I have been troubled by asthma since I was six months old, but after all of the medications and tests, I found a solution that works for me—acupuncture. Years ago, I was bothered by frequent attacks that sometimes sent me to the hospital. While I was at my acupuncturist for my back, I casually mentioned my problems with breathing. “I can help with that,” and she did. Since then, I have not been hospitalized for asthma. Acupuncture has become my treatment of choice (in conjunction with traditional medicine for acute symptoms).
But those of us who use acupuncture had to go on faith, we knew it worked, but there were few scientific explanations for its effectiveness.
That changed in 2018 when Dr. Neil Theise published a paper that identified a third conduit in the body. He named it the interstitium. (The other two are the lymphatic and cardiovascular circulatory systems, more about them later.) The interstitium is a previously unrecognized interconnected network of fluid-filled spaces between the fascia and bodily organs.
Fascia is a continuous web of thin, stringy, and tough connective tissue composed primarily of collagen. It surrounds, supports, and separates every muscle, bone, nerve, blood vessel, and organ in the body, acting much like an internal scaffolding.
Recently, these researchers discovered microscopic fluid-filled compartments in both organs and fascia, and they called the spaces and the movement of this fluid through a pathway—the interstitium. This fundamentally changed medical understanding, revealing that what was previously thought to be dense, solid tissue is actually a sprawling, microscopic, interconnected network that acts as a sponge for fluid and then sends the fluid through its own channels where it is picked up by the lymphatic system. The lymphatic system purifies the fluid and sends it indirectly to the bloodstream.
As further confirmation of the interstitium, in 2021, researchers examined skin-biopsy samples with tattoos. They found the ink particles had traveled into the fascia surrounding the skin (which is an organ). Prior to this discovery, it was believed that the organs and their fascia had no interconnection.
The existence of this previously unknown pathway between our organs and the fascia surrounding it — two tissue layers not known to connect with each other in this way — broke accepted anatomical boundaries.
Until this discovery, Western medicine only knew of two conduits in our body: the lymphatic system and the cardiovascular system. The lymphatic system removes excess fluid from tissues and provides a mechanism for depositing the fluid into the bloodstream. The cardiovascular system uses the heart to pump blood through arteries, capillaries, and veins.
In the interstitium, microscopic areas in the organs and fascia interconnect with one another using the fascia. The fluid moves within this interstitium before entering the lymphatic and cardiovascular systems, like groundwater flowing through the earth before returning to springs and rivers. The interstitium and the other two known conduits combine to operate like a multi-layer web in our body.
The interesting aspect for acupuncture is that the interstitium system may be the Western scientific explanation for acupuncture’s Qi (pronounced chi) and how it works.
Acupuncture is used to treat conditions as varied as chronic pain, infertility, bronchial issues, migraines, seasonal allergies, and nausea but why it works has never been fully understood. The interstitium is likely to be a Western scientific explanation. The principles of acupuncture invoke two circulating elements: Qi and blood. Qi flows along one of twelve main pathways, called meridians. Acupuncturists insert small needles into specific points on the body to eliminate blockages and enhance the flow of Qi along that meridian. These acupuncture points have been found to lie where fluid flows through the interstitium.
To study the relationship of the interstitium to acupuncture, scientists injected dye into acupuncture points in the forearms of volunteers. The dye slowly migrated upward along a route corresponding to the pericardium meridian, which passes through the wrist and along the inner arm. (Pericardium is the same meridian stimulated by anti-nausea wrist acupressure devices.)
I reached out to Katherine Binder, a licensed acupuncturist, of Eastern Shore Acupuncture to help me understand how acupuncture works and its relationship to the interstitium. When she treats my asthma, she inserts tiny needles along the lung and kidney meridians to stimulate Qi. The kidney meridian aids in inhalation, and the lung meridian helps with exhalation. I rest for 30 minutes while the needles are doing their job of unblocking the channels and stimulating the movement of Qi. In Western science this likely means that the fluids are flowing freely through the interstitium and thereby reducing inflammation. Furthermore, Binder explained that the insertion of needles stimulates white blood cells at each point, which is believed to aid in healing. Acupuncture is both science and art as my acupuncturist listens to each patient and chooses which meridians to activate.
(While acupuncture works great for me, it does not work for everyone. In some cases, it is as simple as finding a different acupuncturist—remember the art and science part—but in other cases, there is no explanation for its lack of effectiveness.)
The implications of the interstitium are enormous, beyond providing an explanation of what may be happening in acupuncture. Research suggests that cancer may use the interstitium to spread before it reaches and metastasizes in the lymphatic system. This concept has been used to develop a new drug for the treatment of pancreatic cancer. Other research is examining the role of the interstitium in diseases like cancer, kidney, diabetes, colitis, and liver illnesses.
The interstitium is not only expanding our understanding for future medicine, but also helping explain an Eastern medical tradition that is 2,000 to 3,000 years old. This is a fascinating development.
