Abstract： Objective： To analyze the correlation between traditional Chinese medicine （TCM） syndrome types and chest imaging features in nontuberculous mycobacterial pulmonary disease， and to provide an objective imaging basis for TCM syndrome differentiation. Methods： A retrospective study was conducted on 210 patients with nontuberculous mycobacterial pulmonary disease admitted to the Department of Tuberculosis， Lishui TCM Hospital Affiliated to Zhejiang Chinese Medical University，from January 2018 to December 2023. Syndrome differentiation was performed based on the comprehensive analysis of four examinations， and the correlation between lesions distribution and morphological characteristics assessed by high-resolution CT and TCM syndromes was analyzed. Results： The distribution of TCM syndrome types was as follows：lung yin deficiency type （41 cases，19.5%），yin deficiency with fire hyperactivity type （67 cases，31.9%），and qi-yin deficiency type （102 cases，48.6%）. Imaging analysis showed widespread lesion distribution，most commonly in both upper lobes. Lesions in the right lower lobe were predominantly of the qi-yin deficiency type （50.98%）， and the qi-yin deficiency type was also more likely to involve ≥ 3 lung lobes（ 83.33%）. Regarding lesion morphology，the qi-yin deficiency type showed a higher prevalence of bronchiectasis， calcification， and pleural thickening， while cavities were more commonly associated with yin deficiency with fire hyperactivity type， with statistically significant differences （P＜0.05）. Conclusion： TCM syndrome types in nontuberculous mycobacterial pulmonary disease show significant correlations with imaging features. Lesions are most commonly distributed in both upper lobes，with the right lower lobe predominantly associated with the qi-yin deficiency type， which also more frequently involves ≥ 3 lung lobes and often presents with bronchiectasis， calcification， and pleural thickening. Cavity formation can serve as an imaging identification marker for yin deficiency with fire hyperactivity type.