Chris Bilardi moves his hands lightly and mysteriously around his patient's head, passing but never touching her shoulders while chanting prayers in German. She sits in a chair holding a Bible in her lap.

"The movement is always downward and away to the left," explains Bilardi, on a bench in Collegeville, his eyes narrowed into slits of concentration. He starts over again at her head.

"All motions are done three times. The next ones will concentrate on specific parts of the body - the esophagus, the liver, the spleen, the lungs, the heart, all the way down to the feet. It can take 15 minutes. I repeat this three times. The entire process can take 45 minutes to two hours depending upon the level of difficulty of the illness. Then I ask the patient to come back two more times."

Bilardi, 40, is horseshoe bald and sports a neat goatee. He speaks with impeccable grammar and an extensive, college-educated vocabulary in a deep voice that resonates as notes rolling through a cathedral. He has the professionally concerned face of a brain surgeon.

But Bilardi is practicing powwow - a folk-healing mixture of prayer and ritual that was widely used in Pennsylvania German communities in the 19th century and believed to have died out in the last generation. However, a new study suggests that powwow remains a persistent, if obscure, part of the American health-care system in eastern Pennsylvania.

Powwow was a word the English colonists applied first to any gathering of American Indians and then to the apparently unrelated practice of religious healing among the Pennsylvania Dutch, or Germans. The German word for the same system is Braucherei, and its practitioners are called Brauchers. But powwow and powwowers remain more commonly used.

Bilardi has written a comprehensive guide to the history, theory, and practice of powwow, The Red Church or the Art of Pennsylvania German Braucherei, published this year. Two years ago, anthropologist David W. Kriebel produced a scholarly examination of the practice today, Powwowing Among the Pennsylvania Dutch, growing out of seven years of research in central and Southeastern Pennsylvania.

The two met for the first time recently on the campus of Ursinus College in Collegeville.

Kriebel says his "guesstimate" is that there are between 200 and 300 powwowers in Pennsylvania.

"They don't advertise. They operate in secret by word of mouth," he says. Patients and practitioners are afraid that others will label them crazy or, at a minimum, old-fashioned and "dutchy."

He says that most powwowers are in eastern Pennsylvania, and that a few operate in Ohio, Indiana, Kansas, North Dakota, Maryland, North Carolina, and Canada.

Kriebel says there are professional powwowers, who either charge fees or accept donations, and nonprofessionals, whose clients are limited to family and friends. Bilardi is in the latter category.

"I see about 10 people a year," he says. "I don't advertise. The people are all family and friends, their animals, and friends of friends.

"The treatments were mostly for pain. Others have included growths such as cysts. In one case there was a dog with a large cyst on a foreleg, which I powwowed, and the cyst was gone overnight. That's the most dramatic result I've gotten thus far. Pain-management cases have been for things like neck and back pain, uterine troubles, enlarged prostate, fatigue, sore throat, and cold symptoms."

Most patients reported some relief, he says.

Bilardi went public and wrote his book because he hoped powwow could help more people. Like most powwowers, he devotes a good portion of his work to his family, and his current "patient" is his wife, Kelly.

"My specialty is pain management," he says, "and Kelly has a lot of problems with neck pain. This seems to relieve it."

Kelly nods her assent.

Kriebel says he collected data on 98 cases of treatment from seven practitioners and found that powwowing helped relieve about 90 percent of them. He says these results could have been due to spontaneous remission, unreported biomedical treatment, or a placebo effect whereby healing occurs because "the mind believes it will."

Bilardi sees powwow as a complement rather than an alternative to medicine. "I always insist that my patients consult a medical doctor, although many people come to me only after they have tried medicine and it hasn't worked."

Bilardi says the rationale behind his hand movements are to "sweep away" the illness or bad energy. "In terms of today's alternative energetic medicine, one would say that the sweeping is of the person's 'aura' or 'energetic body.' These modern terms are ones that old-time, traditional powwowers wouldn't have used."

Indeed, Kriebel says, this isn't your grandfather's powwowing. "Contemporary powwow appears to have more in common with healing prayer than with any form of magic, white or black. Powwow no longer requires the use of charm books and rarely uses material components. Powwowers speak less of their own power now than they did in previous times and usually are quick to credit God for their results."

Powwow has been handed down through a tradition of cross-gendering: Men teach it to women, women to men. Bilardi learned at the side of Daisy Dietrich in Schuylkill County, who was taught by her husband, Julius Dietrich, who got his knowledge from Ruth Strickland Frey, who practiced in Lehigh County in the early 20th century.

"Powwow is a kind of structured prayer," Bilardi says. "We are just conduits between the patient and God.

"We act as sponges. We don't get the illness, but sometimes we absorb the symptoms. I will sometimes experience great fatigue after powwowing. My first question is, 'Do you believe in God?' If the answer is no, then I don't treat them. It would be pointless."

Bilardi works full time as an order processor for "a large Fortune 500 company" in Wilkes-Barre, and lives in nearby Trucksville, where he meets most of his patients. As a teenager, he considered becoming a Roman Catholic priest - he has an eight-inch tattoo of the Virgin Mary on his left forearm - but went to Wilkes College and majored in English instead. He became interested in Pennsylvania German culture in his senior year at Wilkes and during graduate work in sociology in 1992 at Lehigh University.

He says a "revelation" at an antiques shop in Gettysburg, Pa., in 2002 led him directly to powwowing. "I touched a large Bible and felt an electric charge telling me to become a powwower."

Many of the powwow long-standing remedies outlined in Bilardi's book are familiar. For example, for bee stings: "Gather a little clean soil and add some fresh water to make a mud plaster. Apply the mud to the area of the sting." Others are less so, as this one for earaches: "Get an old smoking pipe and fill it with tobacco. Place the stem into the patient's sore ear; blow upon the lit bowl."

Kriebel says the tradition is likely to survive for many years.

"Based on my interviews with the families of powwowers," he says, "I believe that powwowing will likely persist in some form in central and Southeastern Pennsylvania for at least two more generations. Its future is uncertain after that, but I would not want to forecast its disappearance at any particular point. Thus far, to paraphrase Twain, reports of its demise have been greatly exaggerated."