Acupuncture in the U.S Armed Forces: A Brief History and Review of Current Educational Approaches

Educational/Instructional Challenges

Fulfilling these objectives was significantly facilitated by the U.S. Air Force's initial partnership with the HMI, which developed and implemented a customized, operationally focused curriculum for this initial cadre of military medical physicians. As the curricular development proceeded, however, it became evident that there were some practical, military-unique considerations that needed to be addressed.

First was the challenge of overcoming some of the initial skepticism associated with introducing an ancient medical practice into a fast-paced, ultramodern, Western-oriented, military medical setting. That said, it did not take long before word of a continuous stream of clinical successes began to spread, especially cases involving patients with refractory pain syndromes. In many respects, this was directly attributed to the efficacy of Dr. Niemtzow and his battlefield acupuncture (BFA) technique, which often led to the dramatic resolution of seemingly intractable pain—within minutes. As the saying goes, “seeing is believing,” and this aptly described the transformation of unabashed professional skepticism into a growing appreciation of just how effective acupuncture can be.

Training military physicians in the art of medical acupuncture had—and continues to have—some very practical challenges as well. Among these are (1) the reality that military physicians generally need to see patients at 10–20-minute intervals, which makes the routine incorporation of a full-fledged, traditional acupuncture history and physical examination—complete with tongue, pulse, and a 5-Phases assessment—virtually impossible to implement. Added to this is (2) the need for military medical acupuncturists to be able to function in a wide range of settings, ranging from the most austere of deployed locations, to fully equipped medical treatment facilities. The former requires cultivating a repertoire of treatment techniques that are highly effective, that minimize the need for full patient disrobing, and involve a limited reliance on highly portable pocket-sized equipment. All of these considerations are especially relevant when supporting active combat operations.

Yet another consideration is that (3) military physicians care for a highly diversified and rapidly mobile population, and that extensive follow-up visits are often not easy to arrange. While this, in itself, is not necessarily unique, what distinguishes many military members from their civilian counterparts is the need for military clinicians to deliberately evaluate the potential impact of an acupuncture treatment on a member's operational readiness. There are, for example, specific guidelines regarding the type and timing of acupuncture interventions that can be provided to a military pilot prior to a flying mission. Similar restrictions apply to undersea divers and other service members who work in unique or atypical environments. Finally, (4) there is a genuine need to expand the military medical “toolbox” used to care for patients bearing the signature wounds of modern unconventional warfare—namely TBI, PTSD, and the complex pain syndromes associated with traumatic amputations and the accompanying phantom-limb pain.

Educational Approaches

As previously noted, the HMI has been instrumental in facilitating the formalized training of military physicians in the art of medical acupuncture. What has been particularly effective is an approach in which military participants completed their foundational acupuncture training in three evenly spaced segments. This was found to be especially efficacious, as it allowed military members to receive an incremental privileging letter at the end of each section. This, in turn, provided the documentation needed for members to secure progressively expanded medical acupuncture privileges at their assigned military treatment facility. A significant advantage of this approach is that it allows students to put their newly mastered skills into immediate clinical practice. As students progress, additional credentials are gained, so that, by the end of the 300-hour training program, participants are fully eligible for independent practice.

Tailoring acupuncture training to a military medical environment has contributed to the development and refinement of a variety of treatment approaches, several of which are discussed in greater detail elsewhere in this issue of the Journal. That said, three particular approaches have been shown to be especially effective in a military setting. These include the well-established BFA technique, the HMI auricular trauma protocol (ATP), and the locally known “Koffman Cocktail,” as refined by U.S. Navy Capt Robert L. Koffman, MD. The latter involves the placement of Seirin-type needles bilaterally at LI 4 and LR 3, with additional needles at GV 20 and GV 24.5. This deceptively simple intervention has been shown to be conducive to use in a wide range of operational environments and is particularly effective as a calming and centering treatment. Use of this therapeutic cocktail, along with the ATP and BFA techniques, provides further testament to the versatility of this ancient art.

In addition to providing formalized, foundational acupuncture education to military physicians via the 300-hour Continuing Medical Education program, another training approach currently offered within the Air Force Medical Service involves the use of exportable “mini-courses” focused on battlefield acupuncture. These short courses are typically conducted over a single 3–4 hour session, with an ideal faculty:student ratio of ∼1:4. Instruction focuses on conveying an understanding of the neuroanatomical basis for the BFA technique and includes a period of highly structured and supervised clinical practice. Mastery of this approach has not only kindled a rapidly expanding interest in acupuncture overall, but, from a clinical–operational perspective, has provided a growing number of military physicians with a rapid and remarkably effective technique that can be used in practices ranging from flight medicine to psychiatry and physiatry, to internal and family medicine, and to orthopedics and occupational medicine, just to name a few.

Introducing acupuncture to practicing military clinicians is, however, just the “tip of the spear.” At the Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, the nation's only military medical school, fourth-year medical students are being increasingly exposed to the role of acupuncture in modern military medical practice. In fact, interested students are encouraged to complete a fourth year elective in Complementary and Alternative Medicine at the Andrews Air Force Base clinic, where they are introduced further to the wide range of clinical conditions that can be amenable to treatment with medical acupuncture and a variety of related modalities.

Future Directions

While there are still a number of challenges to overcome, an ideal vision for military medical acupuncture would involve a situation in which a growing number of medical students—particularly those who have committed to, and/or who might aspire to, military medical service, would graduate from medical school with a select “armamentarium” of basic acupuncture techniques. These could include, for example, demonstrated skills in BFA, ATP, and some fundamental surface-release and trigger-point techniques. As Joseph M. Helms, MD, noted, (personal communication, June 19, 2011) this collection of basic but versatile skills can be viewed as a form of “medical acupuncture first aid,” and can easily be mastered in a 3–4-day training period.

Looking into the future with an idealized perspective, one could also appreciate the value of cultivating and ultimately deploying multidisciplinary military medical teams whose members have been trained in several aspects of medical acupuncture. Over time, this could evolve into a situation in which appropriately selected patients could receive one level of acupuncture interventions from a trained medical technician or corpsman, with other levels of treatment being administered by a trained nurse–practitioner or physician assistant. This would allow physicians to concentrate on administering the more complex and advanced levels of acupuncture as dictated by the clinical situation and/or the operational environment.