TABLE 1.
Characteristics of included studies of acupuncture vs. sham acupuncture, medication, and moxibustion in treating Diarrhea-Predominant Irritable Bowel Syndrome.
| References | Design | Participants | Interventions | Main outcomes | Mechanism research |
| Hu et al., 2021 | Parallel | n: 37 (F 19); Age (mean): TEA (44.4 ± 13.4), CONT (45.4 ± 11.7); Groups (n): TEA (21), CONT (16); Diagnosis: Rome IV | EXP: TEA (LI4, ST36); CONT: Sham TEA (LI4, ST36, no current delivered); Duration and frequency: EXP&CONT: 30 min, twice per d, for 1 month | Decreased VAS scores in TEA and greater than SA (P < 0.05); improved IBS-QOL scores in TEA not in SA; decreased IBS-SSS scores in both TEA and SA | Inflammatory cytokines (Serum; IL-10 and IL-6); Neurotransmitters (Serum, NE); GI hormones (Serum, PP) |
| Guo et al., 2021 | Parallel | n: 231 (F 103); Age (mean): MA (46 ± 12), CONT (44 ± 13); Groups (n): MA (154), CONT (77); Diagnosis: Rome III | EXP: MA (GV20, GV29, ST25, ST36, ST37, SP6, LR3); CONT: Oral pinaverium bromide tablets; Duration and frequency: EXP: 30 min, once every other d, for 6 wk; CONT: 50 mg, tid, for 6 wk | Decreased IBS-SSS scores in MA and greater than CONT (P < 0.01); improved IBS-QOL in MA and greater than CONT (P < 0.01) | Genetic polymorphism (5-HTTLPR) |
| Sun et al., 2021 | Parallel | n: 73 (F 39); Age (mean): MA + EA (39 ± 10), EA (41 ± 10); Groups (n): MA + EA (36), EA (37); Diagnosis: Rome IV | EXP: MA (GV20, GV24, GB13); CONT: MA + EA (CV4, CV12, ST25, BL25, ST36, ST37, LI4, LR3); Duration and frequency: EXP&CONT: 30 min, once per d, 6 times per wk, for 4 consecutive wk | Decreased IBS-SSS scores in MA + EA and greater than EA (P < 0.05); improved IBS-QOL in MA + EA and greater than EA (P < 0.05) | Mental status (HAMD) |
| Li, 2015 | Parallel | n: 60 (F 33); Age (mean): MA (32), CONT (34); Groups (n): MA (30), CONT (30); Diagnosis: Rome III | EXP: MA (CV6, CV12, ST25, ST36, ST37, ST39, SP6, SP7, SP9); CONT: Oral pinaverium bromide tablets; Duration and frequency: EXP: 25 min, once per d, 5 times per wk, for 4 wk; CONT: 50mg, tid, for 4 wk | Decreased symptom scores in MA and greater than CONT (P < 0.05) (symptom scores without identified source) | Neurotransmitters (Serum; VIP and 5-HT) |
| Zhenzhong et al., 2015 | Parallel | n: 41 (F NA); Age (mean): EA (39 ± 5), Mox (39 ± 8); Groups (n): EA (19), Mox (22); Diagnosis: Rome III | EXP: EA (ST36, ST37); CONT: Moxibustion (ST36, ST37); Duration and frequency: EXP&CONT: 30 min, once per d, 6 times per wk, for 4 consecutive wk | Decreased VAS scores in both EA and Mox; decreased BSFS scores in Mox and greater than EA (P < 0.001) | Neurotransmitters (Colon tissue; SP and VIP) |
| Zhao et al., 2015 | Parallel | n: 62 (F NA); Age (mean): EA (42.75 ± 10.22), Mox (39.53 ± 8.91); Groups (n): EA (32), Mox (30); Diagnosis: Rome III | EXP: EA (ST25, ST37); CONT: Moxibustion (ST25, ST37); Duration and frequency: EXP&CONT: 30 min, once per d, 6 times per wk, for 4 consecutive wk | Decreased VAS scores in both EA and Mox; decreased BSFS scores in Mox not in EA; decreased HAMD and HAMA scores in both EA and Mox (P < 0.05 or P < 0.01) | Mental status (HAMD and HAMA); Neurotransmitters (Sigmoid tissue; 5-HT, 5-HT3R and 5-HT4R); Brain activation (fMRI) |
| Zhan et al., 2014 | Parallel | n: 57 (F 36); Age (mean): MA (42 ± 14), CONT (37 ± 13); Groups (n): MA (29), CONT (28); Diagnosis: Rome III | EXP: MA (GV20, GV29, LR3, ST25, ST36, ST37, SP6); CONT: Oral live combined bifidobacterium and lactobacillus tablets/pinaverium bromide tablets; Duration and frequency: EXP: 30 min, once per d, 5 times per wk, for 4 wk; CONT: 2 g, tid/50 mg, tid, for 4 wk | Decreased Rome III IBS symptom scores in MA and greater than CONT (P < 0.01); significantly higher PR in MA than CONT (P < 0.05) | Neurotransmitters (Serum; 5-HT) |
| Wu et al., 2013 | Parallel | n: 40 (F 22); Age (mean): MA (41 ± 13), CONT (39 ± 13); Groups (n): MA (21), CONT (19); Diagnosis: Rome III | EXP: MA (GV20, GV29, LR3, ST25, ST36, ST37, SP6); CONT: Oral live combined bifidobacterium and lactobacillus tablets/pinaverium bromide tablets; Duration and frequency: EXP: 30 min, once per d, 5 times per wk, for 4 wk; CONT: 2 g, bid/50 mg, tid, for 4 wk | Decreased symptom scores in MA and greater than CONT (P < 0.05) (symptom scores without identified source); significantly higher PR in MA than CONT (P < 0.05) | Inflammatory cytokines (Serum; IFN-γ, IL-2, IL-4, IL-10 and IFN-γ/IL-4) |
| Chu et al., 2012 | Parallel | n: 30 (F 15); Age (mean): EA (42.3 ± 12.2), SA (44.2 ± 14.5); Groups (n): MA (15), CONT (15); Diagnosis: Rome III | EXP: EA (ST36, ST37, SP6); CONT: Sham EA (ST36, ST37, SP6; touch but not penetrate into acupoints); Duration: EXP&CONT: 15 and 30 min, once during fMRI | − | Brain activation (fMRI) |
| Schneider et al., 2007 | Parallel | n: 34 (F 28); Age (mean): MA (46.23 ± 15.00), SA (41.80 ± 14.51); Groups (n): MA (19), CONT (15); Diagnosis: Rome II | EXP: MA (LR3, ST21, ST25, ST36, SP6, HT7, GV20, RN12); CONT: Sham MA (LR3, ST21, ST25, ST36, SP6, HT7, GV20, RN12; 2 cm adjacent to acupoints); Duration and frequency: EXP&CONT: twice a wk, for 5 wk | Decreased FDDQL global scores and SF-36 pain scales in both MA and SA | Stress hormones (salivary cortisol); Autonomic functions (ECG) |
BSFS, Bristol Stool Form Scale; CONT, control group; EA, electroacupuncture; ECG, electrocardiogram; EXP, experimental group; F, female; FDDQL, functional digestive diseases quality of life; fMRI, functional magnetic resonance imaging; HAMA, Hamilton Anxiety Rating Scale; HAMD, Hamilton Depression Rating Scale; IBS-QOL, IBS quality of life; IBS-SSS, IBS severity scoring system; IFN-γ, interferon γ; IL, interleukin; MA, manual acupuncture; Mox, moxibustion; NE, norepinephrine; PP, pancreatic polypeptide; PR, proportion of responders; SA, sham acupuncture/TEA; SF-36, 36-Item Short Form Survey; SP, substance P; TEA, transcutaneous electrical acustimulation; VAS, visual analog scale; VIP, vasoactive intestinal peptide; 5-HT, 5-hydroxytryptamine; 5-HT3R, serotonin receptor 3; 5-HT4R, serotonin receptor 4; 5-HTTLPR, serotonin transporter.