Dong Quai and Ulcerative Colitis: Safety Assessment
Dong Quai should not be used in patients with ulcerative colitis, as there is no evidence supporting its safety or efficacy for this condition, and current guidelines recommend against unproven therapies that could delay effective treatment.
Evidence-Based Treatment Framework
Why Dong Quai Is Not Recommended
No guideline support exists: The most recent British Society of Gastroenterology (2025), American Gastroenterological Association (2020), and European Crohn's and Colitis Organisation guidelines make no mention of Dong Quai for ulcerative colitis treatment 1.
Lack of clinical trial data: Unlike other herbal medicines such as Qing Dai (indigo naturalis) which has been studied in prospective trials for UC, Dong Quai has no published evidence for ulcerative colitis 2, 3.
Risk of delaying proven therapy: Using unproven supplements can postpone initiation of evidence-based treatments that reduce morbidity and prevent colectomy 1.
What Guidelines Actually Recommend Against
Probiotics are not recommended for induction or maintenance of remission in UC due to low-certainty evidence and unclear optimal formulations 1.
Antibiotics are not suggested for moderate to severe UC, with high certainty that they show no difference versus placebo (conditional recommendation, low overall certainty) 1.
Fecal microbiota transplantation (FMT) is not suggested for routine use, with only trivial to small magnitude of effect and low certainty evidence 1.
Evidence-Based Treatment Algorithm for UC
Mild to Moderate Disease
First-line therapy: 5-aminosalicylic acid (5-ASA) 2.0-4.8g daily orally, with rectal 5-ASA ≥1g daily for enhanced efficacy in left-sided or extensive disease 4.
If inadequate response: Oral corticosteroids (prednisolone 40mg daily) combined with 5-ASA 4.
Moderate to Severe Disease
Early biologic therapy is preferred over gradual step-up in patients at high risk of colectomy 1, 5, 4.
Preferred first-line biologics: Infliximab or vedolizumab over adalimumab or golimumab based on network meta-analysis 5, 4.
Standard infliximab dosing: 5 mg/kg at weeks 0,2, and 6, then every 8 weeks for maintenance 5.
Acute Severe UC (Hospitalized Patients)
Intravenous methylprednisolone 40-60mg daily as mainstay of initial therapy 1, 5.
Assess response after 3-5 days: If steroid-refractory, initiate rescue therapy with infliximab or cyclosporine 1, 5.
Important Clinical Pitfalls
Avoiding Ineffective Therapies
Do not continue 5-ASA in patients who have escalated to biologics/immunomodulators after 5-ASA failure, as there is no added benefit 1, 4.
Traditional Chinese Medicine caution: While some herbal medicines like Qing Dai have shown preliminary efficacy in small studies, systematic reviews rate the evidence quality as very low with significant methodological limitations 6, 7.
Safety Concerns with Unproven Therapies
Even studied herbal medicines like Qing Dai have reported adverse effects including liver dysfunction and require monitoring 2, 3.
Rhubarb-based therapies, another traditional Chinese medicine approach, show some promise but are only recommended for 1-13 weeks due to potential toxic effects 8.
Treatment Goals
Modern treatment targets: Complete remission assessed biochemically, endoscopically, and histologically to prevent long-term complications including colorectal cancer 4.
Biomarker monitoring: Use fecal calprotectin, fecal lactoferrin, or CRP to guide therapy adjustments without requiring endoscopic confirmation in symptomatic patients 5.