms and clinical response as an add-on to standard drugs, but the evidence is limited by low-quality trials. A meta-analysis of 13 randomized trials with 1,030 people found that acupuncture combined with mesalazine gave better clinical results than mesalazine alone, though the quality of evidence was low to moderate and the trials had high or unclear risk of bias. Adverse events did not differ significantly between groups.^[7]

A 2025 network meta-analysis of 76 trials with 7,484 participants ranked several acupuncture-related approaches, such as warm acupuncture and acupuncture combined with other therapy, highest for several outcomes. It called these findings preliminary and asked for larger, higher-quality trials.^[8] A review of moxibustion found only 5 low-quality trials and concluded the evidence was insufficient to show it works.^[9]

Many of these trials compared acupuncture with older drugs such as mesalazine and sulfasalazine, so the findings may not apply to people on current biologic therapy.^{[7, 9]} A broader review of complementary treatments in bowel disease found only two acupuncture trials.^[10]

For fatigue, a pilot trial of 52 people with quiet inflammatory bowel disease found that electroacupuncture and sham electroacupuncture both improved fatigue more than waiting, with no clear difference between real and sham.^[5] A Cochrane review rated the evidence for electroacupuncture on fatigue as low certainty.^[4]

How acupuncture may work

The proposed explanation is an anti-inflammatory effect. In the 2025 network meta-analysis, some acupuncture-related treatments were linked with lower blood levels of the inflammatory molecules IL-6 and TNF-alpha.^[8] This is an association in trials of uncertain quality and does not prove how acupuncture works in people.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. A course is several visits, and we reassess to see whether symptoms such as discomfort, fatigue or stress are improving. Acupuncture is directed at symptoms and does not treat colon inflammation.

Serious problems are rare. In prospective studies about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). People on immune-suppressing medicines should also tell us, since they may be more prone to infection.

Ayurvedic medicine as supportive care in Ulcerative Colitis

The Ayurvedic view

In Ayurveda, bloody, mucus-containing diarrhea is traditionally compared with Pravahika, a dysentery-like disorder, and related conditions of the large intestine described in terms of Pitta and weak digestive fire (agni). These are traditional categories, not biomedical diagnoses, and they do not replace a diagnosis by a gastroenterologist.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Simple, warm, easily digested meals, kept in line with the advice of your gastroenterologist or dietitian
• Calming routines such as breathing practices, gentle exercise and regular sleep
• Individually prescribed herbs, of which turmeric (Haridra) and Boswellia (Shallaki) are the best studied, described under herbal medicine below

Panchakarma procedures, especially purgative therapies and enemas, are not appropriate during a flare, with bleeding, in acute illness, in pregnancy, or in frailty, and we would not use them for active colitis.

What the research shows

We found no controlled trials of Ayurvedic treatment systems, including Panchakarma, in ulcerative colitis. We found only a single published case report, which cannot show that a treatment works. The research on individual herbs that Ayurveda uses, such as turmeric and Boswellia, is covered in the next section.^[12]

Some Ayurvedic products contain heavy metals. About one fifth of those bought online had detectable lead, mercury or arsenic, so products should come from tested sources.^[13]

Herbal medicine as supportive care in Ulcerative Colitis

Herbs and formulas that have been studied

Several herbs have been tested in trials of ulcerative colitis, alongside standard drugs. They include curcumin (from turmeric), Andrographis paniculata, aloe vera gel, Plantago ovata (psyllium seed), Boswellia serrata and Indigo naturalis, a traditional Chinese preparation.^{[12, 14]} Chinese herbal medicine is also widely used in China, often by mouth with an enema.^[15]

What the research shows

Curcumin has the most support, but it is limited and mostly as an add-on. A meta-analysis of 6 randomized trials with 385 participants found adjuvant curcumin improved the rate of clinical remission, but not clinical improvement or endoscopic remission.^[16] A systematic review of 28 trials of 18 herbs in active disease found a higher rate of clinical remission with turmeric, and a higher clinical response with Indigo naturalis, while Andrographis showed no significant benefit. The authors still called for larger, well-designed trials and manufacturing regulation.^[14]

For keeping people in remission, a Cochrane review found only one trial of 89 patients. Fewer patients relapsed with curcumin at six months, but the difference was not statistically significant, and there was no significant difference at 12 months.^[17] An earlier review of 21 trials in bowel disease reported promising results for several herbs, but called the studies limited and varied.^[12]

For traditional Chinese medicine in general, an evidence map of 73 systematic reviews found the review quality very low and advised that it be recommended only cautiously.^[15]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. People with ulcerative colitis often take immune-modifying drugs, and a review of herb-drug interactions describes St John's wort lowering blood levels of ciclosporin, which in some cases led to organ rejection.^[18] Case reports also describe bleeding when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^[19]

Herbal and dietary supplements are also a recognized cause of liver injury, so people taking medicines that affect the liver need extra care.^[20] Product quality varies, and the trials above used different preparations, so their results may not apply to a store-bought product. Tell us if you are pregnant or breastfeeding or have liver or kidney disease. Please do not add or change any herb or supplement without telling your gastroenterologist.

Translating traditional medicine into modern biological language

These links are interpretation, not equivalence. Chinese medicine may describe colitis as damp-heat in the intestines, or as spleen deficiency in long-lasting cases. Researchers studying acupuncture and herbs look at inflammatory signaling molecules such as IL-6 and TNF-alpha as possible parallels.^[8]

Ayurveda's Pitta excess and weak agni describe heat, inflammation and poor digestion. Modern medicine links ulcerative colitis to a weakened gut barrier, the gut microbiota and an overactive immune response.^[2] No study has shown that a dosha or pattern corresponds to a specific biological process.

How this care fits with your medical care

This care is supportive and complementary. We do not diagnose or manage ulcerative colitis, and we do not prescribe or change medicines. Keep your gastroenterologist, continue your prescribed treatment and surveillance colonoscopies, and do not stop or reduce aminosalicylates, steroids, immune-modifying drugs or biologics without your prescriber.

Please bring your diagnosis, recent colonoscopy and lab results, and a full list of medicines and supplements. We also ask that your treating team knows you are receiving complementary care. New or changing bowel symptoms should be reviewed by your physician.

When to seek urgent medical care

Severe flares and complications of ulcerative colitis can become emergencies.^[3]

• Heavy rectal bleeding or passing blood clots
• Many bloody stools a day with fever, a fast heartbeat or dizziness
• Severe abdominal pain or a swollen, rigid abdomen
• Persistent vomiting or signs of dehydration, such as very little urine
• Fever of 100.4 F or higher with a flare
• New eye pain, yellowing of the skin or eyes, or severe joint swelling

If any of these occur, call 911 or go to the nearest emergency department.