Abstract：Objective：To compare the efficacy of different traditional Chinese medicine (TCM) formulas for regulating liver and spleen in the treatment of diarrheal irritable bowel syndrome (IBS- D) through Network Meta- analysis (NMA). Methods： Randomized controlled trials (RCT) on the treatment of IBS- D with TCM prescriptions for harmonizing liver and spleen were searched from seven Chinese and English databases including CNKI and PubMed from establishment to December 2022. The GeMTC package in R language software was used for statistical analysis. Results：A total of 52 RCT were included，all of which took conventional western medicine as the control measure， involving eight TCM intervention measures. NMA results showed that combination therapy was superior to single therapy，and the probability of each intervention becoming the best was ranked as follows：Tongxie Yaofang Decoction combined with Chaihu Shugan San (84.5% ) ＞Chaihu Shugan San (75.8% ) ＞Tongxie Yaofang Decoction combined with Shenling Baizhu San (64.1% ) ＞Tongxie Yaofang Decoction combined with Sini San (63.7% ) ＞Tongxie Yaofang Decoction combined with conventional western medicine (56.1% ) ＞Sini San (45.4% ) ＞Tongxie Yaofang Decoction combined with Sijunzi Decoction (45.0% ) ＞Tongxie Yaofang Decoction combined with Sijunzi Decoction (45.0% ) ＞Tongxie Yaofang Decoction (15.5% ) ＞conventional western medicine (0). TCM has good safety in terms of adverse reactions. Conclusion；Tongxie Yaofang Decoction combined with Chaihu Shugan San may be the best prescription for regulating liver and spleen in treating IBS-D. This study still has some limitations，and more high-quality RCT studies are expected to verify it.