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This article examines how the aesthetic design of clinics and interactive discourse 5 and rituals construct the social reality of acupuncture sessions as a form of holistic medical therapy. Verbal and nonverbal interactions create an appealing medical environment but also help prevent the emergence of undesired counter-realities (e.g., pain, biomedical intervention). Based on observations of acupuncture sessions conducted in Galway, Ireland, I illustrate how 10 ambiance and aesthetic elements of clinics create a complex medico-cultural environment that balances oppositional associations (Western=non-Western, exoticism=convention, medical alterity=medical professionalism). Patients inter- viewed continually referred to acupuncture as a natural and non-invasive form of medical treatment. This suggests that interpersonal discourse and aesthetic 15 design play key roles in how patients define acupuncture treatment, and that these ephemeral agents may also influence how patients come to define efficacy.