Chronic diarrhoea

Chronic diarrhoea is loose or watery stool passed more often than usual for more than 4 weeks, as the British Society of Gastroenterology’s 2018 guideline on its investigation defines it. Functional diarrhoea is the form with no structural or medical cause that tests can find: in the Rome V criteria, the Rome Foundation’s current diagnostic definitions for gut disorders, loose or watery stools in more than 25% of bowel movements over the last 3 months, with symptoms that began at least 6 months before diagnosis. Diarrhoea-predominant irritable bowel syndrome (IBS-D) is the related disorder in which abdominal pain comes with the diarrhoea. Cochrane has not published a review of acupuncture for chronic or functional diarrhoea, so the evidence on this page comes from one review that pooled functional diarrhoea with IBS-D, two trials against the antidiarrhoeal drug loperamide, and sham-controlled trials run only in IBS-D.

The review

A 2020 systematic review by Jianbo Guo and colleagues at Guang’anmen Hospital in Beijing searched five English and Chinese databases to June 2020 and included 31 randomised trials with 3,234 adults with functional diarrhoea or IBS-D. It pooled the two conditions and did not report them separately. Every comparison was with a drug: loperamide, trimebutine maleate, or pinaverium bromide, an antispasmodic. One trial used sham acupuncture, added to pinaverium in both groups, and the authors wrote that their results were a comparison between acupuncture and conventional drugs. They graded five outcomes with GRADE.

SMD is the standardised mean difference, which puts results measured on different scales into one unit so that they can be pooled. The authors reached several of these figures by setting aside trials that disagreed with the rest: the weekly bowel movement result, for example, comes from 2 of the 4 loperamide trials after the other 2 produced heterogeneity of 96%. A funnel plot of the overall response rate suggested 7 unpublished trials, a sign of publication bias. Most adverse events the review recorded with acupuncture were small bleeds under the skin. The authors rated the overall quality of the included studies low and called for sham-controlled trials.

The review carries the PROSPERO registration of a 2017 protocol by Zongshi Qin and colleagues, which set out to search nine databases, including the Cochrane trials register and Japanese and Korean sources. The published review searched five.

Trials against loperamide

The largest trial that enrolled people with functional diarrhoea is a 2016 trial in Medicine by Hui Zheng and colleagues, led from Chengdu University of Traditional Chinese Medicine and the China Academy of Chinese Medical Sciences in Beijing and run at 8 hospitals in 8 Chinese provinces. It randomised 448 adults who had had diarrhoea for at least 6 months and met the Rome III criteria for functional diarrhoea or IBS-D; 275 of the 441 analysed had functional diarrhoea. Three groups had 16 sessions of electroacupuncture over 4 weeks at different points: LI11 (Quchi) and ST37 (Shangjuxu); ST25 (Tianshu) and BL25 (Dachangshu); or all four on alternating sides. The fourth group took loperamide 2 mg three times a day.

• Stool frequency fell from about 16 a week at baseline by 5.4 a week on average at week 4, with no significant difference between any electroacupuncture group and loperamide (differences of 0.6, 0.4 and 0.0 a week, inside the trial’s margin of 1).
• Stool form, days with a normal bowel movement and quality of life improved in all four groups to a similar degree, and the results held when functional diarrhoea and IBS-D were analysed apart.
• 11 people reported adverse events, 1 of them in the loperamide group, a difference the trial could not distinguish from chance.

Neither patients nor acupuncturists were blinded, and the trial had no sham group. The authors named a placebo effect and regression to the mean, the tendency of extreme symptoms to ease on their own, as possible explanations, and wrote that 16 sessions a month may not be cost-effective.

A 2022 trial by Xiaohu Xu and colleagues at Tongji Hospital in Wuhan kept to functional diarrhoea. It randomised 73 people to electroacupuncture at ST25 and BL25 at a low current (0.1 to 0.8 mA), the same at a high current (1.0 to 1.8 mA), or loperamide, for 4 weeks; the authors report that patients, assessors and statisticians did not know the allocation. At the end of treatment the proportion of normal bowel movements did not differ between the three groups. In the 4 weeks after treatment both electroacupuncture groups stayed better than at baseline and the loperamide group did not. No adverse events were reported. The trial planned 237 people and stopped at 73 for want of recruits and funding.

Sham-controlled trials in diarrhoea-predominant IBS

None of the trials in Guo’s review compared acupuncture with sham in functional diarrhoea alone, and Europe PMC listed no such trial by October 2026. In IBS-D, a 2022 pilot trial in JAMA Network Open by Ling-Yu Qi and colleagues at Beijing University of Chinese Medicine randomised 90 people at 4 hospitals to 12 sessions over 4 weeks of acupuncture at points chosen for the condition, acupuncture at other points, or sham with blunt needles that did not pierce the skin at non-acupuncture sites. At week 4, 46.7%, 46.7% and 26.7% met a combined target for less abdominal pain and fewer days of watery stool, a difference the pilot could not distinguish from chance; its authors wrote that so small a sample risked missing a real effect. The same group then ran the 280-person ACTION trial against sham, which Irritable bowel syndrome reports with the Cochrane review and the other IBS trials.

A 2026 meta-analysis in Gastroenterology by Zheng and colleagues pooled 11 trials of acupuncture against sham needling at non-acupuncture points in IBS of any subtype, 12 trials and 1,105 people in all. Responders were more common with acupuncture (risk ratio 1.61, 1,004 people), with high inconsistency between trials, and only that result and symptom severity at the end of treatment held in sensitivity analysis. The authors rated the certainty of the evidence low; the abstract does not report IBS-D separately.

What guidelines say

The Japan Gastroenterological Association’s clinical guidelines for chronic diarrhea 2023, published in English in 2024, recommend lifestyle and diet first for functional diarrhoea and then probiotics and antidiarrhoeal drugs, and do not mention acupuncture. The British Society of Gastroenterology’s 2018 guideline covers investigation rather than treatment and does not mention it either. The American Gastroenterological Association’s 2022 guideline on drugs for IBS-D covers drugs only, and recommends loperamide, the comparator in both trials above, conditionally on very low certainty evidence. NICE’s IBS guideline, CG61, has advised since 2008 that acupuncture should not be encouraged for IBS; NICE last updated the guideline in 2017 and ran an exceptional surveillance review in April 2025. Clinical guidelines compares other bodies’ positions.

What the reviews could not settle

No review has weighed acupuncture against sham in functional diarrhoea, and no sham-controlled trial of it was found, so whether the results against loperamide reflect the needling, the attention of a practitioner or patients’ expectations is unsettled. Sham acupuncture explains what a sham control can rule out. The only review that included functional diarrhoea pooled it with IBS-D, set trials aside to reach its figures, and found signs of publication bias. Both loperamide trials were funded under the same Chinese national research programme; the larger shares investigators with the constipation trials that Constipation reports; and all four trials on this page were run in China. Where the trials come from discusses what the country of a trial tells a reader. Neither loperamide trial followed people for more than 4 weeks after treatment ended. Electroacupuncture describes the method both loperamide trials tested.

AcuiQ’s diarrhoea, chronic diarrhoea, functional diarrhoea and diarrhoea-predominant IBS pages list the protocols individual studies prescribed, each with its citation.