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Huangkui Lianchang decoction (HLD) is a traditional Chinese medicine (TCM) herbal formula primarily utilized for the treatment of ulcerative colitis (UC). Its primary active component is derived from *Abelmoschus manihot* (L.) Medicus, commonly known as Huangshukui. The formula is frequently administered as a retention enema (HKE) to provide localized therapeutic effects for mild-to-moderate active distal or left-sided colonic UC. Mechanistically, HLD exerts potent anti-inflammatory effects by inhibiting the TLR4/MyD88/NF-κB signaling pathway, which leads to the downregulation of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6). Additionally, it has been shown to modulate autophagy and improve intestinal barrier function. Clinical research, including multicenter randomized controlled trials, has demonstrated that HLD can achieve clinical remission and mucosal healing rates comparable to standard treatments like mesalazine.
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