What I’m Learning in Acupuncture School

Making an acupuncture school is an intriguing experience when you’ve been accused of “dumbing down” the profession as often as we have. Seriously — it’s not what I expected. Even though I didn’t know what to expect, this is definitely something different. And it’s getting more different with each passing month.

For example, in the last module, we had a class on the Causes of Disease. On page 21 of the ACAOM Accreditation Manual, under “Standard 8: Program of Study”, it says we have to teach “Internal and External causes of disease such as Six External Evils/Liu Xie, Seven Emotions/Qi Qing and Non-internal or External Reasons/bu nei wai yin”. So we obediently followed directions. But talking about Causes of Disease means asking, why do people get sick?

As we have learned from Paul Unschuld, Chinese medicine is characterized less by “either-or” thinking and more by “not-only-but-also”. Everything doesn’t have to reconcile perfectly with everything else; new ideas can just be added — as long as they work. It seems like this must have happened with the Causes of Disease. You can get the Seven Emotions and the Six External Evils from the classics, but if you’re taking care of real people in the real world, eventually you have to add “snakebite”, which doesn’t fit in either category, and eventually “snakebite”  turns into “parasites and poisons”, and after a while you end up with a whole new list. So you have Internal Causes of Disease, External Causes of Disease, and Other Causes of Disease/Miscellaneous, which includes, besides parasites and poisons, things like diet and trauma and wrong treatment.

As we talked about preparing for this class, it seemed like we had to address whether or not that Miscellaneous list was complete. Chinese medicine is a living thing, right? Living things change. The I-Ching says everything has to change. At some point somebody had to add “snakebite” to the list because it was obvious that snakebites made people sick, and it had nothing to do with their emotions or with Wind (even though Wind is the Chief of a Hundred Diseases). So when we wrote the list on the whiteboard, I added “inequality”. Don’t worry — I noted that the NCCAOM exam would not reflect “inequality” as a Miscellaneous Cause of Disease. But if we’re going to talk about why people get sick, we know now that inequality is a pathogen, so we should include it. See Unnatural Causes, see Status and Stress, see The Spirit Level: Why More Equal Societies Almost Always Do Better; snakes have nothing on social and economic inequality.

It has always been striking to me that so many acupuncturists identify our work as “holistic”, and claim that we are so much better than conventional medical practitioners at treating “the whole person”, and yet are so uninterested in how social and economic inequality affects our patients — and also, especially, the people who can’t afford to be our patients. When acupuncture is only accessible to people who can pay $50 to $100 out of pocket or who have the 1% of insurance that covers acupuncture, and when so much research shows that unequal access to resources contributes to ill health for the entire population — doesn’t it seem like we should think about what that means?

Community acupuncturists have spent years now on the defensive about whether what we do is really good enough if we’re not (for the most part) using back shu points.  We’ve asserted hotly that we can treat everything that private practitioners can treat, and we’ve pointed out that we can treat people who private practitioners can’t treat, because they can’t afford their fees. But maybe we should be talking about not just who, but what community acupuncture can treat that private acupuncture can’t: inequality.

For years now we have had conversations with patients, often while they were crying and we were crying too, about how much it means to them that they can afford to get the treatment they need. It’s a big deal. It’s a big enough deal that POCA is successful as a co-op, which is no small feat. But what if, as the research suggests, equalizing access to resources is a big deal to society as a whole? That knocking down barriers is good for everybody, not just people who want to be able to get acupuncture three times a week?

And maybe we should be asking why the Chinese medical classics had so much to say about balance and so little to say about inequality, which was no doubt just as pathogenic back then as it is now. It’s not only history that was written by the winners.

This is why I’m excited about having an acupuncture school. It kind of feels like getting a treatment in a community acupuncture clinic. Just like a POCA clinic creates a space where I can process and integrate what’s going on in my body/my mind/my life, POCA Tech is creating a space where I can process and integrate what it means to be an acupuncturist in this society, at this time, in my intersectional identity.  And I don’t know about the rest of you, but I really need that.

Community acupuncture isn’t half of something, with the rest of it missing — it’s an entirely different something. POCA Tech is like that too — we’re not just teaching the bare minimum of what we need to get through accreditation, we’re becoming something entirely different. Not long ago I read this comment from a local acupuncturist about POCA Tech and rolled my eyes: “Now, this program looks so watered-down to basically merely enable people to needle certain points (safely, I hope) with very limited understanding of the root concept/philosophy of the medicine.” Now I want to say, wait, whose understanding is limited? We’re not watering anything down, we’re trying to clear away layers of mystification and obfuscation in order to be able to think clearly and critically and carefully about acupuncture. About acupuncture as it is now, and here. What does it do, who is it for, and what does that mean?

If you are, like me, excited about where this all is going, please become a sustainer of POCA Tech. You can do it for as little as $5 a month, it will mean the world to us, and you’ll get monthly updates a lot like this blog post except that they are not public, and they have awesome pictures. How often do you get to make an acupuncture school from scratch? I promise, it’s not like anything else you’ll do, it’s completely different — and getting more different all the time.

Author: lisafer

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


  1. If you want “watered down”, you’ll get all you can drink at most mainstream skools.

    Just less than a year left at mine, and I could swear they dock a faculty member’s pay for every single word that isn’t included on the board exams. Even clinic is no escape from this.

    Seriously, I’ve probably learned more just from reading posts ABOUT POCATech than I have in whole semesters worth of classes.

    Which is why it is SO EXCITING to be able to watch this all unfold!

  2. I’m grateful for being able to read this piece tonight. Inequality seems to haunt a lot of what I do everyday. From the expensive bakery I work for to the healthy food I buy, I regret the fact that I can barely afford it and that there are large numbers of people who cannot come close. Like climate change, no one I know wants to talk about it. I just want to say thanks, because community acupuncture has been so good to me and this piece is like a drink of clear cool water.

  3. Thank you, David! I think all you would need to do to increase the amount of your donation would be to log back in and change the amount. But I will ask Carmen to confirm.

  4. Yes, you can change the amount of your donation or any of your other info at any time. Just login (your login information is in your Welcome Letter) and change away.

    Some of you have been victims of the recent large data-breaches and have new credit card numbers. You can input your new numbers now, or wait until you hear from me.