# Advancing ulcerative colitis therapy: a review of 5-ASA synergy with traditional Chinese medicine and natural bioactive compounds

## TL;DR

This paper reviews how combining 5-ASA with traditional Chinese medicine and natural compounds can improve ulcerative colitis treatment.

## Contribution

The paper highlights novel synergistic strategies combining 5-ASA with TCM for enhanced UC therapy.

## Key findings

- Combining 5-ASA with TCM compounds like berberine and curcumin boosts anti-inflammatory and antioxidant effects.
- TCM formulations inhibit key inflammatory pathways and improve gut microbiota and mucosal healing.
- The combination improves clinical outcomes without increasing adverse effects.

## Abstract

5-Aminosalicylic acid (5-ASA) is a first-line drug for the treatment of mild to moderate ulcerative colitis (UC), yet its monotherapy efficacy remains limited. In recent years, the combination of 5-ASA with bioactive components of traditional Chinese medicine (TCM) has emerged as an important strategy in UC management. Studies have shown that natural bioactive compounds from TCM (e.g., berberine, curcumin) contribute to synergistic anti-inflammatory and antioxidant effects, as well as enhanced drug-targeted delivery, while TCM formulations (e.g., Gegen Qinlian Decoction, Xilei San) exert holistic multi-target regulation by inhibiting key inflammatory pathways such as nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK), modulating gut microbiota composition, and restoring mucosal barrier function. This combination strategy significantly improves clinical response rates, endoscopic remission, and mucosal healing, without increasing the risk of adverse effects. It reflects a modern treatment philosophy of “Western medicine for primary action, Chinese medicine for synergistic support,” and provides a safe and effective evidence-based approach for optimizing UC therapy.