Combined TCM and conventional medicine therapies show higher overall effectiveness than monotherapy in ulcerative colitisCombined therapies show higher effectiveness for ulcerative colitis patients

ObjectiveTo optimize clinical management of ulcerative colitis (UC) and evaluate the efficacy of traditional Chinese medicine (TCM), conventional medicine (CM), and integrated TCM- CM therapies.MethodsRandomized controlled trials (RCTs) investigating integrated TCM–CM treatment for UC were retrieved from PubMed, Embase, Web of Science, CNKI, Wanfang Data, VIP Database, and SinoMed from database inception to June 2025. Study quality was assessed using Review Manager 5.4 and the 7-point Jadad scale. Statistical analyses were performed using Stata MP 15 and R 4.3.1 with Rstudio.ResultsA total of 46 RCTs involving 3,763 patients with UC were included, comprising seven intervention regimens: four commercial Chinese polyherbal preparation (e.g., Yunnan Baiyao) and sixteen classical TCM decoctions (TCMDs; e.g., Baitouweng Decoction). The results showed that conventional medicine combined with TCMD and acupoint catgut embedding achieved the highest total effective rate. CM alone ranked highest in alleviating key clinical symptoms (e.g., diarrhea and abdominal pain) and in reducing inflammatory markers, including IL-8, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). For cytokine regulation, comparative advantages varied across interventions: CM + TCMD + acupuncture ranked highest for IL-6 reduction, CM + TCMD ranked highest for IL-10 improvement, whereas CM alone ranked lower for these two outcomes.ConclusionCompared with the single use of conventinal medicine, the combined use of traditional Chinese and conventinal medicine in the treatment of ulcerative colitis demonstrates greater overall efficacy. Through network meta-analysis, this study identified optimal intervention regimens for different outcome indicators, including both monotherapy and combination therapy. In clinical practice, the optimal regimens may be selected according to individual patient conditions. Although TCM interventions can improve clinical symptoms and inflammatory biomarkers in patients with ulcerative colitis, relevant clinical score improvement and endoscopic mucosal healing evidence are still insufficient. Further high-quality clinical evidence is still required to confirm the definite clinical efficacy of TCM.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1109183, identifier CRD420251109183.