{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:59:28Z","timestamp":1791572368744,"version":"4.3.4"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,5]],"date-time":"2020-11-05T00:00:00Z","timestamp":1604534400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Indigo naturalis (IN) is a blue pigment extracted from Assam indigo and other plants and has been confirmed to be highly effective for ulcerative colitis (UC) treatment in several clinical studies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>We conducted a multicenter double-blind study to confirm the efficacy and safety of short-term IN administration.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A multicenter, randomized controlled trial was conducted between December 2015 and October 2018 in our facilities. Forty-six patients with mild to moderate active UC (Lichtiger index: 5\u201310) were randomly assigned to the IN group or the placebo group and received 5 capsules (500 mg) twice a day for 2 weeks. We investigated the efficacy according to blood tests and the Lichtiger index before and after administration, and we also examined adverse events.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The analysis included 42 patients (20 males, 22 females) with an average age of 45 years. Nineteen patients were assigned to the placebo group, and 23 were assigned to the IN group. After treatment administration, in the placebo group, no change in the Lichtiger index was observed (7.47 to 6.95, p = 0.359), and hemoglobin was significantly reduced (12.7 to 12.4, p = 0.031), while in the IN group, the Lichtiger index (9.04 to 4.48, p = 0.001) and albumin (4.0 to 4.12, p = 0.022) improved significantly. Mild headaches were observed in 5 patients and 1 patient in the IN and placebo groups, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Short-term administration of IN is highly effective without serious adverse events such as pulmonary hypertension or intussusception and may prevent the occurrence of serious adverse events.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0241337","type":"journal-article","created":{"date-parts":[[2020,11,5]],"date-time":"2020-11-05T18:50:54Z","timestamp":1604602254000},"page":"e0241337","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":39,"title":["Efficacy and safety of short-term therapy with indigo naturalis for ulcerative colitis: An investigator-initiated multicenter double-blind clinical trial"],"prefix":"10.1371","volume":"15","author":[{"given":"Kan","family":"Uchiyama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichiro","family":"Takami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1469-7449","authenticated-orcid":true,"given":"Hideo","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyotaka","family":"Umeki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4862-5926","authenticated-orcid":true,"given":"Satoshi","family":"Mochizuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobushige","family":"Kakinoki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Iwamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoko","family":"Hoshino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Omori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunji","family":"Fujimori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinori","family":"Yanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Mizokami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshifumi","family":"Ohkusa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,5]]},"reference":[{"key":"pone.0241337.ref001","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/s00535-016-1220-2","article-title":"Indole compounds may be promising medicines for ulcerative colitis","volume":"51","author":"S Sugimoto","year":"2016","journal-title":"J Gastroenterol"},{"key":"pone.0241337.ref002","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1159\/000444217","article-title":"Clinical Efficacy and Safety of Oral Qing-Dai in Patients with Ulcerative Colitis: A Single-Center Open-Label Prospective Study","volume":"93","author":"S Sugimoto","year":"2016","journal-title":"Digestion"},{"key":"pone.0241337.ref003","doi-asserted-by":"crossref","first-page":"2718","DOI":"10.3748\/wjg.v19.i17.2718","article-title":"Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis","volume":"19","author":"H Suzuki","year":"2013","journal-title":"World J Gastroenterol"},{"key":"pone.0241337.ref004","first-page":"1","article-title":"Development of an Indigo Naturalis Suppository for Topical Induction Therapy in Patients with Ulcerative Colitis","volume":"25","author":"Y Yoshimatsu","year":"2019","journal-title":"Digestion"},{"key":"pone.0241337.ref005","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1159\/000106755","article-title":"A Suppository Chinese Medicine (Xilei-san) for Refractory Ulcerative Proctitis: A Pilot Clinical Trial","volume":"75","author":"K Fukunaga","year":"2007","journal-title":"Digestion"},{"key":"pone.0241337.ref006","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1053\/j.gastro.2017.11.024","article-title":"Efficacy of Indigo naturalis in a Multicenter Randomized Controlled Trial of Patients with Ulcerative Colitis","volume":"154","author":"M Naganuma","year":"2018","journal-title":"Gastroenterology"},{"key":"pone.0241337.ref007","doi-asserted-by":"crossref","first-page":"1992","DOI":"10.1093\/eurheartj\/ehw090","article-title":"Chinese herbal drug natural indigo may cause pulmonary artery hypertension","volume":"37","author":"M Nishio","year":"2016","journal-title":"Eur Heart 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Gastroenterol Hepatol"},{"key":"pone.0241337.ref011","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1038\/s41385-018-0019-2","article-title":"Aryl hydrocarbon receptor and intestinal immunity","volume":"11","author":"B Lamas","year":"2018","journal-title":"Mucosal Immunol"},{"key":"pone.0241337.ref012","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13020-015-0061-x","article-title":"Qing\u2011dai powder promotes recovery of colitis by inhibiting inflammatory responses of colonic macrophages in dextran sulfate sodium\u2011treated mice","volume":"10","author":"HT Xiao","year":"2015","journal-title":"Chinese Medicine"},{"key":"pone.0241337.ref013","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/den.13226","article-title":"Indigo naturalis-induced colitis","volume":"30","author":"S Yanai","year":"2018","journal-title":"Dig 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