Abstract:The incidence of diarrhea-predominant irritable bowel syndrome (IBS-D) remains high, with microRNA (miRNA)-mediated intestinal barrier dysfunction, visceral hypersensitivity, low-grade inflammation, and dysbiosis playing significant roles in its pathogenesis. Traditional Chinese medicines can treat IBS-D by directly or indirectly targeting miRNAs to regulate multiple pathways and targets in a coordinated manner. This article systematically reviews the involvement of miRNAs in the pathogenesis of IBS-D and the progress of traditional Chinese medicine interventions. It explores the relationship between traditional genetics, epigenetics, and the Chinese medicine concepts of ‘kidney’ and ‘spleen’ in terms of congenital and acquired interactions from a molecular biology perspective. This review thus provides a reference for exploring the micro-material basis of the ‘Zang-Xiang’ theory of traditional Chinese medicine, and offers new ideas and method for the effective treatment of IaBS-D using traditional Chinese medicine.