Stimulated by Yang et al 2025.[1]
IBS – irritable bowel syndrome
IBS-D – diarrhoea-predominant irritable bowel syndrome
BUCM – Beijing University of Chinese Medicine
MA – manual acupuncture
BSFS – Bristol stool form scale– key to acronyms
This is a paper from a well-known research group based in BUCM. It reports a multicentre trial, so the authors cover six different centres in China, but the first and last authors are from BUCM. I met the boss (Professor Cun-Zhi Liu) for the first time in Jeju last year, but I have been specifically following his research publications for several years, and have highlighted at least 9 here already, see: VCIND; Functional dyspepsia 2020; Frequency of Rx in OAK; Intensive EA/MA in OAK; EA and the gut microbiome; Acupuncture for SCD 2024; Acupuncture for ARC 2022; EA for ERAS 2022; Acupuncture for chronic sciatic 2024.
This trial, which comes with an acronym (ACTION), was performed at 6 centres in China and included 280 patients with IBS-D. The report is published in the journal Gastroenterology (IF ~26), the principal journal of the American Gastroenterology Association (AGA), although it has several others as well.
It is a straightforward parallel arm sham controlled trial of acupuncture in IBS-D. The Rome IV criteria were used, and patients were selected if they reported a certain level of severity of diarrhoea and abdominal pain in the 2-week run-in period.
MA or sham MA was applied in 30-minute sessions over a 6-week treatment course. Treatments were 3 times per week for the first 3 weeks and 2 times a week thereafter, making a total of 15 sessions.
Real or blunt non-penetrating needles were inserted into adhesive pads over the points selected. In the real MA group a set of 5 fixed points (8 needles in total) and 1 optional bilateral point (from a set of 3 based on TCM syndrome) were used. In the sham MA group a standard set of 5 bilateral non-acupuncture points were used. Both groups had 4 needles in the abdomen and 6 needles in the lower limbs.
The points used in the real MA group were CV12, CV4, ST25, ST36, ST37, plus one of the following: SP6 or LR3 or ST44.
Apart from the acupuncturists, everyone else involved was blind, and the assessment of blinding (James Blinding Index) confirmed patient blinding at the end of the treatment phase. Follow-up continued for 12 weeks after the end of the treatment phase, although the primary outcome was measured at the end of treatment. This was a composite outcome including both pain and stool consistency. Abdominal pain had to reduce by at least 30% and the number of days with loose stools (6 or 7 on BSFS) had to reduce by at least 50% for a patient to be considered a responder.
At the end of 6 weeks and 15 sessions of either real or sham MA, 71 (58%) patients in the real MA group and 47 (41%) in the sham MA group met the primary outcome criteria.
The ‘placebo’ response (or response to non-penetrating sham MA) is relatively high, as would be expected in IBS. The placebo response to the pain outcome (37%) was notably higher than the functional response in terms of stool consistency (29%). This was partially, if not totally responsible for the fact that the pain outcome was not significant until the end of follow-up, whereas the stool consistency outcome (BSFS) became significant at 5 weeks in the treatment phase, and the combined outcome became significant at 3 weeks (after 9 sessions of acupuncture).
This is a well conducted trial (as we have come to expect from this team) with believable results and a straightforward protocol that any acupuncturist could adopt.
References
1 Yang J-W, Qi L-Y, Yan S-Y, et al. Efficacy of ACupuncTure in Irritable bOwel syNdrome (ACTION): a multi-centre randomized controlled trial. Gastroenterology. 2025;S0016-5085(25)00826-1. doi: 10.1053/j.gastro.2025.05.016
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