The May 11th interactive article in the New York Times, “The Human Body’s Hidden Pathways” [1] is a beautiful visual representation of findings about how the body works conducted by colleagues at The NYULH Center for Biospecimen Research and Development, Histology and Immunohistochemistry Laboratory [2].
This 2021 study investigated whether there was continuity in the ‘interstitial’ spaces between cells, tissues and organs throughout the body. The researchers explain that these spaces were once thought to be separate “like a patchwork quilt” [1], while this groundbreaking information shows they are actually continuous throughout the body “more like a knitted blanket” [1]. This realization has wide-ranging implications and augments a biomedical understanding of how acupuncture works (including earlier research on fascia, or connective tissue summarized in a previous blog post).
This NYU study used two methods:
1) looking at the movement of non-biological particles (tattoo pigment and colloidal silver) in and between the colon and skin and into nearby fascia. While the tattoo pigment studied was injected into either the skin or the colon, the colloidal silver had been applied topically to the skin.
2) examining the distribution of hyaluronic acid (HA) by staining it. HA is understood to regulate the flow of fluid and small molecules within the interstitial fluid [3], and this study used a stained HA to validate HA as a surrogate marker of many, if not most, interstitial spaces.
Results showing migration of these three substances proved there is, “continuity across large, multiorgan regions of the body, including the entirety of the dermis and the fascia of diverse organs and organ systems” [2]. This continuous system is now dubbed the ‘interstitium’ and conceptualized as a “third bodily system for the circulation of fluids” (in addition to cardiovascular and lymphatic systems). The movement of particles through larger areas is understood to be aided by both external forces (like massage) and internal (such as the heartbeat, respiration, and bowel movements). Researchers also note that interstitium along nerves elucidates a route of communication between the digestive and neurological systems, sometimes referred to as the gut–brain axis [4].
This research adds relevant insight to Traditional East Asian Medicine in a few ways:
– It helps confirm why distal acupuncture points (say on the extremities) can have notable effects on organs in other parts of the body.
Along similar lines, numerous studies show that acupuncture on specific points affects the microbiome in particular ways, aiding in the treatment of various conditions [5]. The interstitium as a physical conduit in addition to the neurological impulses created by acupuncture certainly helps explain these effects.
– It validates the clinical use of topical medicinals.
In my practice, I use a high grade hyaluronic acid (HA) as a base for my topical serums. This study explains how this is an ideal carrier to transport the medicinal components in the serum through the skin and into the deeper layers of the dermis.
I greatly appreciate the work of writer Avraham Z. Cooper and illustrator Jerome Berthier to bring this important research to a broader audience. My patients indeed found that this article reinforces their experiential understanding of this medicine.
Works Cited:
[1] Cooper AZ. “The Human Body’s Hidden Pathways.” New York Times. May 11, 2026. Accessed [May 14, 2026]. https://www.nytimes.com/interactive/2026/05/11/magazine/interstitium-anatomy-acupuncture-medicine.html.
[2] Cenaj O, Allison DHR, Imam R, et al. Evidence for continuity of interstitial spaces across tissue and organ boundaries in humans. Commun Biol. 2021;4(1):436. Published 2021 Mar 31. doi:10.1038/s42003-021-01962-0
[3] Wiig H, Gyenge C, Iversen PO, Gullberg D, Tenstad O. The role of the extracellular matrix in tissue distribution of macromolecules in normal and pathological tissues: potential therapeutic consequences. Microcirculation. 2008;15:283–296. doi: 10.1080/10739680701671105.
[4] Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann. Gastroenterol. 2015;28:203–209.
[5] Xu H, Luo Y, Li Q, Zhu H. Acupuncture influences multiple diseases by regulating gut microbiota. Front Cell Infect Microbiol. 2024;14:1371543. Published 2024 Jul 8. doi:10.3389/fcimb.2024.1371543
