Table 1.

Characteristics of randomised controlled trials of moxibustion vs. pharmacological medications for IBS

Study (year) Country	Sample size (% female)	Diagnostic criteria used for IBS	Type of IBS (based on the predominant stool form)	Criteria used to define symptom improvement	Moxa intervention (duration)*	Control intervention (duration)	Risk of bias assessmenta
Luo (2012) China [26]	40 (53%)	Rome III, negative GI investigations and TCM criteria (liver-qi stagnation type)	C 100%	Any improvement in global IBS symptoms	Moxa (4 weeks): Herbal cake-partitioned and individualised, o.d.	Medication (4 weeks): Mosapride 5 mg/time, t.i.d.	U-U-N-N-Y-Y
Chu (2011) China [20]	60 (22%)	Rome II and TCM criteria	D 100%	≥ 30% improvement in global IBS symptoms	Moxa (15 days): Indirect and partially individualised, o.d.	Medication (15 days): Loperamide 2 mg/time, b.d.	Y-U-N-N-Y-Y
Luo (2011) China [25]	60 (42%)	Rome III, IBS-C according to Bristol Stool Form Scale, and negative GI investigations	C 100%	≥ 30% improvement in global IBS symptoms	Moxa (2 weeks): Indirect and fixed, o.d.	Medication (2 weeks): Mosapride 5 mg/time, t.i.d.	U-U-N-N-Y-Y
Luo (2008) China [27]	95 (49%)	Rome III, negative GI investigations and Standards for clinical diagnosis for IBS from 1986 National conference for chronic diarrhea	D 100%	Any improvement in global IBS symptoms	Moxa (30 days): Indirect and fixed, b.d., 10 days/course, 3 courses in total	Medication (30 days): Pinaverium, 50 mg/time, t.i.d.	U-U-N-N-Y-Y
Huang (2007) China [22]	65 (unspecified)	Rome III, negative GI investigations and TCM criteria	Unspecified	Any improvement in global IBS symptoms	Moxa (4 weeks): Indirect and partially individualized, o.d.	Medication (4 weeks): Trimebutine 0.2 g/time, t.i.d.	U-U-N-N-Y-Y
Zhang (2007) China [36]	60 (62%)	Rome II	D 100%	≥ 30% improvement in global IBS symptoms	Moxa (2 weeks): Ginger-partitioned and fixed, o.d. for 2 weeks	Medication and standard care (2 weeks):	U-U-N-N-Y-Y
						- Standard care such as diet, psychiatric, and anti-diarrheal therapy
						- Entero-soluble glutamine 0.4 g, t.i.d. or smecta 3 g, t.i.d. or probiotics 630 mg, t.i.d.
Ni (2001) China [28]	56 (63%)	Negative GI investigations and Standards for clinical diagnosis for IBS from 1986 National conference for chronic diarrhea	D 100%	Change of total IBS symptom score (pre-defined)	Moxa (15 days): Indirect and partially individualized, o.d. for 15 days	Medication (15 days): Nifedipinum, 10 mg/time, t.i.d.	U-U-N-N-N-N
Wu (1996) China [32]	81 (44%)	Standards for clinical diagnosis for IBS from 1986 National conference for chronic diarrhea and TCM criteria	Unspecified	Any improvement in global IBS symptoms	Moxa (72 days): Herbal cake-partitioned and individualised, o.d., 12 sessions/course, 5 courses in total, with 3 days of no TX interval	Medication (3 months):	U-U-N-N-Y-Y
						- Piperazine 0.2 g/time, t.i.d.
						- Smecta, 3 g/time, t.i.d.

^aRisk of bias was evaluated for 6 criteria in order [11], i.e. sequence generation, allocation concealment, blinding of participants, blinding of outcome assessors, incomplete outcome data, and selective outcome reporting. Each criterion was scored as yes (Y), no (N), or unclear (U), where Y indicates a low risk of bias, N indicates a high risk of bias and U indicates an unclear risk of bias.

*Moxibustion method was classified into three categories on the basis of the levels of individualisation: “fixed” means all patients receive the same treatment at all sessions, “partially individualised” means using a fixed set of points to be combined with a set of points to be used flexibly, and “individualised” means each patient receives a unique and evolving diagnosis and treatment [38].

b.d., twice a day; C, constipation-predominant subtype of IBS; D, diarrhoea-predominant subtype of IBS; GI, gastrointestinal; IBS, irritable bowel syndrome; moxa, moxibustion; o.d., once a day; TCM, traditional Chinese Medicine; t.i.d., three times a day; TX, treatment.