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Overall, 196 patients with IBS\u2010D were recruited for this study; consequently, 132 patients randomized to receive daily 400\u2009mg of berberine hydrochloride, delivered twice daily or placebo for 8\u2009weeks followed by a 4\u2010week washout period. After a 2\u2010week run\u2010in period, diarrhea, abdominal pain, urgent need for defecation frequency and any adverse events were recorded daily. Prior to administration of the medication and after completing the treatment, assessment of IBS symptom scores, depression and anxiety scale scores and the IBS scale for quality of life (QOL) was carried out. The effects of berberine hydrochloride on IBS\u2010D, defined by a reduction of diarrhea frequency (<jats:italic>P<\/jats:italic>\u2009=\u20090.032), abdominal pain frequency (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) and urgent need for defecation frequency (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01), were significantly more pronounced in the berberine group than the placebo group in the 8\u2009weeks of treatment. A trend of improvement (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05) was observed with berberine hydrochloride for IBS symptom score, depression score and anxiety score and the IBSQOL, compared with placebo. At last, berberine hydrochloride was well tolerated. So we concluded that berberine hydrochloride is well tolerated and reduces IBS\u2010D symptoms, which effectively improved patients QOL. 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