Alternative Medicine

The National Center for Complementary and Alternative Medicine (NCCAM) is an organization dedicated to overseeing alternative medical practices.  NCCAM examines healing practices in the context of research and science (The National Institute of Health Almanac, 2010).  This organization provides on-going information to health professionals and the public.  The NCCAM conducts clinical research and overseas alternative medical practices throughout the country.  It also offers postdoctoral training.
   
As with all major organizations, there are always potential deficits of current regulatory oversight and practices.  Alternative medical practices have often been criticized as unscientific, and much of the research has been conducted in Asia.  Thus, the NCCAM has worked diligently to validate the healing properties of alternative treatments through on-going research, education and training for alternative healthcare professionals.

On criticism of CAM has been that there needs to be tougher oversight of dietary supplements and herbs (Doheny, 2005).  Dietary supplements are not considered drugs so the FDA and NCCAM do not strongly regulate their use.  Herbs, which are classified as food, are available at most health food stores, but can be harmful if improperly used or have side effects if taken in large doses.  Thus, herbs need more regulation and oversight.  Other methods of alternative medicine such as meditation, qigong, and chiropractic services have no side effects and therefore do not present dangers to patients.

Acupuncture has been used for decades to relieve pain and gain therapeutic response. The process includes the use of filamentous needles inserted to the different points of the body to create alleviating treatment for some health-related conditions such as hypertension. Many studies have been published claiming that acupuncture is one of the best ways to either reduce or treat hypertension effectively. However, this therapeutic method is still being criticized by many researchers and health professionals due to a lack of scientific information to support it. In relation to this, the panel would like to present the reasons why acupuncture does not alleviate hypertension.

Hypertension is more effectively treated by anti-hypertensive drugs and proper diet.
Hypertension is one of the most common diseases worldwide. Patients with such disease are frequently advised to take medicines for maintenance. According to the research of Brunner et al., chronic inhibition of the angiotensin-converting enzyme with an orally active compound offers a new, efficient, and well-tolerated approach to the treatment of hypertension. Evidence shows in their studies where 22 hypertensive patients effectively reduced and controlled the patients blood pressure by having chronic inhibition of angiotensin.1
Also, in the study of Hansson et.al, Acetylsalicylic acid significantly reduced major cardiovascular events with the greatest benefit seen in all myocardial infarction. Their study conducted used 790 patients with hypertension from different countries and tested for the efficacy of acetylsaliclic acid and it resulted to the reduction of major cardiovascular events. Also, rest assured that there was no effect on the incidence of stroke or fatal bleeds.2

According to the study of Newborg and Kempner, dietary modifications should be made gradually.120 patients with hypertensive nueropathy treatment with the rice diet was carried. On the process, it was identified that only 3 out 7 were following it corretcly. However the effect of rice diet on blood pressure, serum cholesterol, blood non-protein nitrogen produces favorable results in treating hypertension.8 Examples that can be applied to diet are
Strict rice diet           
Avoidance of too much sodium
avoidance of fatty foods
taking of supplements.

According to the study of Dr. Longhurst, high blood pressure is best controlled by keeping ones weight down, eating plenty of fruit and vegetables, cutting salt intake, increasing physical activity, and if needed, taking appropriate medications.4

Traditional Chinese medicine including acupuncture is just theoretical.
According to the book of Stein and Oz, the theory called moxibustion is the reason behind the acupuncture process. This theory claims that there is a special herb burned to the needle to heat it and the heat will just be transferred to the body. This therapeutic way of healing merely helps the patients to feel relax, but it does not necessarily treat or alleviate disease such as hypertension unlike modern medicine and medical procedures do.5

The relaxation brought about by TCM s only changes the psychological aspects of the patients to feel better but not to cure the illness. The therapeutic effect of acupuncture just bring backs the body s energy to reduce the pain but not to alleviate illness.5

In July 1999, the British Medical Journal published an extensive review of Chinese research on  traditional Chinse medicine and found numerous problems, including poor controls, inadequate protection against bias, etc. In fact,the chart shows half a bell- a few trials showed acupuncture was very effectiveand the largest number showed it was slightly effective.7

Acupuncture does not work at all.
Many studies have already been shown stating that acupuncture works for hypertension. However, studies suggest combining acupuncture with other ways of treatment such as electronic stimulation. Without any of these additional treatments, acupuncture will not work alone.6

Acupuncture can be an excellent complement to other medical treatments, especially for those treating the cardiac system but the type of electro acupuncture is only effective on elevated blood pressure levels, such as those present in hypertension, and the treatment has no impact on standing blood pressure rates. - Dr John Longhurst,Lead researcher of the study  Acupuncture cuts blood pressure presented in BBC News.4

According to Belinda Linden of British Heart Foundation, the research would need to be supported by controlled clinical trials before applied as an accepted form of blood pressure control for humans. She also added that high blood pressure is best controlled by keeping the weight down, eating plenty of fruits ad vegetables, cutting the salt intake, increasing physical activity and if neede, taking appropriate medications.4
Acupuncture is interesting but it doesn t alleviate hypertension and doctors would not recommend patients acupuncture treatment for high blood pressure.-Dr. Mike Cummings, medical director of the British Medical

Acupuncture Society.4

Acupunture and Chinese Traditional Medicine are based on a unique philisophical model and the instruments of biomedical research may be inadequate and inappropriate. -Adams. 7

Acupuncture at best can be said to alleviate rather than eliminate pain, but eve then,we dont know whether its just blocking the pain pathway or simply just having a placebo effect.7

Acupuncture defenders also recognize its inadequacies and stated that thirty years of active acupuncture research have failed to unequivocally demonstrate its clinical efficacy.7

According to the randomised, clinical cotrolled study in hypertension, 192 participants with untreated blood pressure (BP) in the range of 14090 to 179109 mm Hg. Particpants were weaned off hypertensives before enrollment and were then randomly assigned to treatments Chinese acupuncture, standardized acupuncture or invasive acupuncture. Categorizing participants by age, race, gender, baseline BP, history of antihypertensive use, obesity, or primary traditional Chinese medicine diagnosis did not reveal any subgroups for which the benefits of active acupuncture differed significantly from sham acupuncture. Active acupuncture provided no greater benefit than invasive sham acupuncture in reducing systolic or diastolic BP.9

Another study also investigated the analgesic effect of acupuncture in placebo trials using 3025 patients. The clinicians managing the acupuncture and placebo acupuncture treatment were not blinded in any of the trials. On the results, a small analgesic effect of acupuncture was found, which stated to lack clinical relevance and cannot be clearly distinguished from bias.10

The National Center for Complementary and Alternative Medicine (NCCAM) has put together a website to define alternative medicine practices in the United States. The awareness of this growing industry lead to many studies conducted and incorporates some practices into conventional medicine today. The website can be used as a tool to broaden the scope of alternative medicine and bring awareness to individuals of these options for their health. Many people may hold fear regarding alternative medicine and its effectiveness, but CAMs website exists to dispel fear and reveal scientific data.
  
 Alternative medicine, according to CAM, is a different method plan for medicine used instead of the traditional medical procedures (What is Cam, 2009). Alternative medicine can be used to treat an illness instead of any type of treatment for the condition. Alternative medicine could be used by patients that feel they could use the alternative methods to heal.
   
Complementary medicine, according to CAM, is the use of both conventional and complementary methods (What is Cam, 2009). The complementary medicine can be used to help patients while seeking conventional methods of treatment. The use of complementary methods may help patients have a greater overall outcome in regard to healing from conventional treatment. Often complementary methods could include visualization methods and meditation to increase the patients chance of survival and healing.
   
Integrative medicine, according to CAM, calls for the blending of techniques including CAM therapy and conventional methods in medicine (What is Cam, 2009). These differing terms include different approaches to healing the body when an illness is detected. In alternative medicine, that is sought instead of any other medicinal techniques and procedures. Using complementary medicine, the conventional therapy is the main technique to overcome the condition. The complementary technique is used to lessen the pain or discomfort, according to CAM (What is Cam, 2009). The integrative technique is a blending of therapy from CAM and conventional methods in order to combat the problem. The two techniques go hand in hand to work together to heal the patient instead of one method working independently.
   
CAMs philosophy is to use natural approaches in the field of healing. These include practices that have had results for proving to work in many case studies and private practices. The use of these practices often date before the use of conventional medicine and use the bodys natural healing systems to overcome conditions. CAMs philosophy uses the practices that have been shown to work including methods for eating and meditation among other sense using abilities.
   
Included in CAMs complementary and alternative medicine groups are whole medical systems, mind-body medicine, biologically based, manipulative and body-based, and energy medicine (What is Cam, 2009). Whole medical systems are the examples of medicine that date before conventional medical practices were introduced. According to CAM these include traditional medicine from China, such as meditation and herb use, and Ayurveda which includes yoga, herbs, and massages (What is Cam, 2009). The whole medical systems are all inclusive across the techniques of healing the body using exercise or stretching, natural eating, and touch relief for relaxation for the mind and body.
  
Mind-body medicine mainly focuses on integration of the mind and body and the belief that the mind can heal the body. Visualizations, prayer, meditation, and other techniques are used with the mind-body medicine therapy (What is Cam, 2009). Biologically based practices are those than can be absorbed by the body. These are supplements, vitamins, herbs, and healthy foods rich in vitamins (2009). This approach includes these methods to overcome a condition through the approach of healing within.
  
 Manipulative and body-based practices include using the bodys movements to overcome the condition. These can include chiropractic methods and massage, according to CAM (What is Cam, 2009). These movements are said to stretch some parts of the body that may need to be focused on in order to help overcome the problem. Energy medicine is the use of the bodys natural energy field. Blockages exist that may have formed the condition and techniques are used to pass the energy blockages from the body. Some of these techniques include Reiki, qi gong, and other methods (What is Cam, 2009).
   
I chose Reiki as the modality of study. Reiki is a form of energy healing where the person performing the treatment places their hands along some of the major chakra areas of the patient (Reiki an introduction, 2009). The energy that is transferred from the professional to the patient is then released to the intended spot within the patients body. According to CAM, Reiki could be effective for those with fibromyalgia (Reiki an introduction, 2009). In some instances, Reiki could be used as an alternative to other medical procedures. Reiki could lessen the effects of other conditions surrounding the joints and muscles as well as mental well-being (Reiki an introduction, 2009).
   
In complementary therapy, Reiki could be used as a good relaxation technique before having any type of surgery performed. The relaxation that Reiki provides through the release of energy could release tension and anxiety in a persons body, making the surgery more effective. Reiki has also been known to release problematic occurrences from memories that are often said to be stored in the bodys energy system.
   
Reiki as integrative style of healing would be used in conjunction with conventional methods. The way that Reiki could be of use in this area can increase the well-being of life, such as the people that have advanced AIDS, according to CAM (Reiki an introduction, 2009). Reiki could also help with many other conditions to reduce the effects and spreading of cancer, which could also be energy related although not yet proven to be.

This study focuses on trying to establish the use of acupuncture and traditional medicine and their net effects on the field of medicine. The research applies various techniques including interview schedule, questionnaires and case study analysis in trying to establish the authenticity of the use of traditional Chinese medicine in treating of infertility related ailments. The study incorporated specialists, and patients of TCM and acupuncture in its research. Through this information was obtained and analyzed in order to establish the actual effect of Chinese method, its consequences in the medical world, its effectiveness and viability.

 Acknowledgement
I would like to acknowledge the help and guidance of my lecturer during this research. Additionally, I cannot forget the assistance accorded to me by both the patients and the specialists who accorded me their time in order to allow the success of this research. I can also not forget the many people who provided answers to my questionnaires as without them there probably will not be data to analyze and draw conclusions.

Acupuncture and herbal therapy
Acupuncture and Herbal Therapy have been used for treatment and disease prevention since the ancient periods of Chinese history. They have been able to achieve astonishing effectiveness over time with people streaming to eat with quiet agility. It is believed that at least 71 of the world population has at one time used acupuncture and Chinese medicine as a form of healthcare(Maciocia,, 199929).. However it is only recently that their sage has been fully recognized in the United States. Dating back from the 11 AD TCM and acupuncture have been used in treatment of in the treatment of infertility (Maciocia,, 199926). This has been done through applications of these techniques in regulating the menstrual cycle and enhancement of the full functionality of the body (Deadman, 200712). Unlike conventional methods, TCM does not put much effort on healing only but focuses on the general health of the individual.

Though old, infertility hormonal related problems easily yield to these techniques allowing it to treat conditions like PMS, endometriosis, immune system incongruities and even blocked fallopian tubes. TCM additionally includes a series of Qi Kung which allow flow of specific meridians.
The mechanism by which these herbal medicines operate has not been well illustrated but they have still been used to successfully treat infertility over the years. The practitioners used a formula based form of herbs which are mixed together to form a decoction which handles the specific ailment.

Practitioners of Chinese herbal medicine rarely use a single herb in treatment. Chinese herbs are formula based many herbs are mixed together to create the perfect decoction specifically designed for the individual patient. Some formulas may contain two herbs while others may contain as much as thirty herbs mixed together. The herbs used have specific trophism, temperature, nature as well as flavor (Maciocia, 199926). This has made prescription of such herbs to need an extensive range of training and expertise.
Herbal medication has over time presented a dual dilemma. The correct prescription involves an accurate differential diagnosis that can only be offered by people with great experience on them. Secondly, they may prove harmful when prescribed by inexperienced personal or when self prescribed by an individual. A case in hand involves the Ma huangEphedra of which many people have died after self prescribing it and consequently taken it without consultation from physicians (Maciocia,, 199936). However, such a case can not be used to give blanket accusation that they are harmful. This case is just a similar as it could happen when one self prescribes aspirin and ends up taking dangerous dosage. Just like, conventional medicine herbal medicine can prove very fatal if used inappropriately. Most herbs are however safe, highly effective and usually free from of side effects often present in pharmaceutical drugs.
Many Chinese traditional Chinese medicine physicians have vast training in observing peoples voice tone, eyes, their complexion, facial expression, overall demeanor among others things in order to arrive at a specific diagnosis(Maciocia,, 199929)..

Diagnosis and treatment

Diagnosis in traditional Chinese medicine is mainly based on voice tone, ones complexion, eyes observation, overall demeanor and facial expression (Maciocia,, 199930). Additionally, observations are made on how one walks and stands. The alternative doctor specializes in needle insertion, herbal prescription and additionally they should be able to see hidden conditions tat exists in patients. Basically there are four examinations that are conducted by Chinese traditional medicine doctors. These include
     1.  Observing
     2.  ListeningSmelling
     3.  Questioning
     4.  Palpation

Patients observation and sensitivity has over time declined especially with the incoming of technological advancement. It has been argued that over time the advancement of technology has led to a proportional decline in sensitivity of the doctors. The diagnostic methods have been used over the last 3,000 years successfully (Maciocia,, 199938). The diagnostic techniques requires years of mastery and experience in order to reduce chances of misdiagnosis. However, alternative medicine treatment focuses more on elimination of disease processes than curative part. They focus more on achieving overall health of an individual through attack of the disease causing factors. To achieve overall health, it focuses on physical, psychological, spiritual and emotional perspectives of health (Holland, 2000 98).
Primarily alternative medicine puts its first concern on strengthening of the immune function through balance of emotional, physical and spiritual patients attributes. By looking at emotional perspective of health, alternative medicine addresses the issue of depression which may result to chronical exhaustion and sickness due to reduced immune system functionality(Holland, 2000 98). Rather than repeated prescription of antibiotics, alternative medicine will address the anxietydepression exhibited by the patients or even refer them to physiotherapists simultaneously with alternative treatment methods.
Alternative medicines view of infertility

Over the years infertility has been believed to arise from psychological problems on the part of either of the partners. In the middle 20th century, scientists attributed 50 of the cases to psychogenic infertility (Holland, 2000 98). Additionally, reproductive failure was attributed to basically psychological and emotional factors. This was believed to occur as a result of unconscious anxiety regarding sexual feelings, motherhood ambivalence, unresolved oedipal conflict and gender identity conflict (Holland, 2000 98). Alternative medicine emphasizes the role of psychopathology in infertility.
Spiritual aspect of infertility
Infertility has also been over time associated with spiritualism. There have been cases where people who are unable to have children have resorted to prayer prophets for help in trying to assist in solving problems of inability to conceive. Conception further regarded with esteem and respect as children are considered a gift from God.

Acupuncture
This is a process that involves use of needle insertion in a grid like pattern that spans the body from the head to the toe (Deadman, 200711).. The needles stimulate energy points in the body thus regulating the spiritual, mental, physical and emotional balance of an individual.
Acupuncture has over the years been used as a form of pain relief. However the Chinese have identified its use in the field of infertility treatment. These may include Menopausal systems, hot flushes, infertility, premenstrual tension and endometriosis (Deadman, 200712).. It applies the balancing of the negative and the positive forces which might result into infertility. LITERATURE REVIEW

Traditional Chinese Medicine
TTCM has over time held the belief that that the kidneys are majorly involved in both male and female infertility. In women however, there is a suggestion than other channels may result o causes of infertility (Holland, 2000 103). The chong and Ren meridians are believed to explain the functioning of the kidneys, spleen and the liver in reproduction (Holland, 2000 103). Each is believed to participating in production of Qi-blood also referred to as the sexual juices. In women they are referred to as tian gui(Holland, 2000 103)..

The liver Qi stagnation results are a result of irritability, depression, and frustration. Organs mainly mentioned in TCM refer to conduit or the meridian. These are pathways that are believed to allow energy Qis to flow (Holland, 2000 103). The liver Qi congestion is believed to originate from people doing jobs they dont like. Working late hours and use birth control pills (Holland, 2000 104)..
 TCM has divided the energy originating from the kidney into two the kidney yin and kidney yang which together are believed to result into kidney Jing also referred to as essence. Additionally, there are some fundamental substances which are believed to contribute to infertility. Lack of them is believed to result into disharmonies that ultimately give rise to infertility. Generally the disharmonies give rise to overwork, sexual intemperance and emotional disharmonies. These hold the key to fertility acquisition.
Categories of TCM used in infertility cases
Generally, there exist two categories namely
Kidney Yang Deficiency
 I
ts signs and symptoms include cold aversion, complexion variations, fatigue, weak knees and lower back, loose stools accompanied by large amounts of urine. Low sexual drive is also characteristic to this category. Other signs include deep and weak pulse, pale tongue with a white coating. Women with this problem experience long menstrual cycles as compared to other cases or even lack of it altogether.
Kidney Yin Deficiency

This category is characterized by heat sensations in the palms, sole and chest accompanied by irritability. Heat aversion mostly in the afternoons is common accompanied by frequent dizziness. The women suffering from these categories usually have short menstrual cycles with
Herbal medicine and acupuncture have been used over the years among the Chinese people in treatment as well as prevention of diseases. . It is believed that currently up to 70 of the population has used traditional medicine techniques.

Advantages of Traditional Chinese Medicine
TCM views individuals as consisting of both body and mind health wise. It addresses both symptoms and the root causes simultaneously.
There exist minimal side effects and accumulation of toxins in the body which may result from invasive drug therapies originating from pharmaceutical companies.
TCM strengthens and at the same time balances the bodys general health. Specific herbal medicine and acupuncture regimes help benefit the individual in terms of general health.
They have proved to be more effective when utilized alongside the post modern procedures.
Traditional Chinese Medicine Viewpoint of Miscarriages
Traditional Chinese medicines hold the belief that most pregnancies occur mainly during the early six months of pregnancy. It focuses on ensuring that health is well maintained during pregnancy in order to minimize risks that may result in miscarriages. TCM herbs help maintain physical health thus limiting problems that a woman might face after conception.

Sex during Pregnancy
Just like conventional means TCM doctors discourage sex during practices especially for women who have previously had miscarriages and those who have attained the age of forty years and above (Mao-Shing, 1995 28). However this has faced rebellion from modern couple who feel it is nor attainable.
In order to raise the fertility quotient through the use of TCM the following should be observed
Timing and consistency of treatment should be given a priority as it involves taking the herbs as prescribed and consistently for the whole period(Mao-Shing, 1995 26).. Additionally it is recommended that they maintain good health in order to minimize imbalances that may lead to difficulty in conception.
TCM practitioners have suggested that women who are nearing forty and have not had contact with external factors like drugs and alcohol have little likelihood of succeed in treatment of their infertility ailment (Mao-Shing, 1995 28). Likewise, women who have perfect health with little imbalances also have little likelihood of getting pregnant even after treatment.                                     

This section dealt with the methods used to collect data and further documenting the results obtained after carefully reviewing literature from primary sources and interviews to establish the role that herbs play to enhance fertility in women. Its primary focus is to display the authenticity of the research tools used as well as their effectives. Additionally, this section provides a clear insightfulness into the results obtained and a step by step documentation of what specific herbs do in their quest to help curb infertility amongst women.
Research methodology

This study applied the use of various methods of data collection in a bid to obtain its data. Its important to note that such a study required extensive research especially with regard to the fact not much has been documented about. It is under this guise that the following methods were chosen
Cross sectional study
Survey
Case study analysis
However it will also be important to acknowledge that to achieve effective results from one method required the assistance of the other hence the methods were applied hand in hand.
Cross sectional study

Usually different age groups experience different hormonal balance and activity. This in essence meant that any medications that require hormone taking part in its effect could possible produce varying results for different age groups. It is under this assumption that this study undertook to classify the study samples into age groups in order to be able to obtain the net effect of TCM to different age groups.teh groups were divided as follows
18 -20 years
21  40 years
Over 40 years
Survey
This method applied the use of questionnaires where a structured list of questions were used to questions some professionals in the area of TCM and acupuncture on the medicinal plants they usually use on their patients as well as any other traditional means that they use. They questionnaires also inquired from tem how they acquired their skills, how they conduct their diagnosis and the uniqueness of their approach as compared to the conventional methods well known to people.
Interview schedules were also used. This was done by anonymously posting them over the internet for the willing respondents to answer the questions after which the data obtained was well documented for later analysis.

Case study
This method involved review of existing cases of use of herbal medicine in treatment of infertility amongst women. To collect data via case study, the researcher at times had to be present when the TCM doctor performed hisher work and additionally had to interview patients who were under such medication of had previously been under such medication. The patients records were also anonymously accessed to be bale to follow the changing trends observed on the patients during their treatment regime.

Research ethics
Given that that research at times required accessing of patients private details and at times being present when a patient was being diagnosed, the question of its ethical conduct was very fundamental and key to its success. To achieve this ethically the researcher through the TCM doctors and acupuncture specialist had to seek permission fro the patients before conducting any case study survey. While some patients would agree some would agree. Colleting data from the patients also required getting some personal details from them which meant that they had to be asked prior to the questioning if they were willing to go that far. Similarly some would accept while other would reject the possibility of discussing their personal matters with any person other that their doctor.
The TCM doctors however, offered quite a resource towards achieving the goals of this research though within ethical limit given that they too like conventional doctors believe in maintaining their patients privacy.

Research methods validity
The question of the validity of the research method used also had to be considered. This was more so with regard to the anonymously posted interview schedules over the internet where some people were expected to give non-genuine answers while other s would simply fill the interview questions for fun rather than from experience. This called for a very sober approach during post data collection documentation in order to minimize the effect of non-genuine answers. However, given the fact that this was not the core tool to be used in analysis the effect of the same was expected to be minimal.
The other research methods that is, survey and case study analysis as well as review of existing literature on TCM were expected to produce valid and genuine results hence the final data collected was expected to have a high level of accuracy.

Research governance
The research was guided by a vast range of internationally accepted regulations, principles and standard s that enhance good practice.
Given that the research would involve analysis of patients medical records, patients observation, surveys and other forms of direct contact with patients, research governance procedures had to be applied. The guidelines were based on the following
Safeguarding research participants
Enhancement of ethical and scientific quality
Risk minimization
Practice monitoring and performance
RESULTS

The interview schedule posted on the internet (refer appendix 1) in classification of the age groups response. The results are tabulated below
Comparison amongst those who have used TCM and those who have not used
Age groupHave used TCMHave not used TCM18 -20 years227821  40 years7822Over 40 years8119
Comparison of those who believed that TCM is effective and those who believed that it is ineffective
Age groupHave used TCMHave not used TCM18 -20 years782221  40 years8911Over 40 years8119
The population aged 18  20 years mostly acknowledged not having tried herbal medicine for infertility as they still didnt believe they had such problems. However, most believed those herbal medicines were effective as compared to orthodox methods.

The chats and interviews with specialists revealed that herbs mainly address the following areas
Hormonal imbalances
Luteal phase defect
Anovulation
Amenorrhea
Unexplained infertility problems
Polycyst ovaries
Endometriosis
Tubal obstructions
Uterine fibroids
Advanced maternal age
Recurrent miscarriages
Immunologic infertility
ART procedures improvement
Premenstrual syndrome
Menopause symptoms

The following are the tabulated results of the herbs and their functions as identified by the specialists in TCM and acupuncture

Herb nameFunctions ChasteberryHelps in stimulation of ovulation hormones, female hormonal balance restoration, normalization of pituitary glands functioning, balancing levels of progesterone and oestrogen, and herbal treatment of infertility.

Peppermint Leaf Red Raspberry Leaf attends to the tone of the uterus, and contractions. It is highly regarded given its ability to tone the uterus and the pelvic region muscles. Their nutritional value is also high and acts as a powerful fertility promotion herb when used in combination with peppermint leaves.
Green Tea This is a powerful antioxidant which enhances reproductive health through engaging in repair of damages that result from oxidation due to environmental toxins as well as aging.
Ladies MantleThis herb is used in regulating women monthly cycle and also has a tonic effect on the cervix.
Nettle Leaf This is a herbal fertility tea recipe that contains plenty of vitamins namely A, C, D, and K. these assist in maintaining good reproductive health. Additionally, Nettle leaf is rich in Potassium, phosphorus, Iron, sulphur and calcium. It provides women with the ability to conceive and also maintain the pregnancy.
Red Raspberry Leaf This is also a herbal fertility tea ingredient that is useful when combined with the raspberry leaf. It has a yummy flavor and sexual stimulation properties.it is among the popular fertility promotion herbs which has high calcium content. Though it has little direct impact on ovulation, it holds ability to strengthen the uterus hence preparing it for pregnancy. It works best when combined with the red clover blossom and can also be taken during an entire cycle.

Black CohoshIt basically deals with mood swings, hot flashes and vaginal dryness which are mainly associated with menopause. Additionally it helps in regulation of LH levels thus keeping the periods and ovulation more regular. It helps in relieving menstrual cramps and is taken during the first half of ones cycle, starting from menstruation to ovulation.

Dong QuaiIts used to regulate menstrual cycle and also provides important nutrients like vitamin B12, iron, and vitamin E. it also has ability to balance estrogen levels and also improves implantation chances amongst women who have auto immune disorders.

Wild YamThis herb increases the production of progesterone in women who have short luteal phases. It is usually taken after ovulation as it is believed to hold the ability to stop ovulation.
False Unicorn RootIt is used to treat delayed and painful periods, endometriosis, hormonal imbalance, morning sickness, threatened miscarriage and ovarian cysts. It possesses a normalization and stimulation effect on the ovaries thus aiding pregnancy and preservation of the pregnancy. Its only taken during the first half of a cycle from menstruation to ovulation.

Red Clover BlossomPossesses vitamins, calcium and magnesium. It nourishes the uterus and relaxes the nervous system which in turn helps in promoting fertility. Its high protein content highly benefits the body and additionally helps in hormonal balancing.
GinsengIts more commonly used by men. However, it is able to promote fertility amongst both women and men.

LicoriceIt helps balance estrogen levels but is usually associated with increased blood pressure.
Nettle LeavesThe herb contains high levels of chlorophyll which help in regulation of hormones and the monthly cycle. It also helps in uterus toning as well as its strengthening.
Evening Primrose OilIt helps lower the cholesterol levels and alleviation of PMS symptoms. It also helps in production of fertile quality cervical mucus, which is greatly assists in the process of conception.
Combination SupplementsAt times herbalist used a combination of the above as necessary.
The above results were obtained from specialists after engaging them in a series of interviews they revealed the functions of the herbal medicine thus revealing their areas of focus during treatment regime.

The case study report was as tabulated below
Patients stagePatients who believed that the herbs were helping the positively (not yet pregnant).Patients who believed that they had seen negligible or minimal change since starting treatmentPatients who had gotten pregnant as a result of the herbsPatients who have just started treatment

Form the records it was observed that most patients starting treatment have great faith that TCM will eventually help them solve their infertility problem. Their faiths translated into reality over time with quite a high percentage getting pregnant. However, they high percentage of those who get pregnant cannot be attributed to high success rates as there are other factors as will be discussed in the discussion section.

Direct observations of the few patients who were accessible revealed the following results
Patients stagesSide effects presentSide effects absentEarly stages of treatment 0100Late stages of treatment496Completed treatment298These results were obtained from talking to the patients who accepted to have interviews with me. However, their implications will be discussed later. It will also be important to note that these were raw results as obtained directly from the patients based on specific questions however, there were other questions that assisted more in establishing other reasons for such results namely

Some patients dropped out of treatment before completion. .
Some patients defied the prescribed dosage prescribed by the TCM doctor.
Some patents attending clinics irregularly e.g. failing to attend clinic when they observe changes only to run back when the changes begin to revere.

Diagnosis techniques were also observed and identified during the doctors  patient sessions. The most used techniques were as follows
Observation mostly once a patient came, the doctor would observe skin complexion, color of the eyes, and behavior during the session, mood among others in order to arrive at conclusions.
Questioning the TCM doctor also had to question the patient deeply in order to establish some of the symptoms that are not easily observable.

Listening  While the literature review had earlier indicated that listening is often accompanied by smelling,  I observed that the TCM doctors did not at any one time used smelling. However listening took place a lot and even some modern technology equipment like fetal scope were used.
Palpation palpation was regularly used by the doctors who seemed to have an astonishing ability to detect variations in habits. It was surprising how they could easily do the things that in the modern world are actually a reserve for technology. When I inquired about this the doctors usually attributed it to experience but more importantly, concentrating on the patient.

Case analysis

A female patient aged 29 after many years of infertility problems decides to rty TCM. She and her husband decide to try TCM. After a series of tests and observation, her husband was found to be okay hence she was the one put under medications to improve her cycle.  As revealed by her won confession, she became pregnant just after two months of treatment.
In another case a 42 year old woman decided to attempt acupuncture and herbs after her first IVF cycle procedures failed. She was put under herbs and acupuncture for a period of three months treatment. Among the herbs she was given included hormonal balance herbs and weekly acupuncture. She became pregnant only after two months of the medication.

DISCUSSION

The TCM doctors belief that conception is quite a simple process is unquestionable.  The causes are mainly a variation of some of the key organs and functions that interplay to result in the process.  A talk with Jenifer Brett, a naturopathist stationed at Wilton Naturopathic Center in Stratford, Connecticut revealed that yes in deed getting the hormones and body cells primed and ready for conception can in deed assist in enhancing pregnancy ability,.

Comparative analysis between orthodox and other alternative medicines

Orthodox medicine approach contrasts alternative medicine by the narrow range of choices it offers. Alternative medicine offers a wide range of choices with limited restrictions and the consumers have a vast range to choose from as they would like. Orthodox means on the other hand believes it has the knowledge to fix problems in human body and parts by interfering with in homeostasis balance.  Further alternative medicine is poorly organized in majority of the cases and also poorly funded. However, this medicine option has been undergoing evolution over time and things might not be similar for the well established cases which exhibit proper organization and even institutions of higher learning have adopted these techniques to solve human health problems.

Orthodox medicine is mainly a reserve for doctors, nurses and consultants. Specific target of these kinds of medicine aims at targeting the specific disease that the patient is suffering from. A good example is the case of cancer where the orthodox medicine focuses more on destroying the cancer cells. Instances when the disease cannot be fixed, orthodox medicine resorts to cutting or removing that part that causes the disease in question. An example is the case where the womb is removed in case of dysmenhorrhea. From the results obtained in the various types of medication shown in the results section, one thing that is clear that is that TCM operates in a totally different direction. It focuses more on restoration of the individuals complete health or the particular organ in question.  Take a case of the rasp berry leaf which assists in helping relax the uterus, prevention of miscarriages, assisting the fertilized egg to attach itself to the uterus lining and stay there for the required duration. Additionally, it also has a toning effect which helps the reproductive system in women to function appropriately. It also has ability to solve a variety of womens problems including morning sickness, cramps and heavy menstrual bleeding. Through this we observe a holistic approach it takes in addressing the patients problem. Unlike orthodox treatment that focuses killing the pathogens or bacteria that cause the uterine wall contract inappropriately, it focuses on restoring the uterine wall to its original state and in a position of ability to counter the pathogens by itself. This enhances its success rate as unlike orthodox medicine that might in deed kill the pathogens but fail to restore the uterus to the position of ability to bear pregnancy.

While OM has put lots of focus on studying the diseased part and how to kill the pathogens that cause these disease, TCM has taken another approach using herbs to restore the affected parts. OM takes a lot of time conducting analysis to identify the nature of the invading organism. X-rays, cat scans, series of blood tests, stool tests among others are conducted on daily basis the main aim being arriving at a diagnosis. Lists of symptoms have been developed over time that acts as reference points for orthodox doctorsnurses to give diagnosis. This has led to increased misdiagnosis as at times even the patients cannot clear account for the symptoms they experience. In general the doctor patient relationship is minimal. However, in TCM doctors have some form of sensitivity to the patients. They have an attachment to their patients problems they exhibit a high degree of concentration to the problems encountered by the patient. Through simple listening and observation they tell things that orthodox doctors seem to care less about. Their conviction to their patients can only be termed as magical. It may be summarized that diagnosis is not guided by the symptom in the picture but more by the doctor instinctual understanding of the patients.The simple approach to complementary medicine is based on a philosophy of being able to support orthodox medicine attempt to disease treatment or alternatively support the patients life while still under treatment. A good example is the case of irritable bowel syndrome, acupuncture treatment would be used to relive the pain or herbal medicine is used to alleviate spasm. In this case the TCM will have been applied to treat the ailment just like orthodox technique. However, TCM goes further to ensure that the bowels are restored to their original position which leaves one wondering whether actually it is complementary of can stand on its own. However, this could be countered by the technological advancement so far achieved in orthodox techniques of which TCM has to at times borrow hence making it indeed complementary.TCM as a discipline have their own diagnostic framework which differs greatly to that of OM. It at times uses relativity as its measure e.g. by comparing the uterus to the fallopian tube and saying that since the fallopian tube if functioning more efficiently than the uterus then it will concentrate on improving the functioning of the uterus. This is quite contrary to what happens in OM application. It argues that the mind, body and spirit all have innate drive towards attaining improved health.Acupuncture follows four basic modalities which include osteopathy, chiropractic, homeopathy and medicine. Acupuncture follows diagnosis different from the ones defined in OM. There are those acupuncturists who treat symptoms and other s who recommend applicable immunizations to the patients. TCM recognizes some of the elements that the body may lack hence resulting to inability to conceive. The body is duly fed with these nutrients through the herbs continuously and appropriately in order to aid the facilities that enhance fertility.  The red clover blossom for instance supplies vitamins, calcium and magnesium thus nourishing the uterus and relaxing the nervous system thus helping in promoting infertility this is even in line with research by Liz Collins who stated in his research that by giving about 100 to 200 IU of vitamin E per day increases the fertility rate amongst couples.

In terms of technological advancement though, TCM still borrows a lot from the orthodox approach to health issues. Orthodox means have over time enhanced invested much in technology to solve problems that have other wise always remained insolvable to The TCM. An example is cases where hearing aid devices were applied by The TCM doctors in trying to establish sound variations. While they take different approaches, each at times has had to borrow from the other.

TCM also offers supplements to women in a bid to enhance fertility. Though there methods of application differ here, they seeming take a similar approach. Orthodox medicine applies the use of pharmaceutical drugs that supplement the required nutrients while TCM in a bid to supply the same nutrients offer herbs that offer them. Herbs like Dong Quai are used to offer the extra vitamin nutrients that are required to help reduce infertility. However, one case that makes them distinct is the side effects. The research established that herbal medicine have minimal side effects and in instances where they appear they mainly are a result of either the patient not following the right instructions or failure to complete the directive. However, the high percentage of success rate should not be misconstrued as an astonishing success rate and have women trooping to these clinics at the expense of the orthodox one. The results used in calculation of these percentages were mainly based on those who completed the treatment regime. Basically those who quit along the way were unaccounted for and hence were not factored in during the final calculations and as we all know mostly its the winning team that stay put till the finals.probably if all the factors had been considered then the results would have given an other wise lower percentage.

Orthodox Medicine

Orthodox medicine usage has mainly been based on scientific medicine inventions mainly relying on pharmaceutical drugs. This type of medicine approach has over time been mainly based on interventionism rather that vitality, and symptoms.  Its main objective seems to be based on supporting the basic inbuilt body healing systems. This may be perceived as active engagement on health problem fixation. It seeks to fix the problem or repair it in a way.

The ability of the body to resist drugs is believed to a result of its own innate vitality. However, orthodox medicine fails to address these issues but instead focuses more on killing the pathogens that cause disease.
After observation and analysis it was established that TCM basically uses the following techniques for treatment

Acupuncture,
Chinese food therapy these involve dietary restrictions that patients are placed on by considering hisher condition.

Chinese herbal medicine this is basically through making of herbal formulas that rectify specific conditions. Once the specialist identifies the patients ailment, a special decoction is made to help restore the affected organ, body health as well as treatment of the ailment itself through use of herbs.
Cupping this is a form of Chinese massage. Its generally used to offer what is termed as reverse pressure massage it applies the suction technique and body oil to allow it slide across the back.
Qigong this has to do with breathing and mediation exercises.
GENERAL DISCUSSION
The Herbs Used To Aid Fertility

During the study I note d that there exists no individual herb that can be used independently in promotion of infertility. There exist more than 150 different herbs that possess medicinal values. Complex formulas usually comprising up to 15 different herbs are made to attend to a specific ailment. This is mainly a result of its holistic approach to treatment that not only focuses on the disease but on the general body health. However no specific guidelines exist as to the specific formula preparation with each specialist having hisher own preference as to the formula to use. The specialists however argue that this is due to the fact they believe that different individuals have different ailment conditions and when similar, the intensity differs.
The research established that the herbs are basically obtained form TCM experts who have acquired skills over the years that enable them to prescribe to their patients. However in the recent past, these herbal medicines are available off the shelves of various drug stores.

Rate of success associated with the herbs

This research identified that rate of success of these medicine to be a high as 91 . this contrasted what reviewed literature had suggested that is 70 on average. However we mst acknowledge that most researches on the same have put the value at between 50 and 90 which is in line with the findings of this research. The success rates in china however are very hogh as compared to other nations given that its an experience that has been accumulated over the years and chances of misdiagnoses are negligible if not non-existent.

Treatment regime duration

A talk with the specialists revealed that treatment period varies from one condition to another. However, from their scoope of experience, it was revealed that usually if pregnancy is not attained after nine months of treatment then probably the possibility of achieving it will have moved to nil. The period also according to the specialists is dependant on dosage administered.

One consolation that people find in this treatment process is that even if pregnancy is not achieved after full treatment regime, at least the overall individual health will have been obtained.

Herbal safety

Response from various persons who were or had previously used Chinese medicines revealed that its side effects are at a very low percentage and could only come as a result of the patient in question failing to keep by the stipulated guidelines of the physician. Previous results have also revealed that children born after these treatments usually have food health at birth and are free of any abnormalities which may be associated by the modern pharmaceutical drugs. This is a result of the vast experience wielded by the physicians handling these illnesses.

Allergic reactions are rare except for instances where individuals may be suffering from environmental allergy syndrome.

Action mechanisms

The mechanisms vary according the problem of infertility in that case. The mechanism used basically is dependant on fertility problem and the herb formula used. There is widespread belief that the number of problems involved is proportional to the level of infertility exhibited.
Chinese medicine believes that its underlying imbalances that results into infertility. it follows therefore that by correcting this underlying imbalances, fertility can be achieved. This is basically what determines the mechanism to be employed. It is based on this that there exists no perfect guideline as to the prescribed mechanism to be used.

With the evolving world, the practice of combining Chinese medicine with western form of medicine is a regular occurrence. Some doctors have even received training on both and in some instances they work together in hospitals and clinics.

Limitations

However Chinese medicine has not just escaped without failure. There have been some cases where the chances of success are reduced e.g. for the case of anorrhea. This is a condition that would require strenuous accident before Chinese medicine can be actually used. Individuals exhibiting a high level of stress as well as multiple health problems usually require that these problems are first addressed before TCM is applied.

Herbal use after pregnancy

The herbs usage is generally discontinued upon pregnancy confirmation except in cases where miscarriages may be expected and there is need for use herbs that serve the purpose of maintaining the pregnancy. There are also certain herbs that can be used to maintain the mothers health  and counteract other effects like morning sickness.Acupuncture therapy also addresses other areas of concern that are either directly or indirectly related to infertility but may play a critical role in speeding up fertility and hence in cases of functional disorders, acupuncture could be independently used.
In general, Chinese medicine practically solves most of the cases of infertility adequately through means that apply little if any use of technology.

This chapter draws conclusions regarding the results obtained after which it will finally offer viable recommendations on the subject of TCM and acupuncture in improvement if infertility.
Infertility and Chinese Medicine
Use of acupuncture and Chinese medicine has yielded encouraging results among the Chinese and also in other countries where TCM has been applied. It addresses infertility by restoration of proper blood circulation, optimal hormonal balance and creates a conducive environment for development of life.
Conception difficulties have been known to normally originate from hormonal imbalance, metabolic imbalance and poor blood circulation. Chinese medicine detects stress body weaknesses and assesses underlying hormonal imbalances. The practitioners take time to understand ten he patients, identifying the patterns underlying her problems and successfully treat it.
TCM and acupuncture enhance fertility through the following ways listed below
Menstrual cycle regulation
FSH and hormone levels regulation.
Increased blood flow to the uterus
Libido increment
Blocked fallopian tube correction.
Enhancing response to IVF
Mind and body relaxation.
Miscarriage prevention.

Such infertility cases may arise from various factors which include advanced age, disposition, poor diet, overwork, inadequate rest and exercise, illness, nutritional deficiencies, and metabolic imbalances.
It has over time worked effectively where conventional medicine has failed. Comprehensive diagnosis reveals to the practitioners the direction to take in diagnosis.
TCM and acupuncture specialist recommend the following for one to be able to maintain good health
One should desist from meals that predominantly consist of sugar and starch, fruits and fruit juices in large and lastly polyunsaturated oils.
Individuals should eat more eggs, fish, meat and poultry in good quantities to supply the body with more proteins.

Engage in regular exercises both aerobic and anaerobic.
 Avoid use of stimulants e.g. nicotine, caffeine and refined sugars.
Avoid use of drugs as well as alcohol.
Increase consumption of mineral water.
One should get enough sleep.

Chinese Medicine Acupuncture Fertility, Herbal Fertility
From the research results, it is clear that Chinese medicine is effective in treatment of infertility amongst women.  Acupuncture as depicted by the research by pacific college is capable of increasing the chances of one getting pregnant by far much percentage as compared to western techniques like the in-vitro fertilization. Reliance on herbal medicine by Chinese medical practitioners can therefore not be said to be in vain as it results and positive and worth worldwide adoption. Combination of both herbs and acupuncture yields more extensive results than has been ever imagined. They have proved to be a more effective way of natural conception facilitation.

Chinese Herbs for Male and Female Infertility
While this research focused more on women, it could not escape the fact that up to 50 of infertility cases require both parties participation. Chinese medicine ostensible addresses both cases of infertility. From the research, they can be used to raise both testosterone levels as well as sperm count. For the case of women they regulate hormones, stimulate ovulation and correct any existing nutritional deficiencies that may hinder pregnancy. The herbs focus on creating more hospitable environments for fertilization and consequently development of the baby.

It will be important to note that some of these problems area result of use of conventional fertility drugs. Additionally they unlike the conventional drugs have negligible side effects.
Greater Fertility when Combining East and West
In some instances where there exist problems regarding structure, in-vitro fertilization may be the only options as the TCM methods would only produce false hopes. In such an instance it may be appropriate to combine both in order to obtain successful results.
A study conducted at the Pacific College of Oriental Medicine revealed that combination of western techniques and TCMacupuncture could yield more positive results as compared to western technology (Qu, 2004 491). The study obtained the results shown below
Fertility Success RatesIn-Vitro Fertilization(IVF) OnlyFertility Acupuncture protocol plus IVF26.342.5Limitations of the Study

During the study some difficulties were encountered. This included the following
Finance the study in order to yield more accurate results would have required adequate financing order to involve more people o a face to face interview. This would have increased the study sample thereby producing a more representative result.

Insecure responses given that the questionnaires were posted over the internet, some people filled them insincerely or just for fun. This called for spending of more time screening in order to minimize the effect of insincere results.

Research ethics the ethics guiding research activities could not allow easy access to patients as case study. The patients had to be requested to allow there searchers presence and this was note easily acceptable to most of the patients.

The TCM doctors excessive support for their medicine The specialists in TCM focused more on amassing praises to their practices and at times getting the negative aspects of TCM was not easily possible as they seems to have a belief that their practice offered the perfect solution to the problem of infertility.
Unavailable documentation on TCM There was very little documented information regarding exact practices of TCM. However acupuncture information was more readily available.
Time constraint there seemed to exist no clear pattern of application of these practices hence more time was required in order to develop more accurate results.

There seem to exist need to learn more about TCM as it could provide hidden solutions to problems that have remained elusive to scientists over time.

Clear policies and guidelines should be developed to guide these practices in order to bar dupes from reaping off profits from unsuspecting customers.

Western medicine techniques should be incorporated to help meet the inadequacies exhibited by TCM as a subject.

More money should be channeled to TCM in order to help it explore the policies of health reinstatement rather than the current trend that channels most of the money to curative practices and research aimed at developing curative means.

Proper structures for developing placebo control groups in acupuncture should be incorporated to enhance results.

Acupuncture requires more training of its providers other than their normal experiences.

The aim of this paper is to investigate the different ethical issues that arise within the medical profession and the difficult decisions that medical practitioners have to make each and every single day in their line of duty. This paper will be looking at the concept of procedure versus ethics, morals versus the norm. This paper should be able to shed light on such difficult situations and even give examples of how to deal with them.

There is the case of a patient who came from abroad and was later diagnosed to be HIV positive. He also has a partner and children who do not know about it and he is also bisexual. He only confides in me as a long time friend and I have been treating him for depression and pain for the past two years. Now, should I let the authorities know or just keep it under wraps This type of dilemma or situation, is common in the medical field with always the presence of a situation where a medical practitioner has to chose to do what is medically correct or morally correct. Thus studying judgments and moral values in relation to medicine is a field of applying ethics and this is called medical ethics. There are a couple of ethical values that normally apply in the medical and practitioners work, such as autonomy, justice, beneficence, dignity, non-maleficence and honesty. In this paper, in relation to the above case of the HIV positive patient, we are going to look at the four prima facie moral commitments. The four principles is a simple and most culturally acceptable way of approaching such issues that require ethical decisions in health care. It was developed in the United States of America, and it involved four moral commitments beneficence, justice, respect for autonomy and non-maleficence. There is also the concern about the scope of application of these basic principles. It is important to note thought that these principles do not offer an order, but instead they are just a guiding principle for members of the medical profession, in aiding them in making decisions that may arise in their work concerning moral issues. These four principles state that whatever our religion, race, or political take, a medical practitioner will find no problem in committing him or herself to the basic moral principles and being concerned about their application (Adshead, G 2000, pp 302-304).
   
Prima facie was a term which was introduced by a certain man named W D Ross, who happened to be an English Philosopher. Prima facie means that unless the principle is in conflict with another principle, then it is binding, but in the case where is a conflict in the principles, then the medical practitioner has to chose one. Since the four moral principles do not present a method or formula for showing what is to be done or what is right, some people have been against it, since they have been expecting a method by which you just apply it directly, the same way one would enter a problem into an algorithm and obtain an answer automatically. The scope and principles can only provide the medical practitioner with is a set of moral commitments which can aid him  her in coming to an ethical decision using the preferred approach to chose whenever there is a conflict in these moral principles (Gardiner, P 2003, pp 297-302).
   
The first moral principle is the respect for autonomy. The word autonomy, means a deliberated self rule and it is considered a special attribute to be owned by moral agents. With the presence of autonomy within the medical practitioners, then they can be able to make decisions based on deliberation. Respect for autonomy is concerned with the respect for the autonomy of the patients, in relation to the respect for all the other parties affected. This is a moral obligation, and thus involves treating individuals as as ends in themselves and never treating them as as just a means. Respecting an individuals autonomy especially in the medical field has many prima facie meanings. One of the requirements is consulting such patients and obtaining their consent before doing anything to them. Thus it involves an obligation to get an informed agreement from the patient before offering medical help or assistance. Another implication for the respect of the autonomy of individuals is the need for medical confidentiality (Tsai, D F-C 2001, pp 44-50). There is no general or legal obligation that health professionals have to keep the work that have done on patients confidential, but there is the promise to the patients themselves that their clinical visits information and details will be kept confidential. This promise to keep the information confidential is a means of respecting the patients autonomy, and it provides a leeway for the patient to be bale to trust the medical practitioner and also be able to give more information, owing to that trust, that will enable the doctor to be able to assist him  her much more better. Without such promises and keeping them, it would be difficult for the patients to divulge their sensitive information which is private and important to the doctor, thus confidentiality apart from building the trust and respecting the autonomy of the patient, also goes a long way in assisting the medical practitioner in assisting the patient (American Medical Association 2006, pp 56-98).
   
The lack of deceit is also an important factor of respect for autonomy and it is valued by moral agents. Such moral agents feel that their autonomy is broken when they are deceived since they usually live their lives assuming that they will not be lied to. Thus the prima facie behind the respect for this autonomy requires those in the medical profession not to lie to their patients, about the diagnosis, for example, without the patient clearly showing or stating that they need to be deceived. Keeping time on appointments is also a form of respect for autonomy, as it is by extension a promise made to the patient and not keeping time is breaking of that promise that was made to the patient. In order to exercise the respect for autonomy, medical practitioners should be able to effectively communicate with their patients. Good communication not only entails the ability to listen well, but also the ability to speak well to the patient and for the patient to be able to understand you as the doctor, in a bid to know if the patient wants a certain medical intervention to be implemented or not (Sim, J 1998, pp 3-10). Good communication is also important to the patients, as some patients do not wish to be given the finer details of their prognosis, or some do not wish to be involved in the decision making of the various options that they have for treatment, but would rather leave that decision to their doctors. In the case of our patient diagnosed with HIV, in respect for the autonomy of the patient, it would be more advisable to tell the patient that he will have to inform his family, not only because it is right, but also to be able to get the support from them and also he should do so to protect his family. In the case of the authorities, I would tell the patient that it is my duty to inform the authorities of his condition, since it is more than a moral obligation, but rather now it is a legal one. Thus I would advice the patient of my situation and the consequences that I might face if I do not inform the authorities of his condition. When there is a conflict in moral decision and a legal on, it is advisable to chose the legal one, since legal decisions are more binding as compared to the moral ones (Duncan, P 1999, pp 249-258).
   
In the medical profession whenever a doctor aims to help a patient, there is also a chance that he  she might actually do more harm to the patient. This is where the principle of beneficence and non-maleficence comes in, where there has to be a more benefit as compared to harm. This is in line with the Hippocratic moral obligation which in essence is in the support of providing net benefit with minimal harm to all patients, which in essence means, beneficence with non-maleficence. In the pursuit of the achievement of these moral obligations, workers in the medical field are normally faced with prima facie obligations. To provide this, doctors should be able to provide the medical professionalism that they promise the patient they can offer, through serious training before and even during the doctors professional life. Also the offering of each patient net benefit should be top priority. Also the respect for the patients autonomy is important, but care has to be taken since what may be of benefit to that patient in one way, may be harmful to the same patient in a different manner. In this case of the HIV positive patient, it is difficult to decide whether to inform the authorities of his condition, and ultimately his family, and thus this causes a dilemma of sorts. Telling the family will be of benefit to the health of the patient and his partner, but may be harmful to his relationship, considering the bisexual factor of the patient. This is where as the doctor, I have to measure the benefit over the harm, and make my decision based on the beneficence and non-maleficence. Making such decisions also requires us as doctors to be able to weigh the risks and the probabilities involved in our medical assessments. In line of these two moral concepts that I have discussed, that is respect for autonomy and beneficence and non-maleficence, there has been proposals to introduce another one that is connecting these two principles and it is known as empowerment which involves doing more to help the patients to be able to do more in regards to their health (Cox, D 1995, pp 261c-262).
   
Justice is the fourth moral principle that is prima facie. This moral principal advocates for fairness in making of decisions where there is a conflict in choices to be made by the medical practitioner. There has been a division of the justice obligations into three categories namely, respect for the rights of the patient also known as rights based justice, there is also the distribution of scarce resources fairly also known as the distributive justice and legal justice which is the respect for the laws that are acceptable morally (Macklin, R 2003, pp 275-280). The moral strategy for justice in relation to the HIV patient is to find out whether it should be me first or the law who has to make the decision. How I am to respond to the patients request not to disclose this information to his immediate family and the relevant authorities, is distinct from the governments policy on immigrants change in HIV status. Also important is what is medical professions view on disclosing this information to the family and the relevant authorities. Lastly it was important to note the societys take or view on this situation, and if it is right for me to disclose the information. There is also the argument that it is not my role as the doctor to punish this patient due to his sexual orientation, by refusing to offer him medication, or discriminate against him. The respect for my patients rights is also very important. If

I am to disapprove of my patients sexual behavior and or orientation, it would be morally unacceptable. Going back to the fact that I should be able to accept the laws acceptable morally, I will have to break the confidence of my patient by informing the relevant authorities, especially since this is a case of an infectious disease. This is due to the legal obligations that I have. But it is also important to note that if I feel that the law is not justified morally, then I am entitled morally of course to break it, but it doesnt give me the legal entitlement to do so, and thus the legal consequences that come with the breaking of the law will be mine to face. Thus the information had to be passed on to the relevant authorities, since it was morally acceptable, and a legal obligation (Benson, J, Britten N 1996, pp 729-737).
   
There is also the case of the policies of the organization, society or profession. For example the hospital that I work for, have it clear in their policy regarding the transmission of HIV to immigrants that the authorities have to be informed. As a member of staff in that medical facility, I a may have argued that it is paramount that in some cases the information be kept confidential, but my arguments were not heeded to. As a member of the hospital staff, I am obliged to inform the relevant authorities since it is what is morally acceptable (Meddings, F, Haith-Cooper, M 2008, pp 52-61).
   
The scope of application of these medical ethics is still a bone of contention within the medical profession, with concerns rising about who and what these moral obligations are owed. For example the duty of beneficence is not owed to anyone and everyone, thus the question arises of who exactly do we owe this moral obligation and to what extent should we be wiling to assist them The non-maleficence factor of not harming anyone should be applied to not harming anyone, but who is anyone The aspect of respect for the autonomy of patients involves autonomous individuals, but who is an autonomous individual
   
Some of the questions can be answered automatically, for example, all the patients of the health worker falls in the medical practitioners duty of beneficence. This is usually clarified thanks to the special relationship that exists between the patients and the medical professionals. It is also clarified thanks to the legal and personal commitments that are made thanks to the societies in which these medical practitioners practice. In the issue of autonomous individuals, it is clear that a severely ill mental patient, or a newly born baby, cannot qualify as an autonomous agent. This is due to the fact that autonomy as I mentioned before, requires the ability of these patients to be able to deliberate. In this case, it is normally wise to find someone to make the decisions for the patient (Geppert, C M. A, Andrews, M R, Druyan, M E 2010, pp 79-88).
   
Definitely, all theories, philosophies, principles and policies have always had their fair share of critics, and these moral principles are not spared either. The medical ethics do not offer a solution to the dealing with conflicts. It is equally important to note that in my research, I am yet to find a critic requiring more principals added on to the already mentioned ones. These medical ethical values offer medical practitioners with a basic guide on dealing with moral ethical  issues especially in the medical field. Since the approaches are neutral in all religious, political or even cultural ways, it is applicable to all societies, no matter which background they come from. Thus in the case of the HIV patient that I had be

This paper talks about acupuncture and its growing importance in the field of health care in contemporary times. The paper focuses its attention on the research and reports on the national market trends for acupuncture. It discusses the opportunities to open the practice and why along with where do the best job opportunities for acupuncturists exist As conclusion, it talks about the future of acupuncture by talking about its future outlook and what is being done to open new doors for the acupuncture program today and as plans being formulated to do the same in future.

Acupuncture is a kind of therapy aimed at promoting health and freeing a person from excess pain and suffering. It is a method which has been being used since the past thousands of years as a therapy have energetic balance, healing and create vital energy in the body through the triggering of certain points on the body. These points are also called meridians or acupoints, which are stimulated in acupuncture with the help if very sharp needles and sometimes, herbs, electricity, lasers and even magnetic energy is used in combination. The entire point is relieving the person of something and making sure vital energy reached areas where it is needed at the correct time and place so that healing can automatically occur. (Chinese-School, n.d.)

National Market Trends for Acupuncture
   
In America, there are many established standards for acupuncture, which have been there for the last twenty five years or so. There has been a lot of training offered too since the eighties in around fifty schools or more that are recognized by the official partner  the Accreditation Commission for Acupuncture and Oriental Medicine. In many schools hence it is proper, formal four year program that teaches the art of acupuncture. The National Acupuncture Foundation has said that the number of licensed practitioners has now increased to a surprising 59 from 5,525 in 1992 to 22,671 in 2004 Now, there are around forty four states in the United States of America that have gained the status of official acupuncture practitioners.

The future of acupuncture in the US tells that people have started to look for therapies that are alternatives to regular expensive medicinal procedures and drug therapies. Therefore, acupuncture remains a good choice for these people. Integration, more and more of it can also be seen as practitioners combine their therapies with acupuncture to further stress upon the efficiency of whatever method as solution to a disease  problem the patient is suffering from through the integrative therapy. A leading market research company known as the Hartman Group said that Acupuncture will become a Mainstream Modality for Pain Management. This was back in 2005, and as history tells us it has been fairly true (Stewart, n.d.)

Job opportunities in Acupuncture

In America, it is highly important that you do thorough research about where you want to locate or practice as an acupuncturist. There is a scarcity of opportunities in this country because of the lack of resources generally available to graduates of acupuncture. The education costs a lot and hence the graduate needs to find a job as soon as he or she graduates so to start getting return on that investment. However, the case that he or she sees only is that there is an option of opening up a private practice or going solo. What a graduate needs to do is

Have someone as a mentor, who has a lot of experience in the field and has been successful in his endeavors as an acupuncturist.

Be smart about learning and doing what you want to do
Collaborate with someone you think will lead to something inspiring and helpful.
Have support from the environment you are in or the community you are a part of
Make sure everything is a learning experience and do not lose hope
Team work is very fruitful  be it part of your professional career or inside the college as part of your degree learning programme.

Look for opportunities all the time by doing a lot of networking, being in contact with wellness centers and being in touch with the alumni from your college  school and other schools websites. (Doherty, n.d.)
   
Even though it is said that the job outlook for acupuncturist is very low and there are low number of resources available in this field or area of therapy  we can still say that the situation is a lot better than what it was like before. It is said that now increasingly more and more doctors are prescribing acupuncture as a healing aid and its acceptance as a therapeutic ailment is greatly increasing. This increase has been indicative of through the fact that many insurance companies have now proposed packages that include acupuncture therapies to their plans. Generally, there are practitioners of acupuncture or acupuncturists that operate privately by having a private practice in the form of clinics. But, again there are many who work under doctors and aid his work through integrated treatments, as mentioned earlier. These are a few of the career opportunities that exist for acupuncturists. Many states have introduced the legislation to legally practice acupuncture, including New York, Oregon, Florida, California and Massachusetts.

The range of return that one gets through working in the field of acupuncture can actually varying depend on what form of practice that the person has  for instance private practice, or working under an MD, or if there is a salary or wage involved or not. Overall, the salary amounts to around forty thousand dollars each year to even sixty to sixty five thousand dollars each year. The health care market has made acupuncture great career choice in contemporary times. It is said that in Canada, acupuncture can be seen to be the future growth or boom areas in the field of health care. It is advisable that whatever degree one gets in this field  a lot of research coupled with appropriate training is done so that there is success in pursuing it as a career eventually. (Hecker, n.d.)

What is being done to open new doors for the acupuncture program
There has been the development of mechanistic models for acupuncture effects further as the field has now being taken seriously. The effects of the acupuncture needles having stimulation on the body  nervous system, tissue and muscles is said to be a primary focus among the many different developments occurring in the field of health care and those that have been predicted for the future too. The future of acupuncture hence stands to be prominent and bright as a lot of research is now being carried out in this area to have more and more developments. The future also lies in iterative testing, expanding, manual stimulation, electric stimulation etc. that are the talk of the health care physicians when they talk about its future as related to being deeply set in the field of physiology. (Altern, 2008) More and more licensing efforts can be predicted as well.

With respect to how new doors are being opened for acupuncture in future, the following come to mind
Research Like mentioned above there are many EBMs or evidence based medicine related research initiatives to be taken in the future since this stands to be a promising field. There will be changes to this EBM so that technicians who are not that well trained can manage front line medical care as well. Research products are predicted to be created by China and within ten years it can be predicted that it will be able to compete with the U.S. strong hold in the health care or science industry. (Morris, 2010)

Lower costs driving growth Acupuncture generally lowers costs since hospital stays are shortened and there are not any very expensive drugs or medicines that are used in combination as part of the acupuncture therapy. However, in future it is expected that the system of reimbursement will change so that there is profit generated from acupuncture activities in hospitals too. (Morris, 2010)

Evolving business models The importance of occupational medicine will greatly increase in the eyes of even those companies like Whole Foods, Apple etc. This is to suggest that more and more people will notice its advancements and take charge. (Morris, 2010)

Education It is expected that in ten to twenty years, more and more acupuncturists will have doctoral titles and easy upgrade paths in their careers. Also, due to more advancement in research and education in this field there will be collaborations with the health care industry on the whole like pharmacists, therapists, health professionals etc. (Morris, 2010)   

This purpose of this paper is to analyze spread of ayahuasca and peyote religion in United States and in the world. There has been development of the religious movements that incorporates plant extracts which are hallucinogenic as a sacrament thus developing highly forms of religious ceremony.

Ayahuasca and peyote in United States and in the world
Ayahuasca and peyote religions do not provoke persecution and controversy in United States and in the world, between the pharmacologists, psychologists and botanists. Ayahuasca and peyote religions were condemned initially because of their satanic mystery but with the change in the communities the use of ayahuasca and peyote is highly embraced. Peyote plays sacramental or religious role in Mexico among the Indians. Ayuasca is any of the psychoactive decoctions that are prepared from the Banisteriopsis spp. Vine. Banisteriopsis species are native to the Amazon rainforest that is also called ayahuasca. Ayahuasca is used to make pharmacologically complex drugs that are used for religious, shamanic and folk medicinal purposes.
Ayahuasca is a narcotic that affects central nervous system (Salak 54). Ayahuasca produce effects on human perception that are remarkable. The user gets repeated encounters by animals and feels like flying. These effects are due to the action of harmaline which is a very stable indole. Harmaline is believed to treat chronic cocaine and addiction (Bennett and Osbourn 158). Western psychologists and physicians have acknowledged that entheogenic substances like peyote and ayahuasca can access to spiritual and non-ordinary consciousness dimensions. Brazilian churches have thousand of religion followers including in Europe and in Europe (Salak 54).

 Amazonian residents brew ayahuasca during special recipes by cooking tea the whole day in open pots (Ross and Howard 118).Amazonian traditional healing practices include drinking of ayahuasca combined with a diet that is highly restrictive thus curing both psychological and physical illnesses. These combinations remove poisonous infections and counteract sorcery. Ayuasca has positive effects on the person psychologically after inducing ayahuasca ritually. Ayahuasca interacts with the neural system central to the emotional processing and interception and point to role of modular in neurotransmission in these processes. Members of peyote-using Native American church in united states and UDV, Brazilian hoasca church shows that users of ayahuasca for a longtime change positively in their behavior after participating in religious ceremonies.

 The principal part of the religious ceremonies consists of a dance and prayers which is followed by feasting period. Psychological, shamanic and pharmacological effects cannot be separated. In the western countries there are healing retreats that are conducted in the South America. Scientific study and reports states that religious rituals that are related to the use of ayahuasca improve physical and mental health. There are various psychic reasons as to why people drink ayahuasca drink and these were to learn the truth about a lover, to gain knowledge in strategy to help in the tribal diplomacy (Salak 54). Ayahuasca healers are believed to diagnose diseases and give medicine to the patients. Ayuasca drink is not a recreational drug but it is given to individuals who want to improve their health.

To confirm an individual commitment to the plant, a strict diet is given to the person. Three days to the ritual, individuals must observe both behavioral and dietary prescriptions, they must also observe hierarchical organization of the commander responsible for maintenance of obedience and they must control the dosage of the drink by the participants. In the United States there is renewal in the studies that a focus on humans due to changes in science and technology animals were used in experimental studies that proved the ayahuasca and peyote are useful for the pharmacology of human.

Molecular biology and advances in technology aided in understanding the functioning and the brain sites that are affected by the hallucinogens. Magnetic resonance Imaging and Positron Emission Tomography scanning techniques are used to scan the brain sites affected by the hallucinogens (Wilner 40). Through advanced molecular biology the functioning of the neurotransmitters is known. Conscious political attitude help to regulate drug abuse in United States. Ayahuasca and peyote in United States is legalized as long as an experimental scientific design is well reasoned, there must be collaboration between a drug company and the manufacturer and funding from the agencies from outside are encouraged as they increase credibility. Ayahuasca is believed to facilitate introspection and self knowledge.

To prepare ayahuasca drink, sections of veins are cut and boiled with the Psychotria viridis leaf. The drink is then stored until it is needed for the ceremony. The resulting brew contains Monoamine oxidase inhibiting harmala alkaloids and a hallucinogenic alkaloid called N, N-dimethyltryptamine (DMT) that can be measured in the individuals plasma after administration of ayahuasca (Ross and Howard 118). In United States the plant from which ayahuasca is made is legal but some of the substances that they contain like DMT are illegal. Raimundo Irineu Serra started religion of the rainforest also called Santo Daime. The religion has spread to North America and Europe.

Entheogen recognize the element of access to the religious issues. Due to the fact that the people from North America and North America can join various ayahuasca ceremonies, this shows that there is discontinuity of values between the industrialized countries and the values in traditional beliefs and practitioners. Despite the effects of the ayahuasca and peyote to the body, acquisition and use of ayahuasca and peyote in the United States are illegal unless if they are used for religious purposes (Bennett and Osbourn 158).
There are various religions that are connected to ayahuasca and peyote and these include Indian shamanism, catholism and spiritism. To be recognized as a legitimate religion, peyote and ayahuasca religions had an outreach program to reach the community as a large, had a liturgy during which sacramental substance was to be offered, a sacramental substance that was specified, commitment to consume the sacramental substance for religious purposes only, a controlled setting to protect the followers and the religion were non profit corporate base (Ott 177). Both the Amazonian shamans and westerners team up and create a contemporary breed with the peyote and ayahuasca as important part of the genetic heritage. It has been shown that the ayahuasca enhances ability of the body to absorb serotonin. 

Consumption of ayahuasca with other medicines leads to high blood pressure or heart conditions. It is important to consult medical help if an individual is taking antidepressants that affect serotonin levels as serotonin selective re-uptake inhibitors block uptake of serotonin in the brain because serotonin breakdown is inhibited by monoamine oxidase inhibitors. Herbal remedies should also be avoided as they influence levels of serotonin. Non prescription medicines, like antihistamines or natural herbal medicines like caffeine should be discontinued prior to working with the ayahuasca. During the ceremony, alcohol, recreational drugs should be avoided. This shows that there is joint association between the trained medical practitioners and the ayahuasca and peyote religion.

In conclusion, it is evident that United States has embraced ayahuasca and peyote religions. Ayahuasca and peyote religions are medico-religious cults. Legal developments have opened doors to religious freedom in the United States. Religious Freedom Restoration Act of 1993 changed the visionary of the Americans after UDV gained legal victory. Ease of the legal suppliers of the hallucinogen, end of the intertribal warfare, lack of federal constraint and exchange of both the religious and social ideas peacefully lead to growth and expansion of the ayahuasca and peyote religion in the United States and in the world.