Ayurvedic Herbs for IBD: What a 2025 Scoping Review of 25 Studies Found

Ayurvedic Herbs for IBD: What a 2025 Scoping Review of 25 Articles Found

A small comparative study published in 1997 reported similar remission proportions among patients with ulcerative colitis treated with Boswellia serrata gum resin and those treated with sulfasalazine. That finding encouraged interest in Boswellia, but its small sample, limited methodological detail, and the later failure of Boswellia to maintain remission in a placebo-controlled Crohn’s disease trial prevent it from being treated as an established alternative to conventional care. A 2025 scoping review in Cureus assembled a broader collection of clinical and preclinical research on Ayurvedic herbs and formulations for inflammatory bowel disease (IBD). The review identified promising signals, especially for curcumin as an adjunct in ulcerative colitis, while also revealing substantial gaps in study quality, standardization, and long-term safety data.

What the Scoping Review Covered

The review was authored by Vakiti and colleagues and published on May 19, 2025. It searched Embase, PubMed, and Cochrane Central for literature published from January 2003 through September 2023 and analyzed 25 full-text articles. IBD includes ulcerative colitis and Crohn’s disease, but the Ayurvedic evidence identified by the reviewers was concentrated more heavily on ulcerative colitis and experimental colitis models.

The included literature was not a uniform collection of randomized clinical trials. It combined human studies with animal experiments and evaluated single-herb extracts, isolated plant constituents, multicomponent formulations, and procedure-based Ayurvedic regimens. Consequently, its findings cannot be combined into one reliable estimate of treatment effect.

Outcomes described across individual papers included:

• Changes in stool frequency, urgency, mucus, rectal bleeding, abdominal discomfort, and general well-being
• Clinical activity, relapse, endoscopic, or sigmoidoscopic measurements in some human studies
• Colon length, colon weight, tissue injury, ulceration, and histological scores in animal models
• Experimental measurements such as myeloperoxidase activity, oxidative-stress markers, cytokines, and prostaglandin E2

These outcomes are not interchangeable. A reduction in a laboratory inflammatory marker in rats may help identify a biological effect, but it does not establish remission, mucosal healing, steroid-free control, or long-term safety in people with IBD. The scoping review is therefore best understood as a map of the available literature rather than proof that the interventions are clinically equivalent to approved medicines.

The Better-Documented Herbs and Formulations

Several plants appeared in human or preclinical studies reviewed in this field. The strongest interpretations come from examining each intervention separately and distinguishing adjunctive human evidence from exploratory animal findings.

Boswellia serrata (Kunduru or Shallaki)

The Ayurvedic Pharmacopoeia of India identifies Kunduru as the oleo-gum resin of Boswellia serrata and lists Shallaki among its Sanskrit synonyms. Boswellic acids and other resin constituents have been investigated for effects on leukotriene-related and additional inflammatory pathways, although the activity of a constituent in laboratory experiments does not establish the clinical effectiveness of a commercial Boswellia supplement.

In the 1997 comparative study, 42 patients with grade II or III ulcerative colitis received either Boswellia gum resin at 350 mg three times daily or sulfasalazine at 1 g three times daily for six weeks. The publication reported remission in 82% of Boswellia-treated patients and 75% of sulfasalazine-treated patients. These percentages should be interpreted cautiously because the study was small, the treatment groups were unbalanced, and the report does not provide the methodological safeguards expected of a modern blinded, adequately powered non-inferiority trial.

A separate 2001 study enrolled 30 patients with chronic colitis and also reported favorable outcomes with Boswellia, but it was again a small comparison. Importantly, a later randomized, double-blind, placebo-controlled trial found that a Boswellia extract was well tolerated but did not outperform placebo in maintaining remission in Crohn’s disease. The total evidence therefore supports further investigation rather than a conclusion that Boswellia can replace established IBD therapy.

Turmeric and Curcumin (Haridra)

The Ayurvedic Pharmacopoeia identifies Haridra as the rhizome of Curcuma longa. Curcumin is one group of constituents obtained from turmeric, but purified curcumin products, enhanced-bioavailability preparations, whole turmeric powder, and classical Haridra formulations are not pharmacologically identical and should not be treated as interchangeable interventions.

The most frequently cited clinical study was a 2006 randomized, multicenter, double-blind, placebo-controlled maintenance trial involving 89 people with quiescent ulcerative colitis. Participants continued sulfasalazine or mesalamine and received either curcumin at 2 g per day or placebo for six months. In the per-protocol analysis, 2 of 43 participants receiving curcumin relapsed, compared with 8 of 39 receiving placebo, corresponding to 4.65% versus 20.51%. Clinical and endoscopic indices also favored the curcumin group during treatment.

This trial evaluated curcumin as an adjunct, not as a replacement for maintenance medication. Results have also varied between curcumin studies. A later randomized trial using a comparatively low oral dose of 450 mg per day did not induce remission in mild-to-moderate active ulcerative colitis. Dose, formulation, absorption, disease activity, treatment duration, and accompanying medication may all influence the result. Curcumin consequently has a more credible adjunctive evidence base than many herbs in the review, but the optimal preparation and regimen remain unsettled.

Amorphophallus paeoniifolius

Amorphophallus paeoniifolius, commonly called elephant-foot yam, was studied in chemically induced ulcerative colitis in rats. Methanolic and aqueous tuber extracts improved several experimental measures, including inflammatory and oxidative-damage findings in colonic tissue. Prednisolone was included as a reference treatment, and some measurements with the plant extracts compared favorably in that model.

These findings do not demonstrate superiority to corticosteroids in patients. Animal colitis is deliberately induced under controlled conditions and does not reproduce the full immunological, genetic, microbial, and relapsing course of human ulcerative colitis. The study provides a basis for identifying active constituents and designing safety studies, not for prescribing the tuber extract in place of steroid treatment during an IBD flare.

Kutaja (Holarrhena antidysenterica)

The Ayurvedic Pharmacopoeia identifies Kutaja stem bark as Holarrhena antidysenterica. Kutaja has a longstanding place in Ayurvedic formulations for diarrheal presentations, but a traditional indication does not by itself establish efficacy for ulcerative colitis, which is a distinct immune-mediated disease requiring biomedical diagnosis and monitoring.

A 2016 randomized, single-blind study enrolled 30 patients with chronic ulcerative colitis. Ten participants each received mesalamine, a monoherbal Holarrhena antidysenterica tablet, or both treatments. All three groups improved, and the authors reported greater changes in several symptom scores in the herb-only group, as well as fewer reported relapses after treatment withdrawal in the groups receiving the herb. However, groups of only 10 people are highly vulnerable to baseline imbalance, chance findings, and unstable relapse estimates. The trial is a useful pilot study but is not large enough to establish equivalence or superiority to mesalamine.

Bilva (Aegle marmelos)

Bilva is identified in the Ayurvedic Pharmacopoeia as Aegle marmelos, with separate standards for plant parts such as fruit pulp and stem bark. Extracts of dried fruit pulp have been evaluated in rat models of chemically induced colitis. These experiments reported improvements in colonic damage, tissue findings, and selected inflammatory or oxidative-stress measurements.

The reviewed evidence does not substantiate the earlier claim that Bilva fruit pulp improved stool frequency in human ulcerative colitis trials. The relevant studies are predominantly preclinical. They may support investigation of the fruit’s constituents and traditional gastrointestinal applications, but they cannot define an effective human dose or demonstrate clinical remission.

Pomegranate (Punica granatum)

Pomegranate, Punica granatum, contains ellagitannins that can be converted by intestinal microorganisms into metabolites called urolithins. Pomegranate extracts, peel, rind, and isolated constituents have been examined in laboratory and animal models of intestinal inflammation. One animal study also evaluated Aegle marmelos and Punica granatum in experimentally induced gastrointestinal barrier dysfunction.

The preparation matters: juice, fruit, rind extract, peel extract, purified punicalagin, and ellagic acid have different compositions and cannot be assigned one common dose or effect. Human evidence sufficient to recommend pomegranate preparations as a treatment for active IBD has not been established by these preclinical findings.

A Closer Look at the 43-Patient Ayurvedic Study

The frequently cited study of 43 patients was published in AYU in 2010, not 2011. It did not test a Basti containing Picrorhiza kurroa and Boswellia. Participants received Udumbara kvatha Basti together with oral Kutaj ghan vati, Udumbara kvatha, and a combination containing Musta, Nagakesara, Lodhra, and Mukta panchamrut rasa for one month.

The authors interpreted ulcerative-colitis symptoms through an Ayurvedic framework involving Atisara and Raktatisara and cited the description of Piccha Basti in the Charaka Samhita. Such comparison can guide Ayurvedic clinical reasoning, but Raktatisara is not a biomedical synonym for ulcerative colitis. UC must still be diagnosed and assessed through appropriate gastroenterological evaluation, including endoscopic and laboratory findings when indicated.

The study reported substantial reductions in bowel frequency, rectal bleeding, abdominal pain, stool red blood cells, and use of prednisolone or sulfasalazine, together with an increase in hemoglobin. Because every participant received several interventions and there was no randomized control or placebo group, the contribution of the Basti, each oral medicine, concurrent conventional treatment, natural fluctuation, and observer expectation cannot be separated. The one-month duration also provides little information about sustained remission or delayed adverse effects.

Study Comparison: Selected Human and Animal Evidence

The principal studies differ greatly in design, population, treatment composition, and reliability. Placing them side by side shows why positive results cannot be treated as one unified clinical conclusion.

How to Interpret the Inflammatory-Pathway Findings

The review described changes in cytokines, prostaglandins, oxidative-stress markers, myeloperoxidase activity, tissue injury, and related experimental outcomes. Curcumin, Boswellia constituents, pomegranate polyphenols, and other plant compounds have each been investigated for effects on signaling pathways associated with inflammation.

Pathway overlap should not be confused with therapeutic equivalence. A plant extract that changes TNF-alpha expression in cells or animals is not thereby equivalent to an anti-TNF monoclonal antibody. Biologic medicines have defined molecular targets, standardized manufacturing, pharmacokinetic data, dose-ranging studies, controlled clinical trials, and ongoing safety surveillance. Herbal extracts may contain numerous constituents whose concentration, absorption, metabolism, and combined effects vary between products.

Multi-component Ayurvedic treatment may act through several physiological processes at once, but it also makes causal interpretation more difficult. When diet, several oral medicines, Basti, and conventional drugs are used together, a study must be designed specifically to determine whether the complete program adds benefit and whether any individual component is necessary.

What the Evidence Does and Does Not Establish

The 2025 review documents a real body of Ayurvedic and plant-based IBD research, but the evidence remains heterogeneous and cannot support a blanket statement that Ayurvedic herbs match or outperform conventional medicines.

• Many studies were small. Several human comparisons enrolled only 30 to 43 people, and some divided them into groups of 10 or fewer.
• Preclinical and clinical evidence were combined. Tissue changes in animal models are valuable for hypothesis generation but cannot be counted as human remission outcomes.
• Interventions differed substantially. Studies tested whole resins, extracts, purified constituents, tablets, polyherbal combinations, and procedural regimens.
• Outcome measures were inconsistent. Symptoms, laboratory values, endoscopic assessments, histology, cytokines, and animal disease scores answer different questions.
• Blinding and control groups were often absent. This increases the influence of spontaneous improvement, concurrent treatment, selection effects, and observer expectations.
• Long-term information was limited. IBD is relapsing and chronic, so brief improvement does not establish durable remission, mucosal healing, or long-term safety.

A scoping review is designed principally to describe the range and characteristics of published literature. It does not automatically provide a pooled effect estimate, establish comparative effectiveness, or correct weaknesses in the studies it includes.

Safety and Clinical Integration

Ayurvedic herbs and supplements should not be used to stop or reduce prescribed IBD medication without the treating gastroenterologist’s supervision. Guideline-based treatment may include 5-aminosalicylates such as mesalamine for mild-to-moderate ulcerative colitis and corticosteroids, immunomodulators, biologics, or targeted small-molecule medicines for appropriate moderate-to-severe disease. Treatment choice depends on diagnosis, disease location, severity, previous response, complications, and individual risk.

Turmeric or curcumin products may cause digestive adverse effects, and formulations designed to increase absorption may have different safety characteristics from ordinary turmeric preparations. Boswellia appears reasonably well tolerated in short clinical studies, but evidence about prolonged use and use alongside complex IBD regimens is more limited. Herbal products and medicines can also interact, and the composition of supplements may vary.

Patients considering adjunctive Ayurvedic care should consult both a gastroenterologist and a qualified Ayurvedic practitioner who is willing to coordinate treatment. The complete product name, botanical ingredients, extract ratio, dose, manufacturer, and any metallic or mineral ingredients should be disclosed. Persistent bleeding, dehydration, fever, severe abdominal pain, rapid deterioration, or suspected complications require prompt conventional medical assessment rather than self-treatment.

Where the Research Needs to Go

The most useful next step is not simply to publish more positive case reports. Future studies need designs capable of distinguishing a genuine, clinically important treatment effect from natural variation and bias.

1. Conduct preregistered, adequately powered, multicenter randomized trials using clearly defined background therapy and control groups.
2. Standardize botanical identity, plant part, extraction method, constituent profile, dose, and contaminant testing, with reference to recognized pharmacopoeial standards where applicable.
3. Use validated clinical, biochemical, endoscopic, and histological endpoints rather than relying only on unvalidated symptom scores.
4. Separate induction of remission from maintenance of remission and follow participants long enough to document relapse, steroid exposure, hospitalization, surgery, and adverse events.
5. Evaluate Ayurvedic interventions first as carefully monitored adjuncts before making comparisons with established medicines as replacements.
6. Report negative and neutral results, including treatment withdrawals and laboratory abnormalities, as completely as favorable findings.

The Bottom Line

The 2025 scoping review identified 25 articles describing Ayurvedic herbs, plant-derived compounds, and multicomponent treatments relevant to IBD. The most persuasive human signal in the reviewed field is the 2006 trial of curcumin added to sulfasalazine or mesalamine for maintenance of ulcerative-colitis remission. Small Boswellia and Kutaja studies are encouraging but methodologically insufficient, while findings for Amorphophallus paeoniifolius, Bilva, and pomegranate remain largely preclinical.

The evidence supports cautious, rigorous investigation rather than claims of proven equivalence to mesalamine, corticosteroids, or biologic therapy. Properly standardized Ayurvedic interventions may eventually earn a defined complementary role, but current evidence does not justify replacing prescribed IBD treatment. Any integration should be individualized, quality-controlled, and coordinated with qualified Ayurvedic and gastroenterology professionals.

References

1. The Efficacy of Ayurvedic Herbs in the Prevention and Treatment of Inflammatory Bowel Disease: A Scoping Review (2025), PubMed
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12. Beneficial effect of Amorphophallus paeoniifolius tuber on experimental ulcerative colitis in rats (2017), PubMed
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Nothing in this article diagnoses or treats a medical condition. Use it as educational information and consult a qualified Ayurvedic practitioner or physician before starting herbs, supplements, detoxes, or therapeutic protocols, especially if pregnant, managing a condition, or taking medication.