Exploring diagnostic and therapeutic approaches for coronary heart diseases complicated by anxiety and depression based on the "atmospheric depression" theory

Coronary heart diseases complicated by anxiety and depression are clinically prevalent dual-disease condition. As independent risk factors for coronary heart diseases, anxiety and depression exert severe negative impacts on patients′ quality of life and long-term prognosis. Recurrent coronary heart diseases episodes further exacerbate patients′ anxiety and depressive symptoms. Therefore, actively identifying and scientifically intervening in anxiety and depression holds significant value for reducing adverse events in coronary heart diseases. In traditional Chinese medicine theory, coronary heart disease and anxiety-depression fall under the categories of "chest obstruction" and "depression-related disorders" respectively. Their coexistence can lead to concurrent disorders of the "physical heart" and the "spiritual heart". Clinical treatment for such conditions often follows the principle of treating both mind and body. Guided by theory of "collapsed vital energy", this paper systematically explores the pathogenesis and diagnostic-therapeutic approach for coronary heart diseases complicated by anxiety and depression, integrating TCM theory with clinical practice. Our research team proposes that the initial stage centers on deficiency of vital energy in the chest, where weakened vital energy fails to support the heart meridian, leading to inadequate nourishment—characterized by insufficient vital energy and impaired heart meridian support. As the disease progresses, it involves the heart and lungs, impairing their regulatory functions and disrupting the ascending and descending movements of qi. This leads to the internal generation of phlegm and stasis, which obstruct the heart vessels and cause mental restlessness. The pathogenesis at this stage is stagnation of qi and blood, with phlegm and stasis obstruction. Prolonged disease ultimately results in depletion of qi and instability of the soul. Clinical treatment must closely follow the progression of pathogenesis, adhering to the overarching principle of fortifying healthy qi and expelling pathogenic factors. Medication should be administered in stages: In the initial stage, the therapeutic principle is to lift and tonify the vital qi to support the heart meridian using Shengxian Decoction with appropriate modifications.During progression, the approach involves nourishing qi to enrich the vessels, clearing phlegm, and unblocking obstructions using modified Yiqi Huayu Decoction combined with Erchen Decoction. In the terminal stage, when the condition is critical, increasing yang, lifting sinking qi, and stabilizing the spirit are prioritized using modified Guizhi Gancao Longgu Muli Decoction combined with Suanzao Ren Decoction.