Ulcerative colitis is a chronic inflammatory disease of the lining of the colon, with diarrhoea, bloody stools and abdominal pain, as a 2020 systematic review by Wang and colleagues at Beijing University of Chinese Medicine describes it. It is one of the two main forms of inflammatory bowel disease (IBD); Crohn's disease is the other. Cochrane has not published a review of acupuncture or moxibustion for ulcerative colitis. The reviews that exist were written mostly by Chinese research groups, pool trials that were mostly run in China and compared acupuncture, electroacupuncture or moxibustion with drugs such as sulfasalazine and mesalazine, and report better response rates with acupuncture-related methods while rating most of that evidence as low or very low in certainty. One small sham-controlled trial, run in Germany, found a small difference between real and sham acupuncture.
What Cochrane reviews report
Two Cochrane reviews of symptoms in IBD each include one trial of acupuncture or moxibustion. The 2020 review of interventions for fatigue in IBD, by Farrell and colleagues, searched to October 2019 and included 14 trials with 3,741 participants. One trial tested electroacupuncture: fatigue scores at week 8 were better than with no treatment (27 participants) and better than with sham electroacupuncture (30 participants), each on low-certainty evidence; the review reports no such difference from sham at week 16. The authors concluded that the effects of interventions for fatigue in IBD are uncertain.
The 2021 review of interventions for abdominal pain in Crohn's disease and IBD, by Sinopoulou and colleagues, searched to April 2021 and included 14 trials with 743 participants. One trial in Crohn's disease compared herb-partitioned moxibustion with acupuncture (51 people) against wheat bran-partitioned moxibustion with shallow acupuncture (51 people), and the review found its pain data unclear. Apart from one trial of transcranial direct current stimulation, the authors could draw no conclusions on any intervention for pain.
Later systematic reviews
| Review | Methods and comparison | Trials and people | What the authors report |
|---|---|---|---|
| Lee 2010, Korea Institute of Oriental Medicine, searched to February 2010 | Moxibustion against sulfasalazine, alone or with other drugs | 5 trials, 407 people | Response rate higher with moxibustion (risk ratio 1.24); all trials of low methodological quality; evidence insufficient to show moxibustion is effective |
| Ji 2013, Shanghai University of Traditional Chinese Medicine | Acupuncture and moxibustion against drugs, in ulcerative colitis and Crohn's disease together | 43 trials; 10 against oral sulfasalazine pooled | Better than sulfasalazine in the 10 pooled trials; no definitive conclusion possible |
| Wang 2020, searched to March 2019 | Acupuncture alone or added to drugs, against drugs | 13 trials, 1,030 people | Acupuncture with mesalazine better than mesalazine alone on clinical effect (4 trials, 232 people, low certainty); acupuncture better than metronidazole with sulfasalazine (3 trials, 318 people, moderate certainty) |
| Hao 2023, Chengdu and Shanxi universities of traditional Chinese medicine | Electroacupuncture, alone or with other treatment, against sulfasalazine or mesalazine | 12 trials, 976 people | Clinical efficacy better than control (risk ratio 1.27) |
| Zhang 2025, Shandong University of Traditional Chinese Medicine, network meta-analysis | Acupuncture, moxibustion, warm needling, catgut embedding and others, against drugs, enemas or herbal medicine | 76 trials, 7,484 people | Total effective rate favoured acupuncture-related methods (moderate certainty); Mayo and endoscopy scores and adverse events of low certainty |
In Wang's review, every trial was run in China and published in Chinese, none reported whether participants or outcome assessors were blinded, and the authors judged the trials at high or unclear risk of bias; adverse events did not differ between groups. Hao's review found that only four of its 12 trials described a proper method of randomisation and one was single-blind. In Zhang's network meta-analysis, 35 of the 76 trials were at high risk of bias and the rest raised some concerns; the authors could not rule out publication bias, given positive results and the predominance of Chinese studies. Its most frequently used points were ST25 (Tianshu), ST36 (Zusanli), ST37 (Shangjuxu), CV12 (Zhongwan), CV04 (Guanyuan) and BL25 (Dachangshu). None of the trials in these five reviews compared acupuncture with a sham.
A 2024 overview by Wang and colleagues at Changchun University of Chinese Medicine assessed 10 systematic reviews of acupuncture and moxibustion for ulcerative colitis, six of them published in Chinese. It rated the methodological quality of all 10 as low or critically low. Of the 27 outcomes it graded, 6 were of moderate certainty, 8 low and 13 very low, and none high; the most common reasons for downgrading were weak randomisation, allocation concealment and blinding in the trials, and small samples. A 2024 analysis by Ye and colleagues of 215 trials of acupuncture and moxibustion for the condition found 54 different outcome measures, and only three trials that clearly named their primary and secondary outcomes. Where the trials come from discusses what the country of a trial tells a reader, and Moxibustion describes the method.
Sham-controlled trials
A 2006 trial by Joos and colleagues at the University of Erlangen-Nuremberg in Germany randomised 29 people with mild to moderately active ulcerative colitis to traditional acupuncture with moxibustion (15) or to sham acupuncture, superficial needling at non-acupuncture points (14), in 10 sessions over 5 weeks, with 16 weeks of follow-up. The Colitis Activity Index fell from 8.0 to 4.2 points with acupuncture and from 6.5 to 4.8 with sham, a difference that was statistically significant; quality of life and well-being improved in both groups, with no difference between them. The authors described the difference between real and sham acupuncture as small.
A 2020 pilot trial by Horta and colleagues in Sabadell, Spain, randomised 52 people with IBD in remission and fatigue to electroacupuncture, sham electroacupuncture or a waiting list. Both needle groups improved fatigue scores against the waiting list; electroacupuncture was not significantly better than sham, and the authors note the study was not powered to rule out a difference. A sham-controlled trial run at Guang'anmen Hospital in Beijing, registered as NCT06615765, plans to randomise 64 adults with mild to moderate ulcerative colitis to 20 sessions of acupuncture or sham over 8 weeks, with blinding of participants and assessors; Europe PMC listed no results by October 2026. Sham acupuncture explains what such controls can and cannot show.
What guidelines say
The British Society of Gastroenterology's 2019 consensus guidelines on IBD in adults, by Lamb and colleagues, found no evidence to recommend the routine use of complementary and alternative medicine, and stated that anecdotal evidence supports acupuncture although there are no controlled trials and blinding is an obvious problem. They advised clinicians to ask patients about such therapies and stressed that patients should continue proven conventional treatment if they use them. The society updated those guidelines in its 2025 guidelines, by Moran and colleagues; the Frontline Gastroenterology summary of their ulcerative colitis recommendations does not mention acupuncture or complementary therapy.
The American Gastroenterological Association's 2019 guideline on mild to moderate ulcerative colitis and its 2024 living guideline on moderate to severe disease cover drug treatment and do not mention acupuncture. The European Crohn's and Colitis Organisation addressed complementary medicine in a separate 2019 topical review by Torres and colleagues, which estimates that up to half of people with IBD use complementary and alternative medicine at some point and notes that appropriate evidence for such therapies is often lacking.
What the reviews could not settle
The pooled trials compared acupuncture-related methods with drugs or added them to drugs, none against a sham, and Ye's analysis shows the trials did not agree on how to measure a response. The comparison with sham in ulcerative colitis rests on the German trial of 29 people, and the Beijing trial has not yet reported. This page does not cover the separate trials in Crohn's disease; Irritable bowel syndrome and Chronic diarrhoea report the evidence for related bowel symptoms.
AcuiQ's ulcerative colitis and Crohn's disease pages list the protocols clinical texts and individual studies prescribed, each with its citation.