Diarrhea-predominant irritable bowel syndrome (IBS-D) is a clinically common functional gastrointestinal disease, in which immune imbalance plays an important role. Related immune cells include innate immune cells and adaptive immune cells, and immune cytokines include immunoglobulin, interferon, interleukin, tumor necrosis factor, etc. Traditional Chinese medicine monomers/compounds or compound formulas can regulate immunotherapy for IBS-D through multi-pathway, multi-target. This article systematically reviews and sorts out relevant literature on targeted immunotherapy of IBS-D using traditional Chinese medicine monomers/compounds and compound therapies from the perspectives of immune imbalance and intestinal infection, dysbiosis of flora, brain-gut axis disorder, and endocrine disorders. At the same time, it confirms the similarities between the "spleen as the guard" and immunity, to provide ideas for traditional Chinese medicine to treat IBS-D and related diseases through immune-mediated pathways.

腹泻型肠易激综合征（IBS-D）是一种临床常见的功能性胃肠病，免疫失衡在其发病中起重要作用。相关免疫细胞包括固有免疫细胞和适应性免疫细胞，免疫细胞因子包括免疫球蛋白、干扰素、白介素、肿瘤坏死因子等。中药单体/化合物或复方可通过多通路、多靶点调节免疫治疗IBS-D。本文从免疫失衡与肠道感染、菌群失调、脑肠轴紊乱、内分泌紊乱的关系等方面，对中药单体/化合物和复方靶向免疫治疗IBS-D的相关文献进行了系统回顾与梳理，并同时印证了"脾为之卫"与免疫相通之处，以期为中医药通过免疫介导途径治疗IBS-D及相关疾病提供思路。