Introduction
Irregular menstruation refers to abnormal changes of the menstrual cycle, volume and color of menorrhea, often accompanied by other symptoms. It is usually caused by endocrine disorder. Menstrual cycle 7 days earlier than usual or even occurrence of menorrhea twice in a month is called early menstruation; menstrual cycle 7 days later than usual or even occurrence of menorrhea once in 40 - 50 days is called delayed menstruation; menstruation either early or delayed without a cycle is called irregular menstruation or disordered menstruation. TCM believes that irregular menstruation is caused by exogenous cold and heat or internal impairment due to emotional disorder, excessive sexual activity and frequent labor that lead to disorder of qi and blood as well as impairment of the thoroughfare and conception vessels.

Syndrome differentiation
1. Early Menstruation
The menstruation occurs earlier than usual and even twice in a month. The sthenia-heat syndrome is marked by the symptoms of profuse menorrhea with fresh red color and sticky texture, dysphoria with smothery sensation, dry mouth and thirst, preference for cold drinks, reddish tongue with yellowish fur and rapid pulse; the asthenia-heat syndrome is marked by scanty red and sticky menorrhea, tidal fever and night sweating, feverish sensation over palms and soles, reddish tongue with scanty fur, thin and rapid pulse; qi-asthenia syndrome is marked by profuse light-colored and thin menorrhea, spiritual lassitude, palpitation and shortness of breath, light-colored tongue with thin fur and weak pulse.

2. Delayed Menstruation
The menstruation is scanty and occurs even once in 40 - 50 days. Blood-asthenia syndrome is marked by light-colored menorrhea, sallow complexion, dizziness, light-colored tongue with scanty fur and thin and weak pulse; cold-sthenia syndrome is marked by blackish-colored menorrhea, cold pain in the lower abdomen, alleviation of pain with warmth, thin and white tongue fur as well as deep and slow pulse; qi stagnation syndrome is marked by blackish-colored menorrhea, oppression in the chest, distension in the hypochondria and breasts, thin and white tongue fur and taut pulse.

3. Disordered Menstruation
The menstruation is irregular and is either profuse or scanty. Liver depression syndrome is marked by blackish-colored, sticky and unsmooth menorrhea, distending pain in the lower abdomen, thin and white tongue fur and taut pulse; kidney-asthenia syndrome is marked by light-colored and thin menorrhea, dizziness and tinnitus, aching and weakness of the loins and knees, light-colored tongue and deep and weak pulse.

Treatment
1. Body Acupuncture
Prescription: Qihai (CV 6) and Sanyinjiao (SP 6).

Modification: For sthenia-heat syndrome in early menstruation, Quchi (LI 11) and Xuehai (SP 10) are added; for asthenia-heat syndrome, Taichong (LR 3) and Taixi (KI 3) are added; for qi-asthenia syndrome, Zusanli (ST 36) and Pishu (BL 20) are added; for blood-asthenia syndrome in delayed menstruation, Zusanli (ST 36 ), Pishu (BL 20) and Weishu (BL 21) are added; for cold-sthenia syndrome, Guanyuan (CV 4) and Mingmen (GV 4) are added; for qi stagnation, Qimen (LR 14) and Taichong (LR 3) are added; for liver depression syndrome in disordered menstruation, Taichong (LR 3) and Ganshu (BL 18) are added; for kidney asthenia, Shenshu (BL 23) and Taixi (KI 3) are added.

Performance: The treatment begins 3 -5 days before menstruation. The reducing needling technique is used to treat sthenia syndrome while the reinforcing needling technique is used to treat asthenia syndrome. Qihai (CV 6) is needled obliquely downward and Sanyinjiao (SP 6) is needled obliquely upward to enable the needling sensation to transmit to the lower abdomen. Quchi (LI 11), Xuehai (SP 10), Taichong (LR 3) and Qimen (LR 14) are needled with the reducing needling technique, while the rest acupoints are needled with the reinforcing needling technique. For the treatment of cold-sthenia syndrome, qi-asthenia syndrome, blood-asthenia syndrome and kidney-asthenia syndrome, needling-warming moxibustion or moxaroll moxibustion can be added.

2. Ear Acupuncture
Acupoints:  Internal Genitalia (TF2), Subcortex (AT4), Kidney (CO10), Liver (CO12) and Endocrine (CO18).

Performance: Each time 2 - 3 acupoints are needled with medium stimulation and the needles are retained for 20 minutes. Or Wanghuliuxingzi (Semen Vaccariae) is used for ear acupressure alternatively on both ears. The patient is advised to press the sealed seeds on the ear several times a day. And the sealed seeds are changed once every 3 - 4 days.