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Korean Herbal Medicine Is Now in the ACG’s UC Guidelines — Here’s What It Means

Hello.

We are Hanstep Korean Medicine Clinic, specializing in Ulcerative Colitis (UC) and Crohn’s Disease research and treatment since 2007.

In a previous video, I briefly mentioned something I’d like to address properly today: the 2025 ACG (American College of Gastroenterology) Clinical Guideline Update for Ulcerative Colitis includes a dedicated paragraph on herbal medicine.

Not just a citation in the references — an entire paragraph in the main text.

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What the 2025 ACG Guidelines Say
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The ACG guidelines are the international standard used by gastroenterologists worldwide. They systematically review the best available scientific evidence to establish clinical practice recommendations.

The guideline states:

“Curcumin and Qing Dai are two natural compounds with known anti-inflammatory effects that have been investigated as treatments for active ulcerative colitis.”

Qing Dai (青黛) is an herbal medicine used in Korean and Chinese traditional medicine for centuries — a blue powder derived from the indigo plant. Curcumin is the active compound in turmeric. The combination of the two is referred to as CurQD.

📄 2025 ACG UC Guideline:
https://gi.org/journals-publications/ebgi/alkazzi_aug2025/
https://pubmed.ncbi.nlm.nih.gov/40701556/

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The Study Behind It
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The research was led by a team from Sheba Medical Center and Tel Aviv University, conducted across multiple centers in Israel and Greece.

Study design: Randomized, double-blind, placebo-controlled — the gold standard of clinical research.

42 patients were enrolled, including those already receiving 5-ASA or biological therapies. Dosage: CurQD 3g/day for 8 weeks.

Results:

  • Clinical response rate: CurQD 85.7% vs. Placebo 30.7%
  • Clinical remission rate: CurQD 50% vs. Placebo 8%
  • Endoscopic improvement rate: CurQD 75% vs. Placebo 20%

After 8 weeks, patients who responded were maintained on curcumin alone for another 8 weeks:

  • Clinical response maintained at 16 weeks: 93%
  • Clinical remission maintained at 16 weeks: 80%

📄 Full RCT paper (PDF):
https://ddicme.com/wp-content/uploads/2025/04/Curcumin-QingDai-Combination-for-Patients-With-Active.pdf

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The Mechanism: AhR Pathway
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What I found most fascinating was the mechanism.

The research team performed rectal mucosal biopsies and measured the expression of a gene called CYP1A1. This expression increased only in patients receiving CurQD, and activation of a receptor called AhR (Aryl hydrocarbon Receptor) was confirmed.

This change was NOT observed in patients taking mesalamine, biologics, or placebo.

Think of the AhR as a switch that regulates immune balance in the intestinal mucosa. When activated:

  • Mucosal defense function improves
  • Excessive inflammation is regulated
  • Balance between gut bacteria and immune cells is restored

This represents a distinct mechanism from many currently used UC therapies.

Safety: No serious adverse events. No difference in side effect rates from placebo. No pulmonary arterial hypertension was observed. (Note: the guideline does mention that high-dose Qing Dai has been associated with pulmonary hypertension in some prior reports, and states that further research is needed before recommending this treatment.)

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My Perspective as a Korean Medicine Clinician
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I also use Qing Dai in my clinical practice. But I don’t use curcumin.

The Israeli team combined curcumin with Qing Dai to reduce the Qing Dai dose while maintaining efficacy — a reasonable approach. However, in my practice, I combine Qing Dai with other herbs that achieve better results with established safety.

But here is the more important point:

Knowing about Qing Dai alone will not treat ulcerative colitis.

There are at least six cause-pattern types in UC: Upper digestive system type, Respiratory type, Inflammatory type, Edema type, Cold abdomen type, and Large intestine functional decline type. Many patients present with more than one of these simultaneously.

When multiple causes are present, there is an order of treatment. The first cause must be addressed first. When that resolves, the second cause becomes visible — and the prescription must change.

Qing Dai belongs to the Inflammatory type prescription. It must be introduced at the right stage. If upper digestive system issues remain unresolved and you begin the Inflammatory type prescription first, the results will be incomplete.

I’ve tried it both ways. When the sequence is followed, the results are remarkable. One recent case: a patient whose calprotectin reached 1,800+ — within one month of changing the prescription, it dropped to 26. This was possible because earlier stages had already been addressed. Like preparing the soil before planting the seed.

Western medicine’s research into this area is just beginning — confirming the effect of a single herb like Qing Dai is itself significant. However, Korean Medicine is already thinking several steps ahead: classifying causes, sequencing treatment, and adjusting prescriptions at each stage. That is what I have been researching for nearly 20 years.

I plan to prepare for the integrative medicine conference in Japan in June 2027, and to publish documented cases — with calprotectin data, endoscopic findings, and clinical course — in international SCI journals.

One day, it won’t just be Qing Dai in the ACG guidelines. It will be the systematic Korean Medicine approach to treating ulcerative colitis.

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References
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If you have questions about UC, Crohn’s disease, Qing Dai research, or the evidence base for Korean herbal medicine, please leave a comment. I’ll address them in future posts.

▶️ Watch our YouTube video on this topic:
https://youtu.be/OkkaHBckhV8
Please turn on subtitles to watch.

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HanStep Korean Medicine Clinic – Inflammatory Bowel Disease Clinic
https://hanstep.co.kr/en/

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