Heart failure is a fatal stage of end-stage cardiovascular disease, which brings a huge medical burden to the society because of its high mortality and re-hospitalisation rates. Intestinal microecology is the largest and most complex microecosystem of human body. It is inhabited by tens of thousands of microorganisms in human gastrointestinal tract. In recent years, with the deepening of the study of intestinal flora, more and more studies have found that the imbalance of intestinal microecology can cause changes of metabolites in heart failure patients, which is one of the key triggers for the development of heart failure, therefore, using the intestinal microbial homeostasis as a new entry point for the treatment of heart failure will be a hotspot in medical research. However, the theory of Chinese medicine, “the spleen is the guardian”, covers the physiological functions of the spleen, such as the spleen's main function of transporting, spleen's main function of ascending and clearing, and its main function of hiding camping, etc., and the functions of intestinal flora and the “spleen is the guardian” are similar to a certain extent. Therefore, this paper starts from a holistic viewpoint and takes the theory of “spleen as the guardian” in Chinese medicine as an entry point to elaborate on the pathogenesis of intestinal microecological imbalance and heart failure, so as to provide a reference for Chinese medicine treatment or drug research.