Pathogenesis and treatment of coronary heart disease with anxiety and depression in older adults

Coronary heart disease with anxiety and depression is a prevalent psycho-cardiological disease among the contemporary older adults with cardiovascular disease. Existing treatment method face challenges in simultaneously improving the clinical psycho-cardiological symptoms and delaying or reversing the course of coronary heart disease, resulting in a serious impact on the quality of life and prognosis of patients. Based on the overall concept of traditional Chinese medicine and classic theories such as the Huangdi Neijing, combined with team research and clinical experience, this paper systematically examines the physiological relationships among the kidney, heart, and vessels. The perspective of "kidney-heart-vessels-spirit" elucidates their synergistic interactions across multiple dimensions, including anatomical structure and the metabolism of body fluids, qi, and blood, and further explains their interactive roles in the regulation of mental functions. The pathogenesis of coronary heart disease with anxiety and depression in the older adults originates from kidney essence consumption, heart qi deficiency and stagnation, and loss of mental vitality. The intermediate stage involves the lack of essence and blood, stiff and astringent heart vessels, and loss of mind are intermediately linked. This leads to progression characterized by endogenous deficiency heat, burning pulse heart, and disorientation of the spirit. Ultimately, deterioration is caused by phlegm retention and blood stasis causing vascular obstruction and obscuration of the mind. According to the above pathogenesis, a specific staging treatment plan is proposed: for the early depression-dominant stage, Huanshao Elixir, combined with Fenxinqi Beverage and Liyu Shengxian Decoction, should be used to nourish the kidney and replenish qi, thereby facilitating yang circulation and alleviating constraint to regulate the spirit; for the early anxiety-dominant stage, Shouwu Yanshou Elixir, combined with Fuling Buxin Decoction and Danshen Beverage, is used to nourish essence and generate blood, thereby harmonizing ying and unblocking meridians to nourish the spirit. During the progressive stage, Anshen Pill, combined with Lianru Jiangfu Decoction, is used to reduce floating yang and downbear fire, tranquilize the heart, and clear the vessels to calm the spirit. In the aggravated stage, Modified Daotan Decoction, combined with Lianzi Qingxin Beverage, Dahuang Zhechong Elixir or Didang Decoction, is used to eliminate phlegm and remove blood stasis, thereby clearing the channels and regulating opening and closing to awaken the spirit. Based on the perspective of "kidney-heart-vessels-spirit", this approach aims to provide a new reference for the prevention and treatment of coronary heart disease complicated by anxiety and depression in the older adults.