Clinical Effectiveness and Safety of Chinese Herbal Enema for Ulcerative Colitis: An Evidence-Based Study

Ulcerative colitis (UC) is a common, chronic, and nonspecific inflammatory bowel disease which significantly impair patients' quality of life, and is characterized by a prolonged disease course and frequent relapses. Due to their localized therapeutic action and low incidence of adverse effects, Chinese herbal enemas have garnered increasing attention in clinical settings. This study aims to systematically evaluate the therapeutic potential of Chinese herbal enemas in UC management. Randomized controlled trials (RCTs) evaluating Chinese herbal enemas for UC, published up to April 19, 2025, were systematically searched. A network meta-analysis was performed using Stata 17.0, and the combined effect sizes were reported as the mean difference or relative risk with corresponding 95% confidence intervals. A total of 41 RCTs involving 2883 UC patients were ultimately included, and data on the risk of bias assessment were reported. When compared with mesalazine (MES) monotherapy, combination therapies, such as MES combined with Qingbai Guanchang Ye or MES combined with Qingchi San, and monotherapies including Huangkui Lianchang Tang and Baitouweng Tang, demonstrated statistically significant improvements in clinical outcomes. Subgroup analyses were also conducted. The clinical effectiveness of these interventions was also influenced by Traditional Chinese Medicine (TCM) syndrome differentiation and disease severity, which underscores the importance of individualized, stratified treatment approaches. Our study data showed that Chinese herbal enema therapy appears to be both clinically effective and safe in the management of UC, and supported both stratified TCM therapy and the refinement of UC treatment guidelines. Future research is needed to prioritize high-quality, large-scale RCTs to validate these findings.