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One by one into an ailing body, Marcie Baer inserts needles. Each one is the width of a strand of hair.

“You might feel the tiniest little prick. Most of the time, you don’t feel anything,” said Port Tobacco resident Rona Bayer, one of Baer’s acupuncture clients. “I can’t say enough about what she has done for me. ... It’s been great for both myself and a dog that I had.”

The treatments for her pet, she said, “I am sure bought him an extra couple of years of life.”

Acupuncture, a form of Chinese medicine, has been practiced in the East for thousands of years. Patients report sensations from a slight pinch to a deep ache as needles are inserted, said to correct or maximize the “qi” (pronounced ‘chee’), considered the life force, that flows along channels within the body. When there is an imbalance in a person’s internal energy flow, discomfort and, eventually, disease develop, acupuncturists say.

“It’s starting to become a trend: acupuncture, holistic, complimentary medicine. All these things that are more focused on maintaining a healthy individual, rather than picking up the pieces when things fall apart,” said Dr. Beatrice Afrangui, an anesthesiologist at the University of Maryland Medical Center in Baltimore. “I hope that this trend is going to continue.”

Today, there are 941 active acupuncturists in the state, up from 240 about 10 years ago, according to the Maryland Board of Acupuncture. There have been at least 77 new applications a year since 2009. Maryland has had an acupuncture board since 1994. Before then, acupuncturists needed to be supervised by physicians.

“More and more states were licensing,” said Penny Heisler, executive director of the Maryland acupuncture board. “Acupuncturists went down to Annapolis and said, ‘We don’t need to be supervised.’”

In Lexington Park, Leonardtown, Waldorf and Prince Frederick, 13 acupuncturists are licensed and practicing, according to the board.

To earn a Maryland acupuncture license, applicants must graduate from an accredited school with a master’s degree or pass the National Certification Commission of Acupuncture and Oriental Medicine exam, and complete 1,800 hours of training. To keep the licenses, acupuncturists take 40 hours of continuing education every two years.

The board receives about 10 complaints a year, Heisler said, for issues such as scope of practice, misconduct and operating without a license. Otherwise, she said, the state board stays busy with regulations, ethics and defining the scope of care.

From 1997 to 2009, for issues including carpal tunnel syndrome, low-back pain and fibromyalgia, researchers found that acupuncture was anywhere from “promising,” “equal to conventional care,” “superior to no treatment,” to “not more effective than placebo.”

It’s difficult to perform controlled placebo studies in acupuncture, Afrangui said. There are more than 365 acupuncture points in the body, so “great care” must be taken before inserting sham needles. “Just the fact that you are inserting a needle may have an effect,” she said. The process can lead to the release of endorphines, brain chemicals that act similarly to drugs like codeine and morphine, and reduce individuals’ perception of pain.

As part of its research, NIH looked at studies that used “sham” needles inserted along non-acupuncture points. Patients who received “trick” acupuncture said they felt pain relief. Patients who received true acupuncture also reported relief. Findings of this sort have led some scientists to say the efficacy of acupuncture is inconclusive or nonexistent. Believers, however, say these studies are proof that acupuncture, even when performed poorly, still has some effect.

Afrangui received acupuncture for pain while she underwent treatment for breast cancer — the same year, she was enrolled in an acupuncture course for physicians.

It was pretty good timing, she said. Learning about acupuncture helped distract her from being depressed about her own disease and gave her a new perspective: how it felt to be a patient.

“It was pretty intense,” she said. Her studies lasted about 10 months. During the course, the students were told that “we’d have to learn a whole new language,” Afrangui said. Instead, “it was like learning on a whole new planet.”

That’s not too far from the truth. says that “in the cosmology of traditional Oriental medicine, in between Heaven and Earth is the person. A person’s state of health is influenced by his or her relationship with Heaven, or the natural order. To enjoy perfect health, we need to live in harmony with God or Nature, according to our understanding of the universe.” For example, the site said, health is influenced by relationships with society and individuals; a person who “struggles bitterly” with family might not be in optimal health.

A person’s, or an animal’s, life force flows along energy pathways called meridians, according to the site. Acupuncture points can be opened to direct the flow of energy. “The meridians are like a string of Christmas tree lights,” the site says. “Bulbs that don’t light or that shine dimly correspond to the points that need treatment.”

Acupuncturists say they know firsthand that the energy is there. Some, like Afrangui, say they can feel a bit of energy transfer, a slight sensation at the same time or right before the patient feels it. When she had her acupuncture practice, Afrangui would treat up to five patients a day. “And I’d be completely spent. More so than just being in the operating room,” she said.

There is something tangible about it, Afrangui said. “It’s not as tangible as a nerve or a blood vessel. ... But there are some anatomically, microscopic differences in areas where there are acupuncture points,” she said, referencing studies where scientists have looked at energy flow along meridian points by X-ray or by measuring electricity within the body.

In acupuncture, five elements are said to correspond to specific organs and govern life force.

The elements are wood (liver and gallbladder), fire (including the heart and small intestines), earth (stomach and spleen), metal (lungs and large intestines) and water (kidneys and bladder). A living being’s life force “waxes and wanes” daily and in seasonal cycles.

In a nutshell, according to Acupuncture-Online: People with stronger energy of the wood have clear visions and goals. A wood energy imbalance can lead to indecisiveness and addictive personalities. Strong fire energy leads to charisma and the ability to command others to action. Weak fire can cause insomnia and heart problems.

Well-developed earth energy usually makes for a well-grounded and compassionate person. Earth imbalances can lead to worry and digestion issues. Strong metal energy might be found in well-organized and self-disciplined people. Weak metal might lead to an overly critical person who has trouble letting go. People with strong water energy are often fearless and determined. But water imbalances can make people anxious, withdrawn and sometimes phobic, practitioners say.

“The original idea of acupuncture is to balance a person, balance the qi,” Afrangui said.

Being an anesthesiologist is “kind of my dream job,” Afrangui said, despite what she called shortfalls in modern health care. “Western medicine is about treating things when there is a problem. ... American medicine [today] is just nuts,” she said, her German accent soft but emphatic. She tries to offer her patients balance, carefully deciding when to prescribe medicine and suggesting acupuncture when she thinks it would be effective in managing pain.

Across the country, Afrangui said, patients come to emergency rooms with conditions that could have been prevented. Then, some doctors do procedures just because they can, she said. “Should we really do extensive surgery on patients we know are not going to be cured, and their last years of life will be tortured?”

Thousands of years ago, half a world away, Afrangui said, Chinese doctors lived with the royals. When patients were healthy, doctors were rewarded. But when the health of their monarchs faltered, those physicians were punished, sometimes executed. She’s not talking about resorting to those extremes but asked, “Wouldn’t that be something? If doctors didn’t get paid unless people stayed healthy?”

During an acupuncture treatment, the needles might stay in the patient from 15 minutes to an hour, treating a perpetual list of ailments, from chronic pain to asthma, stroke rehabilitation to carpal tunnel syndrome. Patients range from the rich and famous to pets and children, silver-haired ladies to the burliest of men.

Actress Penelope Cruz was spotted with a narrow string of acupuncture beads in her ear to manage stress. A group of veterans meets in Annapolis every week for free treatments in a group setting to soothe symptoms related to post-traumatic stress syndrome.

“Chinese medicine looks at the whole person,” said Mina Johns, a member of Acupuncturists Without Borders, who runs the Annapolis clinic for veterans and their families. People drive to her from several parts of the state, she said. One veteran walks two miles for his appointment. She places needles in the cartilage around their ears, targeting energy pathways she says soothe their flight-or-fight responses, promote heart regulation and kidney detoxification, and support functions of the liver and lungs.

“It’s a very quiet and yet healing space,” she said. “Everybody is focused on their own health care and getting better.”

Soon, most patients forget they’ve become human pin cushions and fall into the abandon of slumber, sometimes aided by music and aromatherapy.

“It’s very relaxing,” said Lorraine Blatchley of Waldorf, who was referred by her doctor to see Baer for pain associated with fibromyalgia. Baer travels to several counties to meet with clients and is earning her doctorate in naturopathy, or natural ways to heal and stay healthy.

“If I didn’t see her, then I wouldn’t be able to move, I don’t think. ... I’m able to do more now in my 60s than I was able to do in my 40s,” Blatchley said.

During the treatments, she usually lies on her belly and Baer inserts needles into her back. How many needles?

“I don’t want to know how many there are,” said Blatchley. She was once so afraid of needles that she thought passing out was inevitable if they got close to her. “Usually, I don’t even feel them,” she said. “It’s not a needle, needle.”

“If I could change one thing, it would be how that word translated,” said Sherry Hamilton of Hamilton Acupuncture and Chinese Herbal Center in Leonardtown. Because of their fear, “some people, they would rather just die in pain than try acupuncture,” she said.

In Chinese medicine, Hamilton said, they called it a point. It finds its way through collagen fibers in the skin like a sewing needle finds its way into clothing fibers.

Beyond fear of needles, some people are resistant to trying something that, in the West, isn’t mainstream.

“They think it’s like voodoo,” said Sherry Lancaster, an acupuncturist in Prince Frederick. “They’re afraid because they don’t know how it works.”

“I ask them if they know how their medicine works,” said Lancaster, who said she also works as a registered nurse. “They say, ‘not really.’”

There are a lot of things people don’t readily understand, Lancaster said. “I don’t really understand how the lights come on when you flip a switch ... Or your television? Good God. How in the world does that work? How do faxes work?” But belief, she said, has nothing to do with the potential success of acupuncture.

Acupuncturists talk to patients extensively to understand their medical history — something, Lancaster said, Western doctors used to have time to do. She’s worked quite a bit with older patients who don’t want another operation or another pill. They usually don’t care how acupuncture works.

Bayer, Baer’s client from Port Tobacco, is 70. “I tend to be pretty peppy,” she said, and she exercises three to five times a week. She was referred to Baer by her doctor for several issues, including a nerve condition, sciatica, which causes pain to shoot from her lower back down to her leg.

“In one session of acupuncture, that pain was gone,” Bayer said. It came back about five years later, and “that time, it took two sessions.”

A few times, the needles went in and “hurt like the devil,” Bayer said. But the pain that brought her in for treatment had been severe. By the time the needles came out, she said, the pain “was completely gone.”

She also took her golden retriever, Thumps, for acupuncture treatments while he suffered from a degenerative spine condition. One veterinarian thought he’d have to be put down by about age 3. Instead, Bayer said, he lived to be 15.

“I have patients who say, ‘I never knew I would be coming to you this long,’” Hamilton said. “It can really effect a positive change in people’s lives.”

When patients are ill or need balance, Hamilton said she tries to cultivate her own qi so that she can influence their life energy. Patient and practitioner have to be a good fit, she said.

Don’t give up if one or two treatments don’t work, Hamilton said. “If you get a bad haircut, would you just stop getting haircuts?” Maybe a new barber would be the answer.

It’s the same idea with acupuncture, Hamilton said. “If you get the right fit, there can be some pretty amazing stuff that can happen.”