A comparative study on the clinical differences in traditional Chinese medicine pattern in ulcerative colitis...

Ulcerative Colitis (UC) is a chronic autoimmune disease with increasing incidence, particularly in Asia. Traditional Chinese Medicine (TCM) provides effective treatment through pattern differentiation. This study integrated multidimensional data to investigate the clinical differences between two common TCM patterns, dampness-heat in the large intestine (Da-Chang-Shi-Re, DCSR) and spleen deficiency with dampness accumulation (Pi-Xu-Shi-Yun, PXSY), providing a basis for revealing the biological connotation of TCM patterns.

A total of 180 UC patients (90 with DCSR pattern and 90 with PXSY pattern) were enrolled from March 2024 to March 2025. Peripheral inflammatory markers were measured. Endoscopic features were assessed using four scoring systems, along with detailed endoscopic characteristics. Multivariate regression models were constructed, adjusting for confounding variables including sex, medication history, baseline lesion severity, disease duration and smoking status. Intestinal histological injury was quantified using the Robarts Histopathology Index (RHI). Immunohistochemical staining was performed to assess tissue CD4 and myeloperoxidase (MPO) expression. Immunofluorescence staining was further applied to detect the expression of NADPH oxidase 2 (NOX2), CD11b, and citrullinated histone H3-labelled neutrophil extracellular traps (NETs).

After adjusting for multiple covariates, patients with DCSR pattern exhibited significantly higher levels of neutrophil-to-lymphocyte ratio (β = 1.602, adjusted-p < 0.006), platelet-to-lymphocyte ratio (β = 75.851, adjusted-p < 0.006), and neutrophil-to-albumin ratio (β = 0.044, adjusted-p < 0.006) compared to patients with PXSY pattern. Endoscopically, DCSR patients showed more severe inflammation with higher endoscopic scores. After adjusting for confounding factors, Multivariate analysis showed that ulcer formation was an independent differentiating factor between the two (OR = 2.429, 95% CI: 1.209-4.880, p = 0.013). Histologically, the DCSR pattern demonstrated more severe mucosal damage with significantly higher RHI scores and increased MPO⁺ cells (p < 0.01). In addition, patients in the DCSR group showed higher expression levels of NOX2, CD11b, and NETs in the colon.

The DCSR pattern is characterized by more severe systemic and local inflammation, while the PXSY pattern reflects a milder, chronic inflammatory state. Neutrophil activation was also markedly elevated among patients presenting the DCSR pattern. The integration of multidimensional biomarkers provides objective evidence for TCM pattern differentiation and offers valuable insights for personalized treatment strategies in UC management.