An irregular menstrual cycle is defned as one which is shorter or longer than a monthly cycle by more than seven days, for at least three cycles in a row （ Yuè Jīng Xiān Hòu Wú DìngQī, 月经先后无定期）.

An irregular menstrual cycle may be characterized by the early arrival of the period for several cycles followed by a late cycle, or two to three cycles of late periods followed by an early cycle, or random and unpredictable short and long cycles. Irregular menstruation however more commonly manifests as an early menstrual period. It is ofen accompanied by heavy and prolonged bleeding and may develop into flooding and spotting. If it is characterized by long cycles accompanied by scanty periods, it may eventually become amenorrhea.

The causes of irregular menstruation are most ofen liver constraint or kidney defciency leading to unregulated storage and discharge from the sea of blood. The disease lies in the chong and ren mai and the uterus, its nature being mainly excess or occasionally defciencyexcess complex.

In Western medicine, the condition may be associated with dysfunctional uterine bleeding.

The chief pathogenesis of this disease is the disharmony of the chong and ren mai and disharmony of qi and blood, leading to the irregular storage and discharge from the sea of blood. Kidney defciency and liver constraint are the most commonly seen paterns of this disease.

Chronic depression or anger can cause a disorder of the liver qi, leading to a bleeding disorder. Chong and ren mai lose control and the storage and discharge of the sea of blood is irregular, resulting in an irregular menstrual cycle.

Kidney qi insufficiency at a young age, or kidney qi declining at menopause, or a constitutional kidney qi insufficiency, excessive sexual activity, many pregnancies, prolonged or severe illness, can all be causes of kidney qi damage, such that the kidney loses its control of the opening and closing function of the chong and ren mai, and an irregular storage and discharge from the sea of blood. The result is an irregular menstrual cycle.

There may be a history of internal damage from the seven emotions or a history of chronic disease.

The menstrual cycle is shortened or prolonged by more than 7 days, for three or more cycles in a row while period fow is usually moderate and normal in duration.

Flooding and spoting: Flooding and spoting is a condition characterized by a severe abnormality of the menstrual cycle and blood flow. The cycle is irregular and either excessive or scanty vaginal bleeding occurs erratically. However in the case of irregular menstruation the period is typically normal in amount and duration.

Pattern differentiation of this disease should not only include the regularity of the menstrual cycle, but also the amount, quality and color of the blood, in combination with accompanying symptoms and tongue-pulse conditions. Thus the organ and channel pathology can be determined.

Generally speaking, liver constraint presents as a heavy or light menstrual fow with clots but a normal color. It may be difcult to discharge and may also be accompanied by a distending pain in the chest and hypochondrium and a wiry pulse. The patern of kidney deficiency is characterized by menstruation with a normal or light flow of light red thin blood. It may be accompanied with aching lower back and knees, a pale tongue and a thready, weak pulse.

Treatment of this disease should focus on soothing of the liver and supplementing of the kidney, harmonizing both qi and blood of the chong and ren mai to normalize the function of the sea of blood.

Liver qi constraint should be treated by soothing the liver and regulating qi. Kidney qi deficiency should be treated by supplementing the kidney and regulating menstruation. The combined illness of the liver and the kidney must follow both of the above methods. In general, when the action of the liver and the kidney return to normal, qi and blood is regulated, with chong and ren mai being harmonized, and the menstrual cycle recovers naturally.

[Main Manifestations]

Irregular menstrual cycle with variable menstrual volume and unsmooth blood flow. Menstrual blood is dark red or purplish red, or with clots.

[Other Signs and Symptoms]

Lower abdominal distension and/or breast distension which refers to the hypochondrium. Frequent sighing, belching and reduced food intake.

[Tongue and Pulse]

Normal or red tongue, thin white or thin yellow tongue coating, wiry pulse.

[Analysis]

Depression or anger damages the liver, causing a disorderly qi fow and a disharmony of chong and ren mai, leading to irregular storage and release of the sea of blood. Irregular menstruation occurs, with the menstrual fow being either heavy or light.

Qi constraint with blood stagnation gives rise to an unsmooth menstrual blood flow and cloting and discomfort or pain.

As the liver channels runs through the lower abdomen and around the hypochondrium, liver constraint and qi stagnation lead to distension in the chest, the hypochondrium, the breasts and the lower abdomen.

Sighs are an atempt to relieve liver qi constraint.

Belching and reduced appetite or food intake are a result of liver qi attacking the stomach. If qi constraint is transformed into fre, the menstrual fow becomes dark and purplish. A thin yellow tongue coating and a wiry pulse are the signs of liver constraint and qi stagnation.

[Treatment Principles]

Soothe the liver and rectify the qi, regulate menstruation.

[Formula]

Xiāo Yáo Săn （Free Wanderer Powder, 逍遥散） .

[Formula Analysis]

Chái hú soothes the liver and relieves constraint.

Bò he strengthens chái hú’s function of soothing the liver.

Dāng guī and bái sháo nourish the blood and regulate menstruation.

Bái zhú, fú líng and gān căo fortify the spleen and harmonize the middle.

Páo jiāng warms the stomach and move qi.

All together, they manage to soothe the liver and rectify the spleen. The free fow of liver qi and normal transportation function of the spleen will return menstruation to a regular cycle.

[Modifcations]

In the case of vexation and bitter mouth, mŭ dān pí （Cortex Moutan） 10 g and zhī zĭ （Fructus Gardeniae） 10 g can be useful.

If there is menstrual pain in abdomen, xiāng fù （Rhizoma Cyperi） 10 g and yán hú suŏ （Rhizoma Corydalis） 10 g can be adopted.

If there are blood clots with the menses, zé lán （Herba Lycopi） 10 g and yì mŭ căo （Herba Leonuri ） 10 g are suitable.

For epigastric fullness and anorexia, zhĭ qiào （Fructus Aurantii） 10 g, hòu pò （Cortex Magnoliae Ofcinalis） 10 g and chén pí （Pericarpium Citri Reticulatae） 6 g can be added.

If it is complicated with kidney defciency, tù sī zĭ （Semen Cuscutae） 10 g, shú dì huáng （Radix Rehmanniae Praeparata） 10 g, xù duàn （Radix Dipsaci） 10 g should be added.

In the case of dizziness and blurred vision, shí jué míng （Haliotidis Concha ） （decocted first） 30 g, jú huā （Flos Chrysanthemi） 10 g and gōu téng （Ramulus Uncariae Cum Uncis）10 g are suitable.

In the case that both kidney and liver are involved, it is beter to treat them together, Dìng Jīng Tāng （Menstruation-Stabilizing Decoction, 定经汤） from Fu Qing-zhu’s [Treatiseon] Gynecology （ Fù Qīng Zhŭ Nǚ Kē, 傅青主女科） is recommended, which includes cháihú （Radix Bupleuri） 10 g, jīng jiè （Herba Schizonepetae） 10 g, dāng guī （Radix Angelicae Sinensis） 10 g, bái sháo （Radix Paeoniae Alba） 10 g, shān yào （Rhizoma Dioscoreae） 10 g, fú líng （Poria） 10 g, tù sī zĭ （Semen Cuscutae） 10 g and shú dì huáng （Radix Rehmanniae Praeparata） 10 g.

[Main Manifestations]

An irregular menstrual cycle, either short or long, with a scanty menstrual fow, of light red blood.

[Other Signs and Symptoms]

Aching weak lower back and knees, dizziness and tinnitus, dull complexion or macula.

[Tongue and Pulse]

Pale tongue with white moist coating, a thready weak pulse.

[Analysis]

The kidney is viewed as the root of the chong and ren mai. If its qi is insufficient, its storing function will be impaired, and the chong and ren mai will be in disharmony, leading to irregular storage and release of the sea of blood. Therefore, irregular menstruation occurs.

Scanty menstrual fow is caused by a defciency of essence and blood; while a light red, thin clear menstrual fow is caused by kidney qi insufciency and yang defciency, which fails to warm the blood.

Lack of kidney qi in the lower body causes aching or weak lower back and knees.

Dizziness, tinnitus, a dull complexion, a pale tongue, and a thready, weak pulse are all characteristics of a kidney defciency.

[Treatment Principles]

Supplement the kidney and regulate menstruation

[Formula]

Gù Yīn Jiān （Yin-Securing Brew, 固阴煎） .

[Formula Analysis]

In this formula, tù sī zĭ supplements the kidney and replenishes essence.

Shú dì huáng and shān zhū yú nourish the kidney and replenish essence.

Rén shēn, shān yào and zhì gān căo fortify the spleen and boost qi, aiming to consolidate the mìng mén via supplementation of the acquired essence to nourish the inherited essence.

Wŭ wèi zĭ and yuăn zhì restore coordination between the heart and kidney, facilitate the downbearing of heart qi to reinforce the consolidation of kidney qi.

On the whole, this formula achieves the effect of supplementing the kidney and regulating menstruation.

[Modifcations]

Dù zhòng （Cortex Eucommiae） and xù duàn （Radix Dipsaci） can be added in appropriate amount to supplement the kidney and reinforce the lumbus.

In the case of cold pain in the loins, ròu guì （Cortex Cinnamomi） 6 g and bā jĭ tiān （Radix Morindae Ofcinalis） 10 g can be used.

In the case of lumbar aching pain, add gŏu qĭ zĭ （Fructus Lycii） 10 g, dù zhòng （Cortex Eucommiae） 10 g and shú dì huáng （Radix Rehmanniae Praeparata） 30 g in heavy use.

For scanty menstrual blood fow, add dāng guī （Radix Angelicae Sinensis） 10 g and jī xuèténg （Caulis Spatholobi） 15 g.

For heavy bleeding, add wū zéi gŭ （Os Sepiae） 10 g and qiàn căo （Radix et Rhizoma Rubiae） 10 g.

If there is profuse vaginal discharge, lù jiăo shuāng （Cornu Cervi Degelatinatum） 20 g, shā yuàn zĭ （Semen Astragali Complanati） 10 g and jīn yīng zĭ （Fructus Rosae Laevigatae）10 g can be added.

[Therapeutic Principles]

Soothe the liver and relieve constraint, rectify qi and regulate menstruation

[Main Points]

BL 18 （ gān shù）, LV 14 （ qī mén）, LV 3 （ tài chōng）, RN 3 （ zhōng jí）, SP 6 （ sān yīn jiāo）

[Manipulations]

Apply reducing method for the above points, except for RN 3 （ zhōng jí） even method.

[Analysis]

This patern is atributed to liver qi constraint, so the combination of BL 18 （ gān shù） and LV 14 （ qī mén） are used to achieve the efect of soothing the liver and resolving constraint.

LV 3 （ tài chōng）, the yuan-source point of the liver channel, functions to soothe the liver and rectify qi.

RN 3 （ zhōng jí）, a key point for ren mai, is able to replenish chong and ren mai.

SP 6 （ sān yīn jiāo） is the intersecting point of the three yin channel（s） of the foot.

The combination of all points aims to relieve liver constraint, thus chong and ren mai regain harmonization, and menstruation arrives on time.

[Therapeutic Principles]

Supplement the kidney and secure the root, nourish the blood and regulate menstruation.

[Main Points]

RN 4 （ guān yuán）, RN 3 （ zhōng jí）, KI 13 （ qì xué）, BL 23 （ shèn shù）, SP 6 （ sān yīn jiāo）, KI 5 （ shuĭ quán）

[Manipulations]

Use the supplementing method for all points. Moxibustion could be used as well, as an additional method.

[Analysis]

RN 3 （ zhōng jí） and RN 4 （ guān yuán）, the channel points of ren mai, can replenish chong and ren mai, as well as regulate the menstruation.

BL 23 （ shèn shù） is efective in supplementing inherited essence.

KI 5 （ shuĭ quán） is the clef point of foot shaoyin channel.

KI 13 （ qì xué） is a connecting point of the chong mai and the kidney channel.

SP 6 （ sān yīn jiāo） regulates the function of the three yin channels.

The combination of the three points forms an effective prescription for irregular menstruation.

[Ingredients]

Functions: This medicine is effective for regulating menstruation and nourishing the blood, normalizing qi, and removing stasis. It is indicated for irregular menses with aching lower back and legs, abdominal distension and pain.

Administration: This is to be taken orally, four pills a time, twice daily.

[Ingredients]

Functions: This medicine is effective in warming the channels and dissipating cold, nourishing the blood, and resolving stasis. It is indicated for the treatment of irregular menses due to cold defciency in chong and ren mai and blood stasis obstruction manifested by early or late menstruation with a heavy or light blood fow, a cold lower abdominal pain, and infertility atributed to uterine coldness.

Administration: This is to be taken orally, six to nine gram a time, twice daily.

[Ingredients]

Functions: This medicine is effective for supplementing qi and nourishing blood, harmonizing the ying level, and regulating menstruation. It is indicated for irregular menses due to blood defciency and qi stagnation.

Administration: This medicine is to be taken orally, one to two pills a time, once or twice a day.

Timely treatment of this disease, along with appropriate lifestyle, can lead to a full recovery. On the other hand, delayed treatment or improper behavior may result in dysfunctional uterine bleeding or amenorrhea. Therefore, timely treatment is paramount.

1. Emotional Regulation: Irritation, frustration and anger should be avoided. Maintaining a good mood benefts harmony between qi and blood and the free fow of qi in the liver.

2. Proper Sexual Activity and Contraception: Birth control is advisable to prevent kidney injury due to too many pregnancies thus protecting the storage and discharge function of the kidney.

3. Proper Diet: The patient should avoid pungent, spicy, raw, or cold food.

Ms Liu, age 27, unmarried.

Initial Visit: February 27 ^th, 1989.

Chief Complaint: Irregular menstrual cycle for 11 years.

Present History: The patient had her menarche at age 14 and had a discorded menstrual cycle since she was 16, with an irregular arrival of menses, mostly delayed. Her menstrual blood was heavy and darkish-red without clots. She also experienced a lower abdominal, colicky pain, lumbago during menses, and intermenstrual pain in the right lower abdomen, profuse yellow vaginal discharge, pruritus in the vulva, dizziness and headache, tinnitus, blood staining on toilet paper afer defecation, yellow urine and nocturia. Her food intake was normal. Her last menstrual period occurred on February 5 ^th, 1989. She had a light red tongue with a thin white coating and a deep, wiry pulse.

TCM Diagnosis: （1） Irregular menstrual cycle due to liver constraint and spleen defciency; （2） leukorrhea disease.

Patern Diferentiation: Liver constraint causes disorderly qi fow and the disharmony of qi and blood, leading to irregular storage and discharge of the sea of blood, thus bringing about irregular cycles and a heavy blood flow. Qi constraint with blood stasis results in inhibited blood circulation, so that abdominal colicky pain occurs during her menses. The liver wood over restricts the spleen earth, causing spleen qi deficiency and the failure to transport water dampness. The water dampness flows down to the lower jiao and damages ren mai and dai mai. Consequently, this leads to profuse vaginal discharge, and the accumulated dampness transforms into heat, which turns the vaginal discharge yellow.

Treatment Principles: Soothe the liver and rectify qi, fortify the spleen and remove dampness.

Formula:

Administration: Three packs, taken as a decoction.

Second Visit: March 2 ^nd, 1989

Afer taking the medication, the patient’s vaginal discharge had been reduced and the lumbago relieved. However, the lower abdominal pain persisted, together with a sensation of heavy distension in the head, chest tightness, epigastric distending pain, and a scorching pain in the anus. Her tongue was red with a thin white coating, and her pulse was weak and thready. Previous treatment was enforced with some additional liver-soothing and qirectifying medicinals.

Formula:

Administration: Three packs, taken as a decoction.

Third Visit: March 5 ^th, 1989

All of the above symptoms had improved except for the periumbilical pain and nocturia. She still had a light red tongue with a thin white coating and a weak, thready pulse. The previous formula was continued with modifcation.

Formula:

Administration: Four packs, taken as a decoction.

Fourth Visit: March 9 ^th, 1989

The patient’s menstruation did not occur at the expected time, accompanied by a lef lower abdominal pain, pain of the vulva, dizziness, normal stools but frequent urination. The patient had a light red tongue with a thin white coating and a deep, thready pulse. Treatment to nourish and soothe the liver, remove the dampness, and activate the blood was applied.

Formula:

Administration: Three packs, taken as a decoction.

[Analysis]

The patient is given Dāng Guī Sháo Yào Săn （Chinese Angelica and Peony Powder, 当归芍药散） at the same time to treat the liver and the spleen, and regulate the qi and blood in order to nourish the blood and soothe the liver, fortify the spleen and drain dampness.

Yán hú suŏ, xiāng fù, gān sōng, hé huān pí, yù jīn and cì jí lí are added to strengthen the effect of soothing the liver and rectifying qi, activating the blood and regulating menstruation.

Fú líng is replaced by tŭ fú líng in combination with Èr Miào Săn （Two Mysterious Powder, 二妙散） and rěn dōng téng to increase lián ròu’s effect of drying dampness and clearing heat.

While dăng shēn, huái shān yào and lián ròu aim to fortify the spleen and boost qi, gŏu qĭ zĭ nourishes the liver, so that liver qi is soothed, spleen qi is invigorated, menstruation becomes normal.

[Follow-up]

In her follow-up survey in June, 1992, the patient’s menstrual cycle was normal in that she has a monthly period which arrives on time.

Source: A Summary of Ban Xiu-wen’s Clinical Experience （班秀文临床经验辑要）

Can you tell the difference between an irregular menstrual cycle, and flooding and spoting?