By FELICE J. FREYER
Journal Medical Writer

In the diffuse light of the examining room, Barbara Bello lies serenely, face down, as S. Erin Baldt slides her fingers around a spot on Bello's bare back, seeking a certain point.

Baldt opens a small sterile package, removes a 2-inch-long needle in a plastic sheath, and holds it upright on Bello's back. "It's such a delicate operation," she says, "getting the needle in. You can feel it when you get it in. It's like the tissue changes."

She taps the top of the needle until it pierces the skin, and then she removes the sheath. "Sometimes, when I'm teasing the Qi right into an area, I feel this zhhht right up my arm," Baldt says. "I can feel it."

Probing the skin with her fingers, asking Bello what she feels, how she feels, Baldt repeats the procedure until 14 needles protrude at various angles from Bello's legs, back and ear. A Rachmaninoff piano concerto plays on the tape deck.

If you ask Erin Baldt what she's doing, she will tell you that she is adjusting the flow of Qi (pronounced "chee"), a life-giving energy, to relieve both the low-back pain and severe anxiety that Bello, 50, of Sharon, Mass., has suffered since a car accident a year ago.

If you ask a medical doctor who accepts the legitimacy of Baldt's work, you will be told that she is probably triggering the release of the body's natural painkillers and possibly affecting brain chemicals, hormone production and blood flow.

If you ask a skeptic, you will hear that Baldt is just drawing on Bello's belief that the needles will work.

But however you view acupuncture, one thing remains indisputable: many patients want to be in Barbara Bello's position — seeking relief from an ancient art for the pains that modern medicine can't cure.

And a growing number of practitioners want to be in Erin Baldt's shoes — offering that relief through the precise insertion of stainless-steel needles the thickness of a human hair.

IN RHODE ISLAND, this has led to a turf war that will play out before the General Assembly this year, as traditional acupuncturists seek to broaden the legal definition of their work and chiropractors try to get a piece of the action.

But it has also led to a quieter revolution. As gently and painlessly as tiny needles slide into skin, acupuncture is easing its way into the traditionally hidebound practice of conventional medicine in Rhode Island.

You see, Erin Baldt and Barbara Bello are not behind beaded curtains in some incense-filled basement. They are in a doctor's office in Pawtucket — Southern New England Anesthesia and Pain Associates, a Brown University-affiliated medical practice whose former president, Dr. Kathleen Hittner, is now president of Miriam Hospital.

Hittner, who also used to be president of the Rhode Island Medical Society, is about as mainstream as you can get. Yet she recruited Baldt from an acupuncture school in New Mexico to offer her chronic-pain patients the option of acupuncture.

"There are physicians who look at me as a little crazy for even thinking of it," Hittner remarked. "But patients have been grateful."

Baldt is in the process of seeking privileges to practice at Miriam Hospital and Roger Williams Hospital, both teaching hospitals in Providence.

Once Baldt's hospital privileges are granted, she will join Alex Tatevian as probably the only non-physician acupuncturist practicing in Rhode Island hospitals. Tatevian works at Women & Infants Hospital — although as a volunteer in an office building around the block from the hospital.

NOT ONLY are acupuncturists breeching doctors' domain, but doctors are taking an interest in doing acupuncture themselves. This has been legal in Rhode Island since 1974, but because doctors showed little interest until recently, the Health Department wrote the necessary regulations only last February.

Since then, four Rhode Island physicians have received certification to do acupuncture. Two of them also won privileges to practice acupuncture at South County Hospital, and one — obstetrician-gynecologist Robert O'Neill — plans to offer acupuncture during childbirth at South County Hospital starting this spring.

Meanwhile, the Health Department is sponsoring a bill that would permit chiropractors to perform acupuncture.

Acupuncturists don't necessarily welcome these incursions.

"It's really bizarre," says Tierney Tully, president of the Rhode Island Society of Acupuncture and Oriental Medicine. "Everybody wants a piece of this profession that everyone says has no scientific basis. ...

"We're just barely getting on our feet here as a recognized profession, and we're being cannibalized, basically."

Acupuncture, Tully says, is just one treatment offered by the multifaceted practices of Oriental medicine, which are rooted in 2,000-year-old traditions and based on concepts vastly different from those of conventional medicine. Oriental medicine, for example, attempts to diagnose illnesses by examining the tongue and remedy them with such practices as therapeutic massage or certain combinations of herbs. The goal is to bring the body into balance so that its own natural healing powers can take over.

Practitioners of Oriental medicine train for at least 2,500 hours, Tully explains, and in most states, including Rhode Island, must obtain board certification from a national group.

But doctors don't need those credentials. They can get permission to do acupuncture after they've studied the procedure for a mere 300 hours, and the chiropractors are looking for a similar arrangement. "We don't believe that's enough," Tully says.

"Most people think of acupuncture as the science," she says. "Really, Oriental medicine is what informs acupuncture. You can't do acupuncture without a thorough understanding of Oriental medicine."

Although Tully insists that there's more to acupuncture than the insertion of needles, that's actually all that acupuncturists are licensed to do in Rhode Island. Nothing prohibits them from practicing other aspects of Oriental medicine, but those practices are not regulated.

Seeking both to stake out their territory and to win official legitimacy, the state's acupuncturists for several years have been trying to convince the General Assembly to define their profession more broadly.

Health Director Patricia A. Nolan, however, has told the acupuncturists that she would not endorse such efforts because, in her view, only acupuncture has scientific validity, and licensing such practices as herbology and cupping (suction by cups containing heated air) will give those methods a credibility they don't deserve.

AS IT HAPPENS, even the scientific evidence on acupuncture is inconclusive at best. Yet acupuncture enjoys a level of acceptance accorded to few other "alternative" therapies. Acupuncture needles are federally approved medical devices. When the American Society of Anesthesiologists was recently asked to provide a skeptic to debunk acupuncture, the medical group was hard-pressed to find one; instead, its spokeswoman said that most anesthesiologists acknowledge acupuncture as a valid option for pain relief.

In 1997, a consensus panel of the National Institutes of Health reviewed the research on acupuncture and found much of it "equivocal." Far from dismissing acupuncture, however, the panel agreed that "promising results" suggest that it can work in treating nausea and vomiting after surgery or chemotherapy and postoperative dental pain. The panel also concluded that acupuncture "may be useful" in treating addiction and asthma, aiding with stroke rehabilitation, and easing numerous types of chronic or recurrent pain.

Dr. Mervyn H. Woolf, a Rhode Island Hospital anesthesiologist who recently obtained certification to practice acupuncture, said that some 3,500 studies have been done on acupuncture, and most are not scientifically valid. That doesn't mean, he says, that acupuncture doesn't work — only that no one has gathered the proof.

Even those who, like Woolf, believe acupuncture works can't fully explain how it works. The ancient theory holds that Qi moves along meridians, or channels, in the body, nearing the surface at some 350 "points." Each point corresponds to a different aspect of the body or the spirit. A needle inserted in the point can adjust the flow of Qi to the affected system, restoring balance and thus health.

But nowhere in any Western anatomy text will you find a meridian, or any structure remotely corresponding to it. That's one reason why some doctors dismiss it as hooey. The National Council Against Health Fraud, an anti-quackery group based in California, says that acupuncture "is based on primitive and fanciful concepts of disease and health" and urges that it be used only in research settings.

Woolf, whose interest was sparked when acupuncture relieved his own pain from a back injury, says that under the microscope, acupuncture points show "a greater accumulation of blood vessels and nerves." Stimulating those points seems to trigger the release of endorphins, the body's natural pain-killers (which are chemically similar to morphine). "The endorphins are incredibly powerful and incredibly long-lasting substances produced by the body," Woolf said. "They remove pain almost completely. You can use acupuncture for anesthesia. They're that potent."

O'Neill, the obstetrician-gynecologist who practices acupuncture in South County, says evidence is emerging for the existence of something like meridians: "There's a lot of scientific evidence that a much more slower-acting system is in the grooves, the fibrous tissues in the muscle bundles — pathways or meridians or channels whereby you can change the way your body's energy works."

Alex Tatevian, an acupuncturist who was a medical doctor in his native Russia, has no doubt that "there is actually something moving in there."

"We can't identify what it is," Tatevian adds. "That's why we call it Qi, which makes doctors puke."

In Russia, acupuncture is regarded as a specialty of medicine, and Tatevian learned it in a postgraduate program. When he emigrated to the United States in 1991, he found that acupuncture here is "alternative medicine" and that it would be difficult for him to practice both.

So he chose acupuncture because he believed it had more potential. "Acupuncture is the most remarkable opportunity to advance the medical field beyond what it is now," Tatevian says.

"Putting acupuncture in the position of alternative medicine creates a lot of problems," Tatevian adds. "Acupuncture is most effective if combined wisely with conventional medicine."

Tatevian recalls being called to a hospital in Rhode Island by a friend whose relative had gone into septic shock — an overwhelming blood infection that was shutting down her organs. He went, but knew immediately there was no role for acupuncture.

Instead, he watched in awe as doctors brought the severely ill woman back from the brink. In China, in Russia, even in most of Europe, Tatevian said, a woman that sick would have died.

And yet the miracles of Western medicine can't do anything for the numbness in Linda Cozine's feet. This feeling — as if her feet had fallen asleep — is an aftereffect of chemotherapy, and it makes it difficult to walk. So Cozine, who lives in Cranston, went to see Tatevian at the cancer program at Women & Infants Hospital, where he has been working for about six months.

There, Tatevian uses acupuncture to ease the nausea caused by chemotherapy. He also believes it may also help prevent the drop in blood count that chemotherapy can cause. If so, acupuncture would be a very useful adjunct to cancer treatment because often chemotherapy has to be interrupted when the patient's blood count drops too low.

Tatevian goes to Women & Infants one day a week, and he works there for free because he can't bring himself to collect money from women with cancer.

Few Rhode Islanders have insurance coverage for acupuncture, which typically costs $50 to $75 per session. In 1999, the General Assembly passed a law requiring insurance companies to offer acupuncture "riders." But only 18 of the 5,600 groups insured by Blue Cross & Blue Shield of Rhode Island and none of those in UnitedHealthcare of New England have bought such riders.

At Women & Infants one recent afternoon, Tatevian inserts six needles in each of Linda Cozine's feet, one in each leg and one in each hand. Lying on her back, Cozine explains that she walked better after her two previous treatments.

Now, she says she senses the needles at work.

"I can feel, like, energy kind of like a tingling," she says. "I know it's working. I can feel the difference."

.