Three studies assessed the use of herbal enemas in the treatment of ulcerative proctitis. Fourteen patients with mild-to-moderate active UC were treated with bovine colostrum enemas or placebo containing albumin solution twice daily for 4 weeks in addition to mesalazine. The colostrum, but not the placebo group, showed a mean reduction in symptom score, and an improvement in histological score.[23] In an 8-week double-blind randomised study, Xilei-san, a traditional Chinese herbal medicine with anti-inflammatory properties, was compared with dexamethasone enemas in 35 subjects with mild-to-moderate active ulcerative proctitis. Subjects were followed up for 12 weeks. Both treatments showed significant improvement in clinical, endoscopic and histological score compared with baseline.[34] In a separate randomised controlled trial, 30 subjects with intractable ulcerative proctitis despite 4 weeks of topical mesalazine or corticosteroid were randomised to xilei-san suppositories or placebo suppositories for 2 weeks. The number of patients who achieved remission (clinical activity index ≤4) was significantly higher in the Xilei-san group compared with placebo (P < 0.04). Endoscopic and histological improvements were also significantly higher and relapse rate at 180 days was significantly lower in the active treatment arm compared with placebo.[35] Rectal Xilei-san appeared to be well tolerated in both studies. Table 1 shows studies of herbal therapy used for the induction of remission in UC.