Glossy views of chinese patients stretched out on operating tables, their bodies bristling, porcupine-like, with needles, used to be the fare of National Geographic or colorful travel brochures. Acupuncture -- the Oriental practice of piercing the flesh with steel needles to relieve illness -- was long as exotic to Westerners as snake soup or the I ching. The mere mention of it to a Western physician would invite a stern, finger-wagging lecture on the perils of quackery.

No more. Today thousands of Americans and Europeans gladly submit themselves to this ancient practice -- often withthe help or approval of their doctors. In addition to thousands of lay practitioners, an estimated 3,000 American physicians have begun to incorporate acupuncture into their practices, and hundreds more are taking courses in its use. In Europe the trend is overwhelming: out of 88,000 practicing acupuncturists, 62,000 are medical doctors.

The mainstreaming of acupuncture is only the most dramatic example of how a wide range of techniques, known collectively as alternative medicine, is winning both popularity with patients and acceptance (or at least increased tolerance) among physicians. As modern medicine moves on to new frontiers, it is uneasily accompanied by a camp following of nonconventional, unorthodox medical practices. Some of them have been around for hundreds, even thousands, of years; others, like biofeedback, are modern techniques that have found useful niches alongside orthodox medicine.

The trend is easily measurable in dollars and cents. A third of adult Americans, most of whom consult medical doctors as well, spend an estimated $13.7 billion a year out of their own pockets on a bewildering array of breakaway treatments, including chiropractic, colonic irrigation, meditation, homeopathy, naturopathy, hypnotherapy, music therapy, folk medicine, guided imagery and Shiatsu massage. More than 1,000 homeopathic medicines are sold over the counter, along with a bewildering variety of vitamins, minerals, herbal remedies, fat burners, passion promoters and bee pollen.

The alternative movement has progressed from offbeat practitioners and adventurous patients to the medical establishment itself, as well as a growing number of health insurers. "We do a lot of clinical trials and research with these treatments," says Cary Badger, vice president of Kaiser-Permanente of Northern California, which reimburses its 5 million subscribers for some alternatives. "But our ultimate judges are our physicians, who feel these are reasonable alternatives."

Illustrious medical schools, no friends of untested practice, have joined lesser-known schools and research groups in taking a new look at what some prefer to call complementary medicine. Harvard Medical School, a bastion of high-end biomedical research, offers a course on how alternative treatments might affect clinical practice and research. Harvard has also endowed a Mind/Body Medical Institute chair, the first in the field of behavioral medicine, which is currently held by Dr. Herbert Benson, the fervent promoter of the "relaxation response," a physiological state of decreased blood pressure, heart rate, metabolism and respiration. Harvard professor Dr. David Eisenberg, who studied Chinese medicine in Beijing, directs the Center for Alternative Medicine Research at Boston's Beth Israel Hospital. Stanford offers its medical students a course that examines the alternatives, and its Center for Research in Disease Prevention is one of 10 centers nationwide that participate in a federally funded project to evaluate promising nonorthodox treatments.

Besides the several thousand doctors who include elements of various "unconventionals" in their practice, many others refer patients to non-M.D. practitioners on a case-by-case basis. Dr. Mark Anderson, an internist in Greenwich, Connecticut, directs some patients to homeopaths or acupuncturists for pain that has not responded to conventional treatment. "Patients ask about these things, and so long as they really want to try them and keep in touch with me afterward," he says, "I go along."

Insurers too have begun to take notice. Several pay for acupuncture, biofeedback and massage, if prescribed by a physician. One company, American Western Life of Foster City, California, covers a wide range of treatments under a pioneering wellness program. Twenty others even cover Dr. Dean Ornish's yoga, meditation and diet program for reversing coronary heart disease. Says Ornish: "When you compare the cost of an angioplasty to the cost of this program, the insurers are saving $5.55 for every dollar they spend. Moreover, 90% of the people recommended for bypass have been able to avoid it." Chiropractors, long the whipping boys of the medical establishment, are licensed to practice in all 50 states, their services covered by Medicare, Medicaid, workers' compensation and, in all but 10 states, private insurers.

But one big question remains: Does all this newfound Establishment attention mean that the nonconventional therapies really work? Critics say a definitive scientific answer must await well-designed experiments involving many patients. Up to now, most of the studies have relied on personal observation and anecdotal testimonials from satisfied patients. The official position of the American Medical Association, the alternatives' chief antagonist, is that a patient's improvement or recovery after alternative treatment might just as well be incidental to the action taken.

That attitude seems suitably skeptical, but many aspects of alternative medicine appear to be based on more than mere coincidence. Common sense dictates that people will rarely follow a course of action unless -- at some level, for whatever reason -- they meet with some success. Some alternative treatments have impressive histories going back to antiquity, and both practitioners and patients have experienced enough quantifiable results to warrant serious investigation. Moreover, there have been a number of speculative but sound scientific studies indicating that something is going on.

Acupuncture is just one example of a therapy once considered bizarre that may indeed have some scientific basis. A linchpin of Chinese medicine for thousands of years, it is based on the belief that inserting needles at various bodily points representing specific organs will balance a nebulous "life force" and influence the course of various diseases. While there is no hard evidence that such a force exists, quite a few reputable researchers -- including those at the Menninger Clinic in Topeka, Kansas; New York City's Mount Sinai School of Medicine; and Stanford -- draw a parallel between it and the bioelectrical-magnetic fields that permeate the human body and are believed by many scientists to play a role in disease.

Doctors and clinicians know that acupuncture can provide at least short-term relief for a wide range of pains, either by releasing endorphins -- naturally produced, morphine-like substances -- or by inhibiting the transmission of pain impulses through the nerves. Recent studies also show it to be effective in alleviating bronchial asthma, bronchitis and stroke-induced paralysis. At Johns Hopkins it is used as an adjunct to standard detoxification treatment for drug addiction. "I'm a healthy skeptic," says Johns Hopkins psychiatrist Mary McCaul. "But look, we don't have all the answers. Patients who choose acupuncture feel calmer. Even if it's a placebo effect, placebos are powerful things."

Relaxation techniques like meditation and biofeedback -- which teach patients to control heart rate, blood pressure, temperature and other involuntary functions through concentration -- have also given respectability to alternative medicine, and are routinely taught to patients and medical students. For good reason. There is little doubt that state of mind and physiological processes are closely linked. The connection between stress and ulcers and heart disease, for example, is well documented. Some scientists suggest that the power of prayer and faith healing, like some forms of meditation, might also be physiological in that they may protect the body from the negative effects of the stress hormone norepinephrine. And experience shows that relaxation techniques can help patients enormously. "Medicine is a three-legged stool," says Harvard's Benson. "One leg is pharmaceuticals, the other is surgery, and the third is what people can do for themselves. Mind-body work is an essential part of that."

Homeopathy, despite the A.M.A.'s characterization of it as a pseudo science, is another popular alternative that is drawing increased attention. Founded in the 18th century by Samuel Hahnemann, a German physician, it is based on the idea that like cures like -- that is, that microdoses of substances known, in large amounts, to cause illness can treat that illness by stimulating the body's own natural defenses and curative powers. In some respects, treatment with homeopathic medicines -- nontoxic compounds derived from plants, animals and minerals -- is akin to immunization or allergy treatments in which similar substances are introduced into the body to bolster immunity.
Allergic conditions occur when the immune system overreacts to certain substances, such as house dust, food, medicines and pollen. Conventional treatment employs antihistamines, steroid nasal sprays, cortisone-like drugs or desensitization shots. All are effective, but some have side effects and, except for allergy shots, only relieve a patient's symptoms. Homeopathic therapy, on the other hand, aims to reduce the allergic response itself. Treatment thus involves a microdose of an individually chosen substance that creates symptoms like those experienced by an allergic patient.

A substantial number of American doctors -- among them Wayne Jonas, a family practitioner who is director of the National Institutes of Health's Office of Alternative Medicine -- have been trained in homeopathy, as have countless nurses, veterinarians, chiropractors and naturopaths. While critics contend that homeopathic remedies are no better than water at worst and placebos at best, a survey of studies published in the British Medical Journal a few years ago indicates that some are actually more effective than placebos, and a number of reports document their efficacy in treating hay fever, respiratory infections, digestive diseases, migraine and a form of rheumatic disease. "I do what works best for my patients," says Dr. Jennifer Jacobs of Edmonds, Washington, a family practitioner and member of the nih Alternative Medicine Advisory Committee. "There are certainly situations where modern medicine is appropriate and lifesaving, but perhaps the pendulum has swung too far toward technology and standard pharmaceuticals and not enough toward some of the early healing methods that have a track record in many cultures."

That pendulum swing might be the main reason so many Americans flock to alternative practices. Many are concerned that their suffering has not been alleviated by standard medical or surgical treatment, or that the traditional treatments themselves are too expensive and often dangerous. Others feel that the intrusion of increasingly complicated and impersonal technology has widened the gap between mainstream care givers and patients. Too many doctors are thought to be coolly professional and emotionally distant, inclined to cure a specific disorder narrow-mindedly without comforting or caring. Many unconventional practitioners, on the other hand, are perceived as being more patient-friendly. Nearly everyone seems to agree that viruses and germs are not the only consideration in patient treatment; mind-body interactions, environment and life-style play roles as well.

Homeopaths pride themselves, for example, in their use of many different remedies for illnesses that are treated by conventional doctors with single medicines. Practitioners of homeopathy also place great importance on obtaining a meticulously detailed medical history that includes dreams and childhood experiences, enabling them to customize therapy. Chiropractic and massage, two of the three alternative therapies most used by Americans (along with relaxation techniques), provide another component many patients feel is lacking in high-tech medicine: touching, as both a curative and an extension of compassion.

Although chiropractic clearly has its drawbacks (notably its stubborn insistence that spinal misalignments cause or underlie most ailments, including those far afield from the backbone), its use of vertebral manipulation has proved useful not only in treating acute low-back pain and other muscular and neurological problems but also in comforting patients who appreciate the deft way skilled chiropractors use their hands. (Osteopaths, licensed physicians whose education is essentially the same as that of M.D.s, also include manipulative therapy in their treatments.) Studies at the University of Miami School of Medicine's Touch Research Institute have found that premature infants gain weight much faster after being massaged than babies in an unmassaged control group. Massaged infants cry less and are calmer than those who are rocked.

Dr. Joseph Jacobs, a former director of the nih Office of Alternative Medicine and a Yale-trained physician, feels the present distinction between alternative and conventional medicine will eventually be blurred. Jacobs, whose father was part Cherokee and mother a full-blooded Mohawk, appreciates how folk medicine can effectively combine with modern methods: his mother used herbal remedies but still took her children to the family doctor when necessary. "I'm neither a proponent nor a naysayer," he says, "but there's a whole gray zone there, and eventually it will just be a matter of different approaches."

While Jacobs is open-minded and urges his colleagues to be the same, he feels strongly that alternative methods need more thorough testing and cautions patients not to abandon traditional treatment. Harvard's Eisenberg agrees. "It is conceivable," he says, "that physical manipulation or acupuncture needles or active ingredients in particular remedies are in fact physiologically powerful. But if for certain patients, in certain instances, faith or belief can cause changes in physiological function in a reproducible way, then we have to bring together the best scientists and ask them to figure out why.'' That search is expected to take place over the next decade or so, and once it occurs, the secrets behind alternative medicine could join the panoply of expanding medical knowledge that has marked the 20th century.

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