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Risk of bias was generally unclear across all domains. Tuina combined with RTs may be superior to RTs for improving overall symptom of IBS-diarrhea. Due to the existing methodological issues and the heterogeneity of Tuina manipulation, current findings need to be confirmed in large scale, multicenter, and robust randomized trials (especially on outcome assessing blinding and allocation concealment). Tuina combined with RTs may be superior to RTs for improving overall symptom of IBS-diarrhea. Due to the existing methodological issues and