How We Teach Acupuncture

"Yes, and..."

Art by A. Cohen

First, a quick announcement for prospective students: Noni will be holding "Registrar Office Hours" at POCA Tech on Sunday 1/4 from 3:30pm-5:00pm. If you’re thinking of applying to Cohort 13 and you’re in town, please stop by.

This is a post I’ve been trying to write all year, off and on. Two things pushed me to finally get it done: one was a prospective student who visited our classroom and had particularly good questions about the program; the other was my rant last week about how the acupuncture profession wants to have its compassion cake and eat it too. Which I bet left some readers wondering: If our school doesn’t teach the one right way to do acupuncture, what do we teach?

It’s hard for people in the acupuncture education industry to imagine entry level programs outside of the dominant (unsustainable) paradigm — so I thought it might be helpful to describe what we do, in detail. And honestly, I kind of enjoy sharing the details, particularly with the acupuncturists who think we’re degrading, devaluing, and dumbing down the medicine — because actually, we’re major nerds about acupuncture and it shows in our program, so there!

Meanwhile I hope to not bore the non-acupuncturists in the audience with all the nerdery. I can’t believe so many of you read this newsletter — thank you! I will try not to make you regret it.

I’ve been a licensed acupuncturist for, whew, 31 years now, so I’ve had a chance to experience personally, as well as observe in others, a particular phenomenon: the longer acupuncturists are in practice, the more idiosyncratic they get. Most acupuncturists, clinically speaking, are very much doing their own thing.

Back in the 90s, I went to a Traditional Chinese Medicine school where I happened to meet a Jingei teacher who was visiting from Japan. If you’re not an acupuncturist, TCM is the standardized way of teaching acupuncture here; Jingei is an obscure alternative, based on an interpretation of Chapter 9 in the Ling Shu. After I graduated, Jingei was what I did in clinic because I liked it better than TCM. Over the years, though, Jingei became just part of what I did; I adapted and modified and tinkered based on learning new approaches like Balance Method and Master Tung. I think most acupuncturists do the same; no matter where they start out, their practice evolves to suit their personalities and the result, eventually, is singular.

There’s nothing wrong with that; acupuncture isn’t brain surgery, so there’s lots of room for creative flexibility. We designed our program to prepare students for an evolving career. Our goal is to help students learn how to learn acupuncture — as opposed to expecting that they’ll learn it only once, in school, and then forever after practice in the same exact way. We want to give students multiple clinical lenses through which to view their practice, and to get used to swapping those lenses out based on their own preferences and the needs of their patients.

We’re free to do that because, to paraphrase John Pirog, all acupuncture theory is metaphor.

Also high on our list of priorities: to demonstrate to students how to run an acupuncture business — and have them participate, so that they can practice the necessary skills — and for them to become safe, competent entry-level practitioners.¹ The core of our program is the clinic, so the first year is about getting ready for clinic; the second year is about learning by doing, in clinic; and the third year is about getting ready to either make a new clinic or work in someone else’s clinic after graduation. To sum up: this is the practical, focused education I wish I’d had.

In first year students do a lot of memorization; point location of course, but also other basic theory like the Chinese clock and channel pathways. We think of first year as a kind of orientation to both the job and the field itself. Students spend many hours working the front desk at WCA’s clinics, which means learning how to talk to patients about acupuncture, and also seeing up close how acupuncture, time and money intersect in the lives of real people.² During observation they unpin patients which is like learning to read other acupuncturists’ clinical handwriting. In the classes I teach, we get into leadership, entrepreneurship, and how the acupuncture profession in the US came to be.

It’s all a run-up to the main event, which is treating members of the public in the student clinic, starting at the end of the first year or the beginning of the second, and continuing until the end of the program. As noted previously, we don’t believe that students can learn the material BEFORE they do something with it, we think they learn BY doing something with it. Because that’s what it’s like once you’re an acupuncturist in practice. There is no BEFORE, there’s only the endless timeless middle, where the learning never stops. See also:

But what I really want to talk about is presenting the clinical approaches, which happens mostly in the second year, and how we use them to introduce core concepts in acupuncture, in carefully curated stages. It’s taken us years to figure out the curation, but we like how it works now.

The first clinical approach is actually taught in the first year, and it’s Miriam Lee’s Great Ten protocol, and then a variation developed by us which we call the Desert Island Ten. Which is exactly what it sounds like, if you were only allowed to take ten acupuncture points with you to a desert island, which would you take? I think lots of acupuncturists have their own personal version of this — the points that become your best friends — so it’s good to introduce the students to that idea, right away. Miriam Lee’s protocol is LI 4 & 11, LU 7, ST 36, and SP 6. (More about it here.) Our Desert Island Ten is LV 3, GB 40 & 34, PC 6, and TW 5. For the non-acupuncturists, yes, those are actually only 5 acupuncture points but the idea is that you needle them bilaterally, so it’s 10 needles.³

Students start with protocols because it helps get them through the first few weeks of clinic, which we also refer to as the “don’t fall off your rolling stool” phase, and yes interns have fallen off their stools because they were so nervous. There are so many things to think about when you’re a new intern that we opted to take “figuring out what points to do” out of the mix. The beauty of protocols is that you can trust them even when you don’t (yet) know why, which allows you to focus on all the other necessary skills. You can see from this checklist for the first phase of internship that most of what interns are practicing isn’t actually about point selection or diagnosis, and so they’ve got plenty to do:

Internship Step 1

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Once students have completed twenty ML Ten/ DL Ten treatments, they’re free to move on to the next approach they learn in the classroom, which is auricular acupuncture. We include auricular acupuncture in our program not only because of community acupuncture’s roots in 5NP, but because it’s a great way to introduce students to the concept of micro-systems in acupuncture. Not to mention that auricular acupuncture is a micro-system that didn’t originate in the Chinese canon, it was developed in the 1950s in France, so it’s also an example of the fluid, ever-developing nature of acupuncture. Since it can be used in almost any setting, it’s a great tool for interns to have.

Once they’ve completed their ear treatments in clinic, they’re free to move on to the next approach they learn, which is Richard Tan’s Balance Method. This approach is potentially so complex and intricate that it can keep practitioners entertained for decades, but in its simplest form (which is what we teach) it introduces the idea of the body as a map along with the clinical uses of that map, including the concepts of mirroring and imaging. It’s a great way to teach channels as systems and to introduce diagnosis based on channels. Plus, it’s really effective at treating pain and so sometimes it delivers instant gratification in clinic — which every acupuncturist should experience at least once, hopefully early on.

The next approach we teach is Jingei, which most acupuncturists haven’t heard of, so you’ll have to take my word that it relies on channel diagnosis and channels as systems in a similar way to Balance Method — except it adds in the concept of pulse diagnosis. Jingei pulse diagnosis is simpler than other kinds of pulse diagnosis so it’s a good place for interns to start. Jingei also introduces students to the idea of using point categories for their individual qualities, along with the strategy of using source points and he-sea points to address the identified “root” of the patient’s problem.

Which gets us to the next approach that students learn, which is Richard Tan’s 12 Magics, which he devised to address non-location-specific complaints such as depression, fibromyalgia, and auto-immune disorders. In other words, things that are all over the map of the body. 12 Magics also uses categories of transport points — but all of them, not just the source points and the he-sea points like Jingei. 12 Magics is basically God’s gift for teaching acupuncture theory, because in a 12 Magics treatment every main channel gets at least one needle, each category of transport points can be accessed at least once, and the transport points are employed to address the idea of layers in the body (superficial to deep). Students learn how to hit every channel (which sometimes is what you need to make a treatment land) and they also practice needling jing-well points, which can be nerve-wracking at first.

Jingei and 12 Magics together prepare students to learn the next clinical approach, which is Korean 4-Point. This approach is reliably surprising and challenging when students try it in clinic, and even students who don’t like it are usually glad they learned how to do it. Korean 4-Point represents a 5 Element way of identifying the “root” with pulse diagnosis, and it relies on the elemental characteristics of transport points, so it’s a great way to demonstrate to students how the elements relate to the channels. In clinic, it looks like using a small number of needles (4!) to focus on helping the “sick” channel. Every year, at least one intern gives a K4P treatment to a patient who says, “I’ve been getting acupuncture for years and I’ve never felt anything like it, that treatment changed my life!” — alongside other patients who say they didn’t feel anything at all from the treatment, because there were only four needles.

Like we say over and over: nothing works for everybody, everything works for somebody.

Art by A. Cohen

One of our goals for teaching Korean 4-Point is to thoroughly shake up any preconceptions that students might have developed, before introducing them to Master Tung’s acupuncture, which is based on an alternate geography of the body and an alternative set of points. Master Tung treats all kinds of pain as well as all kinds of internal conditions; it’s encyclopedic, and like Balance Method (which it gave rise to), it can keep practitioners entertained for years.

This post is getting long, so regarding the next three clinical approaches, I’ll just say that we teach scalp acupuncture because it’s another micro-system (and it’s so useful) and then 8 Extras, mostly as an exercise in thinking about the extraordinary meridians as the key element in a treatment. (Almost every year, at least one intern discovers that they love using 8 Extras in the clinic.) And finally, in third year, we teach Traditional Chinese Medicine’s approach to acupuncture — because we have to, thanks to the national credentialing exams. We teach it last in hopes of not contaminating students’ perspectives on other styles of acupuncture. (Yeah, we have a bad attitude about it.)

Once students have learned all ten approaches, and performed the required treatments in clinic (which is not unlike requiring someone to eat their vegetables before offering them dessert), the last stage in the process is for them to remix at will everything they’ve learned in order to develop their own style, which we call “the eleventh approach”. Then they spend their remaining clinical hours doing that. One of the last assignments in the third year is for each student to do a presentation to their cohort describing their eleventh approach. These presentations are always fascinating because every student’s approach is unique. Of course they are, because acupuncturists’ personal quirks are a feature not a bug! We believe that one of the most satisfying aspects of acupuncture, besides relieving suffering, is how creative and personally expressive it can be.

So that’s what we do in our iconoclastic little school. We hope to prepare students to try things, to experiment, to trust themselves — and to feel confident about adapting in order to accommodate their patients’ needs (more about that in next week’s newsletter). It’s not unlike improv; it’s all “yes, and”. It’s acupuncture for pragmatists and free thinkers, not acolytes of any specific approach. And our program is streamlined and simple because it’s just acupuncture, and a lot of it.

Speaking of streamlined and simple, our year end fundraiser is going great! We’ve raised almost $14,000 thanks to some very generous donors and some very hardworking students! This is the last time I’ll ask — if you’re getting anything out of this newsletter or the existence of our quirky school, would you like to give us $25?

Here’s the link to donate:

See you in the new year!

1. We’re not trying to teach them everything they might ever want to know, just preparing them practice independently. See also, why we call ourselves a technical school.

2. As Dilip Babu MD, one of POCA Tech’s Board members wrote:

I feel extremely fortunate to have the opportunity to study acupuncture (at POCA Tech). Previously, I completed medical school, residency in internal medicine, and a fellowship in hospice and palliative medicine, then practiced for several years as a palliative care physician. I subsequently completed an additional fellowship in hematology and medical oncology, going on to practice as a medical oncologist.

I have been exposed to acupuncture in several settings during my medical career, and found myself impressed by its clinical effects. This made me highly motivated to learn more about the modality. My education at PTI thus far has proven very much in line with my prior training, both in terms of academic rigor and depth of clinical experience.

That said, I am consistently impressed by the breadth and scope of instruction at PTI…I would like to highlight one uniquely educational component of the curriculum at PTI: students are given the opportunity to learn and master every patient-facing role in the clinical space. Over the course of multiple rotations, time is devoted to work as a front-desk receptionist and scheduler, observer (essentially an assistant to the main clinic provider), and student intern acupuncturist. I have benefited greatly from these rotations as they have afforded me an understanding of the patient care experience that is multi-dimensional. By interacting with patients from various different angles, so to speak, I have come to know them in a richer, more well-rounded way than before.

3. In practice we often don’t do the five points bilaterally, we do them in a circuit. Obviously I’m biased but I think ML 10 in a circuit is hands-down the best treatment for a new patient who’s never had acupuncture and who’s nervous. By a circuit I mean: LI 4 & 11 on one arm (say the right, but it doesn’t matter, you could do it the other way round); LU 7 on the opposite arm (left), then ST 36 on the leg (left) and SP 6 on the opposite leg (right) Start with LI 11 because it’s almost always painless. Quick, simple, classic! And only five needles.