Meta-Analysis And Network Pharmacology Study On The Clinical Efficacy Of The Method Of Resolving Phlegm And Activating Blood In The Treatment Of Chronic Pulmonary Heart Disease

Objective: To evaluate the clinical efficacy of the resolving phlegm and activating blood in treating chronic pulmonary heart disease（CPHD）using meta-analysis system and to explore its core Chinese herbal medicine combination.Network pharmacology techniques were used to investigate the potential targets and mechanisms of the drug combination in treating CPHD,providing reference for clinical application and experimental research.Methods: Clinical randomized controlled trials on the resolving phlegm and activating blood in treating CPHD published before October 2022 were retrieved from 7 major databases at home and abroad.The final inclusion literature was determined by inclusion and exclusion criteria.Rev Man 5.4,Stata17.0,and IBM SPSS Modeler 17.1 software were used to complete meta-analysis and association rule analysis,and to obtain core Chinese herbal medicine combinations with high support and confidence levels and uplift >1.The HERB database was used to obtain the compounds in the core herbal combinations,and the compounds were screened by the five rules of Lipinski and pharmacokinetic parameters.The swiss Target Prediction database was used to predict drug targets.Gene Cards database was used to screen for CPHD expression genes.The protein-protein interactions relationship was constructed using the String database.DAVID and Omicshare platforms were used for GO and KEGG enrichment analysis of core targets.Molecular docking was performed using the Dock Thor platform to observe the binding affinity between core compounds and core targets.Results: A total of 18 randomized controlled trials were included in this study,with a total of 1648 cases,including 828 cases in the experimental group and 820 cases in the control group.The results showed that the resolving phlegm and activating blood combined with Western medicine was superior to Western medicine alone in terms of overall clinical efficacy,blood gas analysis,lung ventilation function,and plasma viscosity level.By analyzing the drug association rules of herbs with a frequency of ≥5 times in the included literature,it was found that "Membranous Milkvetch-Rhizoma chuanxiong-Lepidium seed" was the core herbal combination for the treatment of CPHD by the method of resolving phlegm and activating blood.A total of 147 Chinese herbal compounds and 900 drug targets were screened using network pharmacology techniques.The number of CPHD targets obtained from the Gene Cards database was 4404.Finally,588 treatment targets and 27 core targets were obtained.GO enrichment analysis showed that the core treatment targets played multiple roles in biological processes,molecular functions,and cellular components.KEGG pathway enrichment analysis showed that the core herbal combinations were mainly enriched in immune-related signaling pathways,endocrine-related signaling pathways,and cell cycle signaling pathways.Molecular docking showed that the core compounds and targets had good binding ability.Conclusion: The resolving phlegm and activating blood combined with Western medicine was superior to Western medicine alone in improvi ng the overall clinical efficacy of CPHD patients,reducing PaCO₂ and plasma viscosity levels,raising PaO₂ levels,and improving lung function indicators such as FEV1 and MVV levels.The core Chinese herbal medicine combination of the Phlegm-resolving and blood-activating therapy in treating CPHD exerted its therapeutic effect by inducing genes such as CHRM1,stimulating airway epithelial cells,improving inflammatory reactions,and inhibiting the production of intracellular reactive oxygen species.The core Chinese herbal medicine combination played a role in treating CPHD by intervening in chemokine signaling pathways,JAK-STAT signaling pathways to repair alveolar wall epithelial cells and promote interstitial cell regeneration,and exerting anti-inflammatory and antioxidant effects.