Many people believe acupuncture does not work. Sometimes this is an uninformed assumption, but often it’s a belief held by those who have tried acupuncture to little or no avail. So, why didn’t acupuncture work for these people?

While living for eight years in China, where I gave and observed thousands of acupuncture treatments, I identified certain commonalities among people who have success with acupuncture. Since being back in the U.S., I’ve noticed that many of these things apply here as well. People who see positive results from acupuncture share several characteristics.

Here are three key requirements for effective acupuncture care.

Gotta get the right dose

In today’s world, instant gratification is in high demand. People who are new to acupuncture often expect immediate results, and stop coming when they don’t get them. Rome was not built in a day, and acupuncture is not going to solve your problems overnight.

Acupuncture works cumulatively, meaning one treatment builds on the next.

I consider a course of treatment to be 10 sessions, received once weekly or more often, depending on the severity, chronicity and urgency of the problem. The first 10 sessions commonly produce some improvement, or even complete recovery. But again, it depends on the nature of your condition.

Certain acute problems—for example, neck stiffness and pain, muscle strains and sprains from sports injuries, early-stage carpal tunnel syndrome—typically resolve in five-to-ten sessions, sometimes less.

Chronic diseases, especially those associated with functional weakness of organs or low immunity, require long-term treatment. Examples of these more chronic conditions include most cases of infertility, asthma, allergies, some skin disorders like psoriasis, and neurological diseases.

Urgent conditions, such as severe migraines or post-operative pain, may require two to three treatments per week until symptoms are controlled, followed by less frequent visits until the condition is stabilized. Eventually, you can go down to once a month or less for maintenance.

Similar to how medications are ineffective unless you take the prescribed dose, if you don’t get acupuncture frequently enough—consistently, and within an appropriate time frame—it is unlikely to yield the desired result.

Gotta have enough energy

Another key factor in the success of acupuncture has to do with constitutional strength. If at the outset of acupuncture treatment you’re already physically or emotionally depleted, or suffering from a debilitating disease or exhausting lifestyle, it’s going to take longer than usual to see results.

Acupuncture works with the energy in your body to promote healing. If your energy is low to start, there’s less to work with. Before the complaints that brought you in the door can be addressed, the acupuncturist needs to work on restoring your baseline.

Acupuncturists can boost energy with certain acupuncture points and other modalities such as moxibustion (burning an herb called mugwort against the skin, often near an acupuncture point, to promote movement throughout the channels). There are also self-care energy-boosting techniques, such as acupressure and qigong exercises, that your acupuncturist may recommend using at home to accelerate the healing process.

If you generally run on the low side energy-wise, or if you have a chronic illness or are going through an especially stressful or tiring period in your life, expect a little preliminary work. Depending on how wiped out you are, boosting your energy levels so that the real work can begin can take anywhere from one to several sessions.

Gotta eat and live right

Diet and lifestyle contribute significantly to a person’s likelihood of success with acupuncture. Along the lines of what I said above, if your body is not being properly nourished and cared for on a regular basis, it’s going to face an uphill battle when it starts trying to heal itself.

During the intake portion of an acupuncture appointment, acupuncturists usually ask people about their daily eating habits. They’re trying to gauge whether diet could be contributing to or aggravating symptoms. Sometimes even foods that are considered “healthy” according to Western dietary standards may be detrimental for your specific constitution.

In addition to diet, acupuncturists ask about lifestyle, things like when you go to bed, how much alcohol you drink, how many hours you work, etcetera. All of these things inform your overall picture of health and help acupuncturists determine your starting place for treatment.

Acupuncture requires thinking about health in a whole new way from what most of us are used to. Healing with acupuncture happens when the patient and practitioner enter a true partnership, a situation where the acupuncturist really listens to the patient and the patient is open to a new perspective on health. Only then can acupuncture produce the outcomes we’ve come to expect.