Dear editor:
This patient's case: The patient featured in “Identifying Underlying Emotional Instability and Utilizing a Combined Intervention in the Treatment of Childhood Constipation and Encopresis—A Case Report” was a complicated case and required various approaches to get to the root.
1
Upon physical examination of the patient, her build was quite willowy and thin. She had weak muscle tone in her legs, especially the right. In addition, the Acugraph reading showed an imbalance in the Heart and Spleen meridians, and because she had a weak pulse and an emotional instability reported by her mother, it appeared to be a Qi and Blood Xu. However, you are correct that Gui Pi Tang was not the appropriate formula or initial assessment, as the constipation did get worse and I immediately recognized the Yang Xu.
2
I shifted over to “Dry Nites” Bu Zhong Yi Qi Tang Jia Wei to address the digestive organs, and “Peaceful Focus” Yi Gan San Jia Wei to address the stagnation and emotional components. These formulas combined with the e-stim on the acupuncture points, tuina along the erectors to release tension in the spine affecting the organs at the innervation sites, and moxa are really what seem to be the effective combination. So, yes, I would agree that gui pi tang would most likely not be needed—but this of course depends on the individual child.
In the end, my conclusion is that encopresis is both a pattern of constipation leading to fecal incontinence, as well as emotional repression and frustration. Therefore, the digestive organs of Spleen, Stomach, and Large Intestine, must be addressed while simultaneously taking into account the smooth flow of Liver Qi (frustration) and the root of childhood fear creating the repression—the Kidney.
