Traditional Chinese Medicine in the Treatment of Ulcerative Colitis: From Pharmacokinetics to Personalized Therapy

Ulcerative colitis (UC) is a chronic inflammatory bowel disease driven by immune dysregulation, intestinal microbiota imbalance, and disruption of the mucosal barrier. Current clinical management is challenged by high relapse rates and significant interindividual variability in drug responses. Traditional Chinese Medicine (TCM) has shown unique therapeutic advantages in UC treatment through multi-targeted interventions such as the modulation of the immune-microbiota axis, restoration of mucosal integrity, and reduction of oxidative stress. However, two major bottlenecks, the complex pharmacokinetic (PK) behaviors of multi-component systems and the lack of personalized dosing strategies, hinder the optimization of its clinical efficacy. This review emphasizes the PK underpinnings of TCM therapy for UC by integrating current knowledge on absorption, distribution, metabolism, and excretion (ADME) characteristics, both PK and pharmacodynamic (PD) and analytical modeling advances, and PK-informed strategies that facilitate individualized clinical use. By integrating PK profiling with patient-specific variables, this review aims both to provide a theoretical and methodological framework for precision TCM in UC management and to ultimately facilitate a paradigm shift from empirical therapy to quantitatively optimized interventions.