The journal-thrust coupled bearing (abbreviated as JTC bearing) works at the end of the crankshaft in diesel engine, with the function of carrying radial load and prevent axial movement of the crankshaft. The journal part and the thrust part of this special bearing both form the oil film lubrication when subjected to the time-varying loads in axial and radial directions during the working condition. In this work, the JTC bearing in marine diesel engines was analyzed using a transient thermal elastohydrodynamic (TEHD) lubrication model. The thermal and pressure (thermal-pressure) coupled effects were taken into consideration based on the flow, pressure, and thermal continuity conditions between the journal and thrust parts. Moreover, the transient time-varying load was considered in the lubrication analysis to explore the coupled effect under the actual operating conditions. A test rig was built to validate the established transient TEHD lubrication model for the JTC bearing. The thermal-pressure coupled effect between the journal and thrust parts was found to significantly affect the transient lubrication behaviors of the JTC bearing, which cannot be ignored. Also, different boundary conditions were investigated for the influence of the coupled effect on transient lubrication characteristics, including axial clearances, radial clearances, waveforms of radial load, incline angles and inlet oil temperatures. This chapter could theoretically support the lubrication design of the JTC bearings used in the diesel engine crankshafts.