• • Global UC prevalence reached approximately 5 million cases in 2023, with North America and Northern Europe maintaining the highest incidence rates, while emerging industrialized nations—particularly China—exhibit the most rapid growth; this epidemiological shift underscores the urgent clinical need for cost-effective, multi-target therapeutic alternatives to biologics, which currently suffer from high non-response rates and prohibitive costs.
• • The 'gut microbiota dysbiosis–barrier injury' vicious cycle is mechanistically driven by reduced microbial diversity, decreased beneficial bacteria, and increased pathogenic taxa, leading to SCFA and tryptophan metabolic disturbances, downregulation of tight junction proteins, and increased intestinal mucosal permeability; this cycle constitutes the core pathological basis for UC's chronicity and refractoriness, making it a prime target for intervention.
• • TCM formulas such as Baitouweng Decoction, Lizhong Decoction, Banxia Xiexin Decoction, Gegen Qinlian Decoction, and Sishen Pill demonstrate efficacy in DSS-induced colitis models by modulating gut microbiota-SCFAs-Th17/Treg axis, activating AhR/IL-22 signaling to repair the intestinal barrier via microbiota-related tryptophan metabolism, and regulating the TLR4/NF-κB/NLRP3 signaling pathway; these multi-target mechanisms offer advantages over single-target biologics in addressing the complex pathophysiology of UC.
• • The 'turbidity-toxin' theory provides a coherent TCM framework linking gut microbiota dysbiosis and cell pyroptosis to UC pathogenesis, with clinical studies showing that Huazhuo Jiedu formulas reduce serum NLRP3 inflammasome, IL-18, and IL-1β levels while improving gut microbiota and mucosal barrier function; this integration of traditional theory with modern molecular targets facilitates the development of evidence-based TCM therapies for UC.