Re: “Identifying Underlying Emotional Instability and Utilizing a Combined Intervention in the Treatment of Childhood Constipation and Encopresis—A Case Report” by Jamie L. Davis (J Altern Complement Med 2016;22:489–492)

Dear editor:

We are greatly interested in the article written by J.L. Davis, Identifying Underlying Emotional Instability and Utilizing a Combined Intervention in the Treatment of Childhood Constipation and Encopresis—A Case Report. The article shows a new view and method of therapy for childhood constipation and encopresis in clinical practice. However, we are still confused about this case.

The author applied a Traditional Chinese Medicine (TCM) syndrome differentiation method as well as acupuncture, medicinal herbs, and tuina to treat childhood habitual constipation. In the light of syndrome differentiation, it was discovered that the children had spleen qi and yang insufficiency, and Guipi Decoction was selected. ¹ First, we are skeptical about the application of Guipi Decoction in clinical practice. It is applicable for both heart and spleen qi-blood insufficiency, whose main indications are fatigue, insomnia, inappetence, palpitations, and dizziness. ² Second, it is warming yang to push the feces that is the main principle in treating constipation of spleen-kidney-yang insufficiency caused by the long-term use of laxatives, ³ so Wenpi Decoction, Jichuan Decoction and Fuzilizhong Decoction are applied in clinical practice. Moreover, the application of Guipi Decoction for constipation in yang insufficiency might inadvertently exacerbate constipation, which would lead to an excessive accumulation of qi and blood. Since the author combined eight therapies and we seldom apply Guipi Decoction to treat constipation of yang insufficiency in clinic, we wonder whether the same effect would be achieved with monotherapy.

Due to the essence of this article elucidated TCM syndrome differentiation, we have come to think that many TCM professors would be interested in this article. Therefore, it is suggested that the author should give an explanation of the reasons for Guipi Decoction's application in constipation of yang insufficiency, which would help readers to reach a better understanding.