one step at a time…

I have seen roughly 4000 patients in the last year working as a community acupunk. This number presumes an average of 16 patients per day (over a 4 hour shift), 5 days per week for 50 weeks. That is a figure with some close approximation to reality; and, as such, it reminds me of how many times I share simple analogies about how I have come to understand and interpret acupuncture with my patients.

Observing how my patients respond to community acupuncture over the past 4 years has shifted my thinking about how acupuncture affects people. I have moved away from the assumption that receiving acupuncture is similar to receiving a medical treatment and instead moved toward the idea of comparing acu to participating in an exercise class. If I think of an acupuncture session as similar to participating in a yoga class, as one example of exercise, I find I can describe consistent similarities with ease.

When I think about what I will likely get out of participating in a yoga class, I think of stress relief, relaxed muscles, increased circulation, improved general energy, and a slight rise in mood. I do not expect my current state of mental and physical tension to be resolved by one yoga class, or even in three or four yoga classes; instead, I recognize that regular exercise is widely known to be beneficial by producing consistent and stabilizing gains over time. The benefits are small at first but if the exercises are done consistently these small gains build upon each other and become very significant and even predicable in their reach. Things like temperament and overall frame of mind tend to become more stable with consistent weekly or bi-weekly acupuncture, just as with exercise. Each experience releases stored mental and physical tensions that build up from the many stresses that make up our daily lives. In thinking about the impact and reach of one single acupuncture treatment, I like to think of the almost lonely feeling that stirs in me when I visualize participating in only one exercise class in hopes of mental and physical relief. Acupuncture treatments, like exercise classes are more of a lifestyle choice; a local, community oriented, affordable, stress management lifestyle choice. They are easy to receive and can be a remarkably stabilizing and powerful support in anyone’s life when experienced consistently over time.

I like to visualize information, and there is another simple way that I picture acupuncture that is a little more mechanical. If you picture a pot of water with a lid on it resting on a hot stove element and starting to build up steam, you can probably guess at my analogy. The pot of water is our body-mind; the heating element is stress in our lives; the bubbles in the water are indications of increased stress-pressure affecting the body-mind; and, steam shooting out at the edge of the pot lid, resulting from a slow or fast build up of stress, could be any of the myriad symptoms that result from acute or chronic stress.

I think of people as pressure cookers in one form or another. We are under a multitude of stressors from our internal and external environments day and night, and we have no choice but to respond somehow to these stress signals. It is as if we have mental and physical pressure in our body system that builds up from the day-to-day stresses in much the same way that a pot of water can develop a rolling boil and plumes of spitting steam if left unattended on a hot element.

So, stress, or the heating element in this analogy, never goes away. The heat is always on so to speak in our lives. How we choose to cope with the pressure that builds up from this constant stress is the main determining factor in health or relative dis-ease in body and mind. Now, as with stress, the heating element is sometimes hotter than usual. This added heat causes pressure to build up faster than usual, which means symptoms are far more intense for that period. The level of stress, or heat in the analogy, determines the quickness of pressure build up in the system.

Acupuncture appears to be one way to release an increment of pressure from the body–mind system and that seems to be what is so great about it. Some symptom of dis-harmony, or too much pressure built up, will eventually surface if we continually build up pressure in our system and don’t find ways to release this same pressure.

So, in a way acupuncture is not all that special, and yet it is one great way to release tension, increment at a time, to help the body-mind heal. Re-establishing balance in the pressurized body-mind system seems to be like jostling the lid on the pot of water. As acupunks, we either move the lid a little to release a little pressure or a lot to release lots of pressure. We don’t always know how much pressure will release with each treatment, but the need for the release is clear.

When I have patients ask me about how many acu treatments might this or that issue require to heal, I share the idea of thinking about this process like trying an exercise class over some time. When you think about it, nobody really expects one exercise class to make them better right away, and once we clarify the similarity in process of acu to exercise there is a reality-based sense of how to think about this new experience. That paradigm shift helps patients relax into the acupuncture treatment process, and allows both patient and practitioner to observe the shifts in body and mind as a team as they navigate the healing process over time.

Moses Cooper
Author: Moses Cooper

hello POCA family, I found community acupuncture in the early days of Working Class Acupuncture. I was lucky enough to be the first trial employee at WCA in 2005 after Lisa and Skip survived a string of uncomfortable independent contractor acupuncturists. I remember showing up during a clinic expansion painting moment and grabbing a brush. I was feeling grateful to be working with folks that were so obviously helping people of all kinds afford pokes. That was a very attractive bottom line at the time, and still is! I consider my family roots working poor where I come from, so I was both familiar with and willing to 'walk through the fire' to figure out how to punk. I was a well-meaning, yet slow and mentally mired punk in the early days. I made all the communication mistakes you can make as a newbie poker... It took all of my energy to develop a punk mindset and clinic awareness. I often felt like I was on trial both from my employers and my patients as I figured out the basics of being a real punk. Having solid boundaries instead of being over-comforting; connecting with subtle body language as much as...

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  1. Great analogy

    The exercise analogy can relieve stress from practitioners as well…

    I think I like it better than the boiling water, though, because if all we’re doing is stress relief, than one might say that going to a place and resting there for an hour twice a week would obviuosly be stress relieving – maybe the needles aren’t necessary. In other words, I believe that stress relief is only part of the whole picture, a big part, but there must be more to it than just that. That’s why the exercise analogy works better for me – the idea of actually going through a process of change.

  2. interesting point royg.

    interesting point royg.


    I don’t presume to understand the physiology/ biochemisrty of what is actually happening in the body once acu needles are place and we are given space to rest in silence. All the same, i wonder if having many micro-injuries isn’t something like experiencing trauma of some sort.


    When we are in pain from some type of trauma the most natual and commonly accepted therapy is “get some rest”. I suspect that acupuncture relaxes us becuse it stimulates the body-mind into a deep healing rest. The needles seems to be a catalyst for dramatically deepening this natural tendency toward resting to repair the system. If the needles aren’t used at all I do personally think just resting would help at little. Although, the acu needles facilitate a rest so deep it makes me wonder about any parallel to the restorative brain activity that has been researched to be happening during deep meditation, under scientific test conditions. We reach certain levels of “quiet” when we slow down and rest on our own. The acu seems to help us reach farther, quiet more deeply, so I vote we keep it as the main ingredient in our treatments!


    – M

  3. (Another) Great Blog Post, Moses!

    You always have these great ways of explaining your perspective on things.  I really like this exercise analogy.  Simple and completely sensible.

    And to add to your comment on Royg’s comment, I think that’s also an interesting perspective on the idea that the needles create something deeper than just rest, parallel to the meditation idea.

    Nice post.

    Justine Deutsch, Lic. Ac., Acupuncture Together


    I hope this adds to the above.

    Here’s how Subhuti Dharmananda, Ph.D., explains it in his article Restructuring American Acupuncture Practices (


    It has been reported to me informally that many acupuncture patients seen here (in the U.S.) will note an improvement in their condition after about 5-6 weekly acupuncture treatments. Further treatments may then be needed to gain the full effect of acupuncture. A course of 10-15 treatments in total is not unusual. Some patients opt for prolonged treatment over several months or even years, but for those attempting to address a particular health problem and then move on, such a course of therapy appears typical. This is not unlike the Chinese experience, in terms of number of treatments, in which patients are given a “course of therapy” that is typically 10 treatments, followed by another course if necessary. However, as pointed out above, the Chinese approach suggests that resolution of the disorder is then accomplished in 10-20 days, rather than 10-15 weeks.

    The ideal frequency for acupuncture therapy (assuming both patients and practitioners have the option to adjust to it) depends on one’s concept of the function of acupuncture therapy. Consider a few examples of other therapies. Would you, or specialists in their respective fields, recommend that a patient:

    * take nutritional supplements (such as a vitamin/mineral) once per week or once per day?
    * take a course of antibiotics, one dose per week for ten weeks or one dose per day for ten days?
    * take a decongestant once per week during allergy season, or every day during allergy season?
    * undertake exercise, 20-30 minutes once per week, or 20-30 minutes at least five days per week?
    * take an herb decoction or other herb preparation once per week, or every day?
    * get a good night’s sleep once per week, or every night?
    * eat healthy foods once per week or every day (or most days)?

    I think you will find it obvious that once per week doesn’t work for any of these things. There are some cancer therapies that are given once per week, but they are severely toxic and long-lasting, and not comparable to the experience of natural therapies. But, diet, exercise, sleep, herbs, vitamins, and common drug therapies are more like acupuncture treatments in their regulatory and recuperative effects, and a person should be doing them daily or almost every day.”

  5. process

    Visual metaphors serve as a valueable tool for helping both ourselves and those seeking relief have a reasonable and clear understanding of acupuncture as a process and I appreciate both the exercise and boiling water analogies in this post.  Thank you, Moses.

    What’s interesting, is observing how taking the lid off the pot on the first treatment can be experienced differently by different people.  It’s as if some folks can only bear the lid being shifted slightly, while others have it removed entirely.  While removing the needles and asking, “So, did you get a chance to relax?” some folks make this incredulous look like “uh, Yeah!” while others don’t….or are actually agitated.  The trick for me is not getting attached to either of these responses.  Process.

    What I’ve noticed lately is how the lid seems to come off progressively with each treatment and that the person that has a lot of anxiety and couldn’t relax on the first visit, slips into deep relaxation during the second and falls asleep on the third.  The bodymind seems to remember and feel more comfortable going further with each trip into aculand.  This compares well to the *process* involved in meditation as well.  What is scary, unfamiliar and retreated from initially is investigated with a humble curiosity as the process evolves for us.

    Thank you for a handy tool I can use explaining process to patients, as well as helping me understand it better myself.  

  6. “The bodymind seems to

    “The bodymind seems to remember and feel more comfortable going further
    with each trip into aculand.  This compares well to the *process*
    involved in meditation as well.  What is scary, unfamiliar and
    retreated from initially is investigated with a humble curiosity as the
    process evolves for us.”


    Gorgeous! I agree. My patients move in baby steps or bounds depending on what they are dealing with personally, yet all of them eventually start to feel more comfortable going further and a little deeper in thier personal explorations of acu-land.



  7. ITM view of frequent acu

    Thanks to both of you Nora and Ryann for bringing attention to this article by Subhuti Dharmananda, Ph.D. I had never read it before!


    Subhuti has a well thoughtout approach in mind for acu delivery in America that makes lots of sense. When I was interning in China for  two months in a TCM teaching hospital, at the end of my acu schooling, I observed the same basic viewpoint that Subhuti shares in his artlicle. Most, if not all, acu tx in China is given daily or every other day for courses of tx instead of weekly for months or years. Acu in China, as I observed it, was purely medical treatment for garden variety medical conditions and for conditions that weren’t responding to modern medicine (of which they had plenty of access from what I could tell).


    From my experience so far, community acupuncture addresses both garden variety and chronic medical needs, by providing a format and price structure that allows for and encourages frequent acu treatmets, similar to the type of tx frequency discussed in Subhuiti’s article. CA seems to address one more aspect of health care that I didn’t observe in China and that I haven’t ever read about in the Journal of Traditional Chinese Medicine. Health management. This means consistent health support over the long term, not only for people with illness, for all people.


    From my experience as a community acupunk for four years, I find that weekly treatments for many health situations help to address the stressful nature of work and personal life in general. For example, the computer technician that comes for treatment because of pains from repetative stress on her/is wrist and finger joints from constant typing. This patient may get much better with acu tx and then relapse off and on due to her/is need to keep typing constantly to stay employed. This type of patient (and our workfoce is full of them) from my view benefits from consistent acu tx beacause the acu tx’s offset the demands of the workplace stressors (both the physical and mental varieties).


    In China, health management is mainly considered the place of diet and exercise. Whether most Chinese people use this sensible approach is another story. In America, diet and exercise are also used as health management approaches; yet, so many people are overstessed and overtired from simply handling the stesses of daily life that they have little energy reserved for health managent approaches, of any kind. I consider these types of people to be the working class in general. I also recognize these folks, with precious little spare energy or spare time in their busy schedules as my main target patients for CA. I love the thought of helping my patients live thier lives more calmly and effecitively longterm. I think acupuncture has a place in health management that has not yet been recognized in the West. I do encourage basic healthy eating habiits and consistent exercise for all, yet I also have my needles at the ready for those that want extra stress relief as they navigate thier day to day lives.



  8. Hi Moses,
    Well, I was going

    Hi Moses,

    Well, I was going to add another post here but I see that my prior posts have been deleted. So much for Lisa’s statement about openness on this forum. It looks like CAN is more concerned about promoting a VERY narrow view of “CAN” as opposed to helping patients through the sharing of ideas.

  9. Ryann, your posts were removed based on their content.

    Since you are not a member, we did not have the chance to email you
    personally to explain why we made the decision to remove your posts.

    I’m going to point us both to CAN’s posting policy as reference for our decision.

    If after re-reading the policy, things remain unclear to you, feel free to email me:, so that we can try to come to a common understanding.

    btw, your observation that, “…CAN is…concerned about promoting a very narrow view of ‘CA”, is true.  We’ve decided that there is nothing wrong with that.  If you want to flesh out and promote your own view of an affordable  acupuncture biz/clinic model, you are welcome like anyone else, to create your own blog.

    In the meantime as a guest on this site we appreciate your participation – just please play by the house rules.