Objective  Based on real-world clinical data, data mining techniques were employed to analyze the medication rules of traditional Chinese medicine (TCM) in the treatment of severe bacterial pneumonia, to provide references for clinical syndrome differentiation and treatment.

Methods  Medical records and TCM prescriptions of patients with severe bacterial pneumonia admitted to the intensive care unit (ICU) of Wangjing Hospital, China Academy of Chinese Medical Sciences, from January 2022 to April 2024 were extracted from the hospital information system (HIS). The Ancient and Modern Medical Records Cloud Platform (V2.3.5), SPSS Modeler 18.0, and Origin 2021 softwares were used to analyze the medication frequency, medicinal properties, flavors, meridian tropisms, efficacy, as well as association rules, complex networks, and clustering of the prescription.

Results  A total of 191 prescriptions were included, involving 245 TCMs, with a total medication frequency of 1,950 times. The high-frequency herbs with a medication frequency ≥70 were Radix Ophiopogonis, Poria cocos, Schisandrae Chinensis Fructus, Dioscoreae Rhizoma. The medicinal properties were primarily warm, neutral, and cold, while the flavors were mainly sweet, pungent, and bitter. The TCMs predominantly acted on the lung, spleen, and stomach meridians, with their efficacy focusing on tonifying deficiency, resolving phlegm, relieving cough and asthma, and clearing the heat. Association rule analysis (support  ≥30%, confidence ≥80%) yielded 8 core herb pairs. The top 3 combinations with the highest confidence were Schisandrae Chinensis Fructus-Dioscoreae Rhizoma-Radix Ophiopogonis, Radix Ophiopogonis-Schisandrae Chinensis Fructus, and Benincasae Semen-Coicis Semen. Complex network analysis identified a drug network composed of 31 kinds of TCMs, including Poria cocos, Radix Ophiopogonis, Schisandrae Chinensis Fructus, Dioscoreae Rhizoma, Citri Reticulatae Pericarpium, and Coicis Semen. Hierarchical cluster analysis categorized the top 20 core drugs by frequency into three effective formula groups: formula 1 (Mori Cortex, Coicis Semen, Benincasae Semen, Phragmitis Rhizoma, Dioscoreae Rhizoma, Radix Ophiopogonis, Schisandrae Chinensis Fructus, Ginseng Radix et Rhizoma, Platycodonis Radix, Cinnamomi Ramulus), formula 2 (Pinelliae Rhizoma,  Citri Reticulatae Pericarpium, Atractylodis Macrocephalae Rhizoma, Poria, Zingiberis Rhizoma Recens, Aconiti Lateralis Radix Praeparata, Astragali Radix, Codonopsis Radix), and formula 3 (Ephedrae Herba, Armeniacae Semen Amarum).

Conclusion  The treatment of severe pneumonia in the ICU of Wangjing Hospital, China Academy of Chinese Medical Sciences, embodies the therapeutic principle of "strengthening vital qi to eliminate pathogens, and combining attack with reinforcement", with the core pathogenesis focusing on "deficiency in origin and excess in manifestation", primarily involving the lung and spleen. The clinical approach mainly focuses on supplementing qi and nourishing yin, reinforcing deficiency and strengthening vital qi, accompanied by eliminating pathogens through clearing heat and resolving phlegm, as well as dispersing lung qi and relieving asthma, forming a medication system centered around tonics, phlegm-transforming, cough-relieving, and panting-alleviating medicines, and interior heat-clearing medicines, characterized by balanced medicinal properties and meridian tropisms targeting the lung and spleen. The core herb combinations and derived formulas obtained from data mining offer an objective basis and provide insights for clinical syndrome differentiation-based medication and new drug development.

1. Ke J, Mao J, Lin C. Effect of imipenem clinical efficacy and inflammatory markers of severe pneumonia[J]. Indian J Pharm Sci, 2022, 84(2): 92-97. DOI: 10.36468/pharmaceutical-sciences.spl.458.

2. Reynolds R, Potz N, Colman M, et al. Antimicrobial susceptibility of the pathogens of bacteraemia in the UK and Ireland 2001-2002: the BSAC Bacteraemia Resistance Surveillance Programme[J]. J Antimicrob Chemother, 2004, 53(6): 1018-1032. DOI: 10.1093/jac/dkh232.

3. Ishiguro T, Takayanagi N, Yamaguchi S, et al. Etiology and factors contributing to the severity and mortality of community-acquired pneumonia[J]. Intern Med, 2013, 52(3): 317-324. DOI: 10.2169/internalmedicine.52.8830.

4. 苏卫华. 纤维支气管镜灌洗联合抗菌药物对重症肺炎患者的疗效观察[J]. 中国药物与临床, 2020, 20(7): 1124-1126. [Su WH. Efficacy of fiberoptic bronchoscopic lavage combined with antimicrobial agents in patients with severe pneumonia: a clinical observation study[J]. Chinese Journal of Drug and Clinical Therapeutics, 2020, 20(7): 1124-1126.] DOI: 10.11655/zgywylc2020.07.033.

5. Mizgerd JP. Pathogenesis of severe pneumonia: advances and knowledge gaps[J]. Curr Opin Pulm Med, 2017, 23(3): 193-197. DOI: 10.1097/MCP.0000000000000365.

6. 谢辉, 冯俊, 黄秋杰, 等. 乌司他丁联合参麦注射液治疗对重症肺炎患者心肌损伤保护及肺功能的影响[J]. 实用医学杂志, 2022, 38(10): 1260-1264. [Xie H, Feng J, Huang QJ, et al. Effects of ulinastatin combined with Shenmai injection on myocardial injury protection and lung function in patients with severe pneumonia[J]. Journal of Practical Medicine, 2022, 38(10): 1260-1264.] DOI: 10.3969/j.issn.1006-5725.2022.10.017.

7. 郭健, 朱亮, 吴祎, 等. 清肺降浊方治疗重症肺炎痰热壅肺证患者的临床研究[J]. 北京中医药, 2021, 40(4): 355-359. [Guo J, Zhu L, Wu Y, et al. Clinical study on Qingfei Jiangzhuo Prescription in treating severe pneumonia of obstruction of phlegm heat in the lung[J]. Beijing Journal of Traditional Chinese Medicine, 2021, 40(4): 355-359.] DOI: 10.16025/j.1674-1307.2021.04.006.

8. 任星, 杨静, 张菀桐, 等. 基于网络药理学探讨新冠肺炎初期用药清肺排毒汤的作用机制[J]. 世界中医药, 2021, 16(19): 2845-2850. [Ren X, Yang J, Zhang WT, et al. Exploring the mechanism of Qingfei Paidu decoction as an initial treatment for COVID-19 using network pharmacology[J]. World Journal of Traditional Chinese Medicine, 2021, 16(19): 2845-2850.] DOI: 10.3969/j.issn.1673-7202.2021.19.007.

9. Iwuchukwu C, O'Keefe GE, Day AG, et al. Application of the modified nutrition risk in critically ill score to nutritional risk stratification of trauma victims: a multicenter observational study[J]. J Trauma Acute Care Surg, 2020, 89(6): 1143-1148. DOI: 10.1097/TA.0000000000002937.

10. Salih W, Schembri S, Chalmers JD. Simplification of the IDSA/ATS criteria for severe CAP using Meta-analysis and observational data[J]. Eur Respir J, 2014, 43(3): 842-851. DOI: 10.1183/09031936.00089513.

11. 中国医师协会急诊医师分会. 中国急诊重症肺炎临床实践专家共识[J]. 中国急救医学, 2016, 36(2): 97-107. DOI: 10.3969/j.issn.1002-1949.2016.02.001.

12. 中华人民共和国药典.一部[S]. 2020: 3-402.

13. 王如意, 蒋兴月, 王月, 等. 基于古今医案云平台探究中医药治疗多囊卵巢综合征的用药规律[J/OL]. 时珍国医国药, 1-8. [2026-03-01]. https://link.cnki.net/urlid/42.1436.R.20260122.1723.002.

14. 陈力铭, 李言, 刘国政, 等. 基于数据挖掘探讨辽宁中医治疗胃溃疡用药特点[J/OL]. 辽宁中医药大学学报, 1-14. [2026-03-01]. https://link.cnki.net/urlid/21.1543.R.20250909.1731.004.

15. 陈蔚文, 主编. 中药学, 第2版[M]. 北京: 人民卫生出版社, 2012: 1-430.

16. 张浩彬, 周伟珠, 编著. IBM SPSS Modeler 18.0数据挖掘权威指南 [M].北京: 人民邮电出版社, 2019: 467.

17. 阙淬林, 高颖, 许茹凡, 等. 基于数据挖掘探讨中药复方治疗急性缺血性中风痰热证的用药特点与配伍规律[J]. 中国中医基础医学杂志, 2026, 32(2): 249-254. [Que CL, Gao Y, Xu RF, et al. Exploration on medication and compatibility rules of Chinese herbal formulas in the treatment of acute ischemic stroke with phlegm-heat syndrome based on data mining[J]. Chinese Journal of Basic Medicine in Traditional Chinese Medicine, 2026, 32(2): 249-254.] DOI: 10.3969/j.issn.1006-3250.2026.02.005.

18. 罗成, 叶远航, 盛国光, 等. 中医药治疗重症肺炎的研究进展[J]. 中国中医急症, 2023, 32(5): 929-932. [Luo C, Ye YH, Sheng GG, et al. Advances in research on traditional Chinese medicine (TCM) in treating severe pneumonia[J]. Chinese Journal of Emergency Traditional Chinese Medicine, 2023, 32(5): 929-932.] DOI: 10.3969/j.issn.1004-745X.2023.05.045.

19. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J]. Clin Infect Dis, 2016, 63(5): e61-e111. DOI: 10.1093/cid/ciw353.

20. 中国医师协会急诊医师分会, 中国急诊专科医联体, 北京急诊医学学会. 急诊成人社区获得性肺炎临床实践指南（2024 年版）[J]. 中华急诊医学杂志, 2025, 34(3): 300-317. DOI: 10.3760/cma.j.issn.1671-0282.2025.03.006.

21. Martin-Loeches I, Torres A, Nagavci B, et al. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia[J]. Intensive Care Med, 2023, 49(6): 615-632. DOI: 10.1007/s00134-023-07033-8.

22. 冯铭. 早期限制性液体复苏治疗重症肺炎合并感染性休克的效果观察[J]. 感染、炎症、修复, 2025, 26(1): 30-33. [Feng M. Effect of early restrictive fluid resuscitation on severe pneumonia complicated with septic shock[J]. Infection Inflammation Repair, 2025, 26(1): 30-33.] DOI: 10.3969/j.issn.1672-8521. 2025.01.006.

23. Olson G, Davis AM. Diagnosis and treatment of adults with community-acquired pneumonia[J]. JAMA, 2020, 323(9):885-886. DOI: 10.1001/jama.2019.21118.

24. 尤文, 周丽雅. 中医药治疗重症肺炎研究进展[J]. 陕西中医, 2021, 42(4): 543-545. [You W, Zhou YL. Treatment progress of Chinese medicine in severe pneumonia[J]. Shaanxi Journal of Traditional Chinese Medicine, 2021, 42(4): 543-545.] DOI: 10.3969/j.issn.1000-7369.2021.04.037.

25. 姚春鹏, 译注. 黄帝内经[M]. 北京: 中华书局, 2022: 282.

26. （清）姚澜, 撰. 范磊, 校注. 本草分经[M]. 北京: 中国中医药出版社, 2015: 64.

27. 张锡纯, 著. 王云凯, 杨医亚, 李彬之, 校点. 医学衷中参西录[M]. 石家庄: 河北科学技术出版社, 2001: 302.

28. 薛伟航, 徐婷莉, 王华雨, 等. 麦冬化学成分和药理作用研究进展及其质量标志物(Q-Marker)的预测分析[J/OL]. 中华中医药学刊, 1-18. [2025-11-11]. https://link.cnki.net/urlid/21.1546.r.20250522.1417.042.

29. （清）邹澍, 撰. 郭瑞华, 谢敬, 王全利, 等校注. 本经疏证 [M]. 北京: 中国中医药出版社, 2009: 59.

30. 胡希恕, 著. 胡希恕金匮要略讲座中日录音增补版, 第2版 [M]. 北京: 中国中医药出版社, 2023: 204.

31. 佚名, 著. 神农本草经[M]. 北京: 科学技术文献出版社, 1996: 29.

32. 王乙波, 焦斌, 王小强, 等. 五味子乙素对克雷伯菌引起的重症肺炎大鼠肺组织Nrf2/Keap-1/PGC-1α信号通路的影响 [J]. 中国热带医学, 2023, 23(12): 1313-1317. [Wang YB, Jiao B, Wang XQ, et al. Effects of schisandrin B on Nrf2/Keap-1/PGC-1α signaling pathway in lung tissue of rats with severe pneumonia induced by Klebsiella pneumoniae[J]. China Tropical Medicine, 2023, 23(12): 1313-1317.] DOI: 10.13604/j.cnki.46-1064/r.2023.12.13.

33. （明）孙文胤, 著. 丹台玉案[M]. 北京: 中国中医药出版社, 2016: 184.

34. 王朝霞, 范铁兵. 中医药治疗重症肺炎的研究进展[J]. 中国中医急症, 2020, 29(5): 930-932. [Wang ZX, Fan TB. Research progress on traditional Chinese medicine treatment of severe pneumonia[J]. Journal of Emergency in Traditional Chinese Medicine, 2020, 29(5): 930-932.] DOI: 10.3969/j.issn.1004-745X.2020.05.053.

35. 尹笑玉, 陈明. 试论“提壶揭盖”法及其扩展应用[J]. 辽宁中医杂志, 2023, 50(9): 60-64. [Yin XY, Chen M. Discussion on "lifting pot and uncovering lid" method and its clinical application[J]. Liaoning Journal of Traditional Chinese Medicine, 2023, 50(9): 60-64.] DOI: 10.13192/j.issn.1000-1719.2023.09.016.

36. 李宁, 姚富科, 叶东珂, 等. 苇茎汤在肺系疾病中的应用进展 [J]. 世界中医药, 2024, 19(3): 426-431, 436. [Li N, Yao FK, Ye DK, et al. Progress in the application of Weijing decoction in pulmonary diseases[J]. World Chinese Medicine, 2024, 19(3): 426-431, 436.] DOI: 10.3969/j.issn.1673-7202.2024.03.022.

37. （明）吴崑, 著. 医方考[M]. 北京: 中国中医药出版社, 2007: 107.

38. （明）李时珍, 著. 本草纲目金陵本, 第6册[M]. 北京: 中国医药科技出版社, 2017: 1209.

39. 黄哲, 刘鹤源, 蒋广祥, 等. 《太平惠民和剂局方》治疗咳嗽用药规律研究[J]. 中国中医药图书情报杂志, 2024, 48(1): 109-112. [Huang Z, Liu H, Jiang GX, et al. Study on medication rules for treating cough in the Taiping Huimin Heji Jufang[J]. Chinese Journal of Library and Information Science for Traditional Chinese Medicine, 2024, 48(1): 109-112.] DOI: 10.3969/j.issn.2095-5707.202301028.

40. 贺斌. 中药半夏炮制的历史沿革及现代药理研究[J]. 基层医学论坛, 2014(13): 1629-1629. [He B. Historical evolution of Pinellia processing in traditional Chinese medicine and modern pharmacological research[J]. Primary Medical Forum, 2014(13): 1629-1629.] DOI: CNKI:SUN:YXLT.0.2014-13-001.

41. 谢满. 半夏不同炮制品的特点及审方实践[J]. 当代医药论丛, 2023, 21(4): 1-4. [Xie M. Characteristics of different gun products of Pinellia pinellia and prescription testing practice[J]. Contemporary Medical Forum, 2023, 21(4): 1-4.] DOI: 10.3969/j.issn.2095-7629.2023.04.001.

42. 宋海燕, 汤金红, 马炳莉. 二陈汤加减治疗慢性阻塞性肺疾病痰湿蕴肺证的临床效果[J]. 临床研究, 2024, 32(7): 106-109. [Song HY, Tang JH, Ma BL. Clinical effect of modified erchentang in the treatment of chronic obstructive pulmonary disease with phlegm-dampness lung syndrome[J]. Clinical Research, 2024, 32(7): 106-109.] DOI: 10.12385/j.issn.2096-1278(2024)07-0106-04.

43. 邓中甲, 主编. 方剂学[M]. 上海: 上海科学技术出版社, 2008: 34.