Chinese Herbal Medicine in Ulcerative Colitis-Associated Carcinogenesis Treatment: Mechanisms, Progress, and Future Directions.

Colitis-associated colorectal cancer (CAC) is a highly prevalent malignancy of the digestive tract. The close association between ulcerative colitis (UC) and CAC makes inhibiting this carcinogenic transformation a critical preventive goal. Based on traditional Chinese medicine (TCM) theories of "dampness-heat stasis" and "latent pathogen-induced deficiency", this review systematically explores the pathological process of ulcerative colitis associated carcinogenesis (UCAC) and its interpretation in TCM. We conducted a comprehensive literature search in CNKI and PubMed databases (2020-2025), systematically analyzing about 79 relevant studies to summarize the clinical applications of TCM in preventing and treating UCAC progression, including oral and topical herbal therapies, as well as non-pharmacological interventions such as acupuncture. Furthermore, we elucidate the underlying mechanisms of TCM interventions in UCAC, with a focus on gut microbiota modulation and key inflammatory signaling pathways (eg, NF-κB, IL-6/JAK2/STAT3), offering new translational perspectives. The novelty of this review is twofold: firstly, it provides the first systematic synthesis of research progress on therapeutic methods, encompassing oral and topical herbal formulations as well as acupuncture, and molecular mechanisms of TCM for UCAC. Secondly, it advances the field by analyzing TCM theories through the lens of modern medicine, comparing TCM's holistic approach with Western medicine's targeted paradigm, and proposing an integrated "gut microbiota-metabolite-target" research framework. This framework aims to furnish a theoretical foundation for both the modernization of TCM and the development of combined therapeutic strategies that leverage the strengths of both medical systems.