【目的】通过构建隐结构模型与应用关联规则算法，对治疗肺心病中的高频中药进行系统分析，以揭示其用药规律， 为临床方案优化、疗效提升及相关指南的制定提供循证支持。【方法】检索中国知网、维普数据库、万方数据知识服务平台、 中国生物医学文献数据库中有关中药治疗肺心病的临床研究文献，检索时间为各库建库至2025 年3月。运用NoteExpress 软 件筛选文献，将符合要求的数据导入Microsoft Excel 2019，对药物的出现频次及药物的功效、性味归经分布进行统计分析。 采用Lantern 5.0 和R-Studio 软件对高频中药进行隐结构模型的构建和关联规则分析，探讨用药规律并推测中医证型。【结果】 最终纳入508 则医案，涉及300 味中药。出现频次≥ 40 次的高频中药共41味，频次居前的药物有茯苓、半夏、白术、黄芪、 葶苈子、甘草、桂枝、杏仁、附子、五味子、紫苏子等。高频中药的功效共归为12 类，其中具有利水消肿、利水渗湿、燥 湿化痰、活血祛瘀功效的中药使用较多。高频中药的四气中温性药居多，五味以甘、辛、苦为主，归经主要涉及肺、脾、 心经。隐结构分析获得26 个隐变量、6 个综合聚类模型及12 个核心方剂，以方测证推断肺心病常见证型有6 个，分别为心肺 气虚证、寒凝心肺证、痰浊闭阻证、瘀血阻络证、气滞心胸证、阳虚水泛证，所对应的方剂分别为生脉散、保元汤，小青 龙汤、枳实薤白桂枝汤，瓜蒌薤白半夏汤、涤痰汤，血府逐瘀汤、丹参饮，柴胡疏肝散、温胆汤，真武汤、葶苈大枣泻肺 汤。关联规则分析获得28 条强关联规则，支持度最高的药物组合为“白术-茯苓”，置信度最高的药物组合为“桂枝-泽 泻-茯苓”。【结论】肺心病属本虚标实之证，本虚以气虚、阳虚为主，标实则多与痰浊、水饮、血瘀等病理因素相关，其痰 瘀阻肺、心肾阳虚的核心病机与肺、心、脾三脏功能失调密切相关。肺心病的常见证候为心肺气虚证、寒凝心肺证、痰浊 闭阻证、瘀血阻络证、气滞心胸证、阳虚水泛证。治疗以温阳利水、健脾化痰为主，随证配合宣肺化痰、活血化瘀等治法。 挖掘得到的临床高频用药及基础方剂，可为肺心病的中医临床治疗和指南制定提供循证依据。

Objective To systematically analyze high-frequency Chinese medicinals used in the treatment of pulmonary heart disease by constructing a latent structure model and applying association rule algorithms，thereby revealing medication rules and providing evidence-based support for the optimization of clinical protocols， enhancement of therapeutic efficacy，and formulation of relevant guidelines. Methods Clinical research on the treatment of pulmonary heart disease with Chinese medicine was retrieved from the China National Knowledge Infrastructure，VIP Database，Wanfang Data Knowledge Service Platform，and China Biomedical Database， covering the period from the inception of each database to March 2025. NoteExpress software was employed for literature screening，and then eligible data were imported into Microsoft Excel 2019 for statistical analysis of medication frequency，efficacy classification，and distribution of nature，flavor，and meridian tropism of the herbs. Lantern 5.0 and R-Studio software were used to construct a latent structure model and perform association rule analysis on high-frequency Chinese medicinals，aiming to explore medication rules and infer traditional Chinese medicine syndrome types. Results A total of 508 medical records involving 300 Chinese medicinals were ultimately included. Forty-one high-frequency Chinese medicinals with a frequency ≥ 40 were identified，among which the most frequently-used herbs were Poria，Pinelliae Rhizoma，Atractylodis Macrocephalae Rhizoma， Astragali Radix，Descurainiae seu Lepidii Semen，Glycyrrhizae Radix et Rhizoma，Cinnamomi Ramulus， Armeniacae Semen Amarum，Aconiti Lateralis Radix Praeparatam，Schisandrae Chinensis Fructus，Perillae Fructus，etc. The high-frequency medicinals were classified into 12 categories according to the efficacy，and the commonly-used types were herbs for promoting diuresis and alleviating edema，herbs for inducing diuresis and draining dampness，herbs for drying dampness and resolving phlegm，and herbs for activating blood and removing stasis. In terms of the properties of the herbs，warm nature was predominated，and the flavors were primarily sweet，pungent，and bitter. The high-frequency medicinals usually have the meridian tropism of the lung， spleen，and heart meridians. Latent structure analysis yielded 26 latent variables，6 comprehensive clustering models，and 12 core formulas. Based on formula-syndrome inference，six common syndrome types of pulmonary heart disease were identified，and they were heart-lung qi deficiency syndrome，cold congealing heart-lung syndrome，phlegm-turbidity obstruction syndrome，blood stasis blocking collaterals syndrome，qi stagnation in chest syndrome，and yang deficiency with fluid retention syndrome，which were correspondingly treated with Shengmai San and Baoyuan Decoction，Xiaoqinglong Decoction and Zhishi Xiebai Guizhi Decoction，Gualou Xiebai Banxia Decoction and Ditan Decoction，Xuefu Zhuyu Decoction and Danshen Decoction，Chaihu Shugan San and Wendan Decoction，Zhenwu Decoction and Tingli Dazao Xiefei Decoction. Association rule analysis identified 28 strong association rules，with the medicinal combination of Atractylodis Macrocephalae Rhizoma and Poria having the highest support，and observed for the herbal group of Cinnamomi Ramulus，Alismatis Rhizoma and Poria having the highest confidence. Conclusion Pulmonary heart disease is characterized by deficiency in the root and excess in the branch，with root deficiency primarily manifesting as qi deficiency and yang deficiency，and branch excess predominantly associated with the pathological factors of phlegm turbidity，retained fluid，and blood stasis. Its core pathogenesis of phlegm-stasis obstructing the lung and heart-kidney yang deficiency is closely related to the dysfunction of the lung，heart，and spleen. The common syndrome types of pulmonary heart disease are heart-lung qi deficiency syndrome，cold congealing heart-lung syndrome，phlegm-turbidity obstruction syndrome，blood stasis blocking collaterals syndrome，qi stagnation in the chest syndrome，and yang deficiency with fluid retention syndrome. Treatment primarily focuses on warming yang and promoting diuresis，strengthening the spleen and resolving phlegm，supplemented by the methods of ventilating the lung and resolving phlegm，and activating blood and resolving stasis according to syndrome differentiation. The identified high-frequency medicinals and core formulas provide evidence-based references for the clinical management of pulmonary heart disease with Chinese medicine and for the formulation of relevant guidelines.

R259.415

国家自然科学基金面上项目（编号：82374239）；中医药广东省实验室项目（编号：HOL2024PZ028）；中医证候全国重点实验 室项目（编号：2020B 1111100004）