LI-18 (Fu Tu) Protuberance Assistant

What does LI-18 Fu Tu do?

Fu Tu LI-18 is a local point on the side of the neck whose recorded work is narrow and anatomical: it benefits the throat and the voice, and it settles the breath. It sits on the Large Intestine Channel of Hand Yang Ming beside the voice box, and Sacred Lotus sources & references classify it as a Point of the Window of Heaven — the only category it carries. Everything recorded for it follows from those two facts: the structures it lies over, and the classical idea that the neck is where qi passes between the body and the head.

• Benefits the throat and restores the voice — the primary recorded action, and the reason it is listed for sore throat, hoarseness and sudden loss of voice. The Large Intestine channel ascends the neck on its way to the face, and LI-18 is its point beside the larynx.
• Alleviates cough and wheezing — the second recorded action, applied to cough and to asthmatic breathing where the breath will not settle. This is the "descending" half of what a neck point on a yang channel is asked to do.
• Dissipates nodules and swelling of the neck — the classical action behind its listing for goitre and for scrofula, the chains of hard nodules described in the classics. It lies directly over the thyroid region, which is why this indication attaches to it rather than to some more distant point.
• Regulates the passage of qi between chest and head — the Window of Heaven action. The classical account of this group is that they govern the traffic of qi through the neck, and that when that traffic is disordered the result is sudden voice loss, a swollen throat, a heavy or dizzy head, and qi rushing upward.

Note what LI-18 is not. It is not a five-shu, yuan-source, luo-connecting, xi-cleft, back-shu, front-mu or confluent point, and no such role is invented for it here. Its whole formal identity is the Window of Heaven classification, and its clinical range is correspondingly local and concrete.

Source: Sacred Lotus sources & references (channel, Window of Heaven classification, existing action record); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 118); Chinese Acupuncture & Moxibustion (p. 144); Ling Shu, on the Windows of Heaven; cross-referenced against multiple online sources.

What is LI-18 Fu Tu used for?

Fu Tu LI-18 is used for the throat and the voice — sore throat, hoarseness and sudden loss of speech — and for cough, wheezing and swellings of the front of the neck. The indications below are those carried in Sacred Lotus sources & references together with those set out in the standard reference literature. They describe traditional use, not proven treatment, and this point carries the significant anatomical cautions set out under needling.

• Sore, swollen and painful throat
• Sudden loss of voice; hoarseness
• Difficulty swallowing
• Cough
• Asthma and wheezing; shortness of breath
• Goitre and swelling of the front of the neck
• Scrofula — chains of hard nodules in the neck
• Pain, rigidity and swelling of the side of the neck
• Excessive salivation
• Numbness or paralysis of the arm along the channel

Source: Sacred Lotus sources & references (existing indication record); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 118); Chinese Acupuncture & Moxibustion (p. 144).

Where is LI-18 Fu Tu, and how is it used in practice?

Fu Tu sits on the side of the neck, level with the tip of the laryngeal prominence — the Adam's apple — in the gap between the two heads of the sternocleidomastoid, the sternal head that runs to the breastbone and the clavicular head that runs to the collarbone. That gap opens up and becomes easy to feel when the head is turned away, which is what makes the point locatable. It is also what makes it hazardous, because the same interval sits directly over the great vessels of the neck. Our two location records agree with each other, and neither has been altered here.

Which points is LI-18 combined with?

• For sore throat and voice loss — with Tian Tu REN-22 in the suprasternal notch and Lian Quan REN-23 above the voice box as local points, and with the distal points He Gu LI-04 on its own channel and Shao Shang LU-11 at the thumb.
• For goitre and neck nodules — with Tian Ding LI-17 immediately below it on the same channel, Ren Ying ST-09 and Shui Tu ST-10 in front, and Tian Jing SJ-10 as the distal point classically associated with dissolving nodules.
• For cough and wheezing — with Tian Tu REN-22 and Shan Zhong REN-17 on the front of the chest, and with Lie Que LU-07 as the distal Lung point.
• Along its own channel — LI-18 is the upper of the two Large Intestine points on the neck, with Tian Ding LI-17 below it; our own location record for LI-17 is measured as the midpoint of the line from LI-18 down to Que Pen ST-12, so the two are located from one another.
• In the modern surgical literature — the point that has actually been tested is LI-18 alone, bilaterally, with electroacupuncture during thyroid surgery, and separately the pairing of He Gu LI-04 with Nei Guan P-06. Those were compared head to head, and both beat GB-34 and a non-point control (PMID 29072015).
• Method — Sacred Lotus sources & references record moxibustion as applicable at this point.

Where does LI-18 sit among its category peers?

The Window of Heaven points are a small set named in the Ling Shu, sited almost entirely on the neck, understood as governing the passage of qi between the trunk and the head. Sacred Lotus sources & references hold ten points carrying this classification: Tian Zhu BL-10 in the nape, Feng Fu DU-16 on the midline of the nape, Tian Fu LU-03 on the upper arm, Tian Chi P-01 on the chest, Tian Tu REN-22 in the suprasternal notch, Tian Chuang SI-16 on the side of the neck, Tian Rong SI-17 below the angle of the jaw, Tian You SJ-16 behind the sternocleidomastoid, Fu Tu LI-18 on the side of the neck, and Ren Ying ST-09 beside the carotid pulse. Eight of the ten are on the neck; LU-03 and P-01 are the exceptions that different classical sources treat differently. LI-18 is one of only two members whose name does not begin with tian, "heaven" — the other being Feng Fu DU-16.

Source: Sacred Lotus sources & references (both location records, the Window of Heaven classification, the full ten-point set and the LI-17, ST-09, ST-10, REN-22, REN-23, SJ-10 and LU-07 records queried directly in the live point records); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 118); Chinese Acupuncture & Moxibustion (p. 144); Ling Shu, on the Windows of Heaven; PMID 29072015; cross-referenced against multiple online sources.

Where is LI-18 located?

• A Manual of Acupuncture (p. 118): On the lateral side of the neck, level with the tip of the laryngeal prominence, between the sternal and clavicular heads of the sternocleidomastoid muscle.
• Chinese Acupuncture and Moxibustion (p. 144): On the lateral side of the neck, level with the tip of Adam's apple, between the sternal head and clavicular head of m. sternocleidomastoideus.

How is LI-18 Fu Tu needled, and what lies beneath it?

Stated plainly: LI-18 is one of the anatomically exposed points of the body. It lies on the lateral neck between the two heads of sternocleidomastoid, level with the laryngeal prominence, and the common carotid artery, the internal jugular vein and the vagus nerve run in the carotid sheath immediately deep to it. Everything below is neutral reference data recording what the standard texts and the published anatomical literature state. It is not instruction, and this page does not teach technique. Needling is carried out only by a qualified, licensed practitioner.

The angle and depth the texts record

• Sacred Lotus sources & references record perpendicular insertion of 0.3 to 0.5 inch, with moxibustion applicable. That is a deliberately shallow figure for a point on the neck.
• Deadman & Al-Khafaji (p. 118) and Chinese Acupuncture & Moxibustion (p. 144) both record shallow insertion here and both attach an explicit caution naming the vessels of the neck. The reference literature is consistent that the needle is kept superficial and that medial angling — that is, angling toward the great vessels and the airway — is what the caution is directed against.
• The carotid pulse is palpable a short distance in front of this point, at Ren Ying ST-09. That palpable pulse is the practical marker of what the caution is about.

What the measured anatomical evidence does and does not cover

This distinction matters and is easy to get wrong. The best-known cadaveric needle-path study in this region dissected 92 sides in 46 adult bodies and reported that the internal jugular vein was pierced on 73.9 per cent of sides, the left common carotid artery on 26.1 per cent, and the vagus nerve contacted on 54.3 per cent (Zhongguo Zhen Jiu 2007;27(2):120–2, PMID 17370496). Those figures are cited on this site under Qi She ST-11, because that study marked and dissected the needle paths at Tian Tu REN-22 and Qi She ST-11 only — it did not measure LI-18. The figures are quoted here for context on what the carotid sheath contains at the root of the neck, and expressly not as a measurement of this point. No equivalent measured needle-path study of LI-18 has been located. Where our sources are silent, we say so rather than borrowing another point's numbers.

What is documented directly at LI-18 is its innervation. Tracer studies injecting the point in animals found its afferent fibres arising in the cervical dorsal root ganglia — chiefly C2–C4 in one series and C1–C6 in another — overlapping in C3–C5 with the afferents of the thyroid gland itself, with a small population of neurons sending branches to both (PMID 21793385; PMID 21375018). That is a description of a point sitting directly over the thyroid's own nerve supply, which is both why it is used in thyroid surgery and why it is a point where depth matters.

The wider adverse-event picture

Vascular injury from needling the neck is rare but documented. In a single-centre series of 15 patients treated for large extracranial carotid artery aneurysms, one case (1 of 15) was attributed to iatrogenic injury from acupuncture; the point needled was not identified (Axier A et al., BMC Neurol 2024;24:468, PMID 39616310, PMC11607796). Against that, a meta-analysis of prospective clinical studies estimated serious adverse events from acupuncture at approximately 1 per 10,000 patients and around 8 per million treatments, placing acupuncture among the safer treatments in medicine (Bäumler P et al., BMJ Open 2021;11:e045961, PMID 34489268). Both things are true at once: the overall rate is low, and the events that do occur cluster at a small number of anatomically exposed points, of which the lateral neck points are one group.

Pregnancy. No pregnancy contraindication is recorded for LI-18 in our sources or in the standard reference literature. On its own channel that caution attaches to LI-04 He Gu.

Source: Sacred Lotus sources & references (existing needling record, and both location records); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 118); Chinese Acupuncture & Moxibustion (p. 144); PMID 21793385; PMID 21375018; PMID 17370496 (measuring REN-22 and ST-11, not LI-18); PMID 39616310 / PMC11607796; PMID 34489268 — each verified resolvable and checked for retraction status before citation.

What does the name Fu Tu mean?

Fu Tu at LI-18 means "Protuberance Assistant" — fu, to support, assist or flank, and tu, a protrusion or prominence. The prominence in question is the laryngeal prominence, the Adam's apple, and the point is the one that flanks it: LI-18 sits out to the side, level with its tip. The name is therefore a location instruction, which is how a good many neck-point names work. Sacred Lotus sources & references translate it exactly that way.

Is LI-18 Fu Tu the same as ST-32 Fu Tu?

No — and this is one of the sharpest naming collisions in the point nomenclature. Two points are romanised "Fu Tu", they are written with different characters, they mean different things, and they are at opposite ends of the body. Sacred Lotus sources & references hold both, and the difference is worth setting out in full because pinyin alone cannot distinguish them:

• Fu Tu LI-18, "Protuberance Assistant" — on the side of the neck, on the Large Intestine Channel of Hand Yang Ming, level with the laryngeal prominence between the two heads of sternocleidomastoid. A Point of the Window of Heaven, used for the throat, the voice and the breath.
• Fu Tu ST-32, "Crouching Rabbit" — on the front of the thigh, on the Stomach Channel of Foot Yang Ming, 6 cun above the upper outer corner of the kneecap on the line from the anterior superior iliac spine. The name describes the bulge of the thigh muscle under the hand, which was likened to a crouching rabbit. It carries no special-point classification, and it is used for weakness, numbness and pain of the leg.

The two share only their romanisation. They differ in written character, in meaning, in channel, in category and in body region — neck versus thigh. Anyone reading "Fu Tu" in a point prescription must check which one is meant, and the reliable check is the point code rather than the pinyin. This is the same class of problem as Zi Gong the Conception Vessel point against Zi Gong Xue the extra point, and Shen Que against Shen Men — both of which are closed explicitly elsewhere in this library.

Why does the Window of Heaven classification matter at LI-18?

Because it is the only category the point has, and it explains an indication list that would otherwise look scattered. The Window of Heaven points are described in the Ling Shu as governing what passes between the trunk and the head, and their shared classical indications are exactly the disorders of that passage: sudden loss of voice, a swollen or obstructed throat, dizziness and a heavy head, disorientation, deafness, sudden visual loss, and qi rushing upward. A point treated for the voice, for the throat, for cough and for goitre is not doing four unrelated things — it is doing one thing at a junction. LI-18's near neighbours Ren Ying ST-09, Tian Chuang SI-16, Tian Rong SI-17 and Tian You SJ-16 ring the same stretch of neck and carry the same idea.

Is there research on LI-18 Fu Tu?

LI-18 has an unusually strong point-specific research position for a minor point, and it comes from one place: acupuncture-assisted anaesthesia for thyroid surgery. Because the point lies directly over the thyroid, it has been isolated and tested as a variable in its own right far more often than most points ever are.

• The head-to-head clinical trial. 216 patients undergoing thyroidectomy at three hospitals were randomised to six arms: local anaesthesia alone; electroacupuncture at LI-18 alone; transcutaneous electrical stimulation at LI-04 and P-06; electroacupuncture at LI-04 and P-06; electroacupuncture at GB-34; and electroacupuncture at a non-point. Pain scores, mean arterial pressure and heart rate at defined surgical stages, and the doses of fentanyl and lidocaine used, were the outcomes. The LI-18 arm and the LI-04/P-06 arms both outperformed the local-anaesthesia and non-point arms on pain scores and haemodynamic control and required less anaesthetic, while GB-34 did not differ from local anaesthesia or from the non-point (Zhen Ci Yan Jiu 2017;42(4):332–7, PMID 29072015). That design — a distant channel point and a non-point as controls, with the site-specific point tested alone — is exactly what "point specificity" research is supposed to look like, and LI-18 came out on the right side of it.
• A surgical case report. Endoscopic partial thyroidectomy performed with acupuncture-assisted anaesthesia at Fu Tu LI-18 (Zhang XW et al., Chin J Integr Med 2021;27(11):854–7, PMID 34738207). A single case, reported here as documented practice rather than as evidence.
• Why it might work — shared innervation. Horseradish-peroxidase and fluorescent double-labelling tracer studies in rats injected LI-18, LI-04, P-06 and the thyroid region separately and mapped the labelled neurons. Afferents from LI-18 arose in cervical dorsal root ganglia C1–C5, predominantly C2–C4, and those from the thyroid region in C1–C6, predominantly C2–C5, giving an overlap in C3–C5; a small proportion of ganglion neurons (about 3.8 per cent for the LI-18–thyroid pair) sent branches to both the point and the gland (PMID 21793385; PMID 21375018). This is a proposed anatomical substrate, established in animals, not a demonstration in people.
• Mechanism work in a neck-pain model. A sustained series of rat studies used a neck incision as the model and compared electroacupuncture at LI-18 against LI-04 with P-06 and against ST-36 with GB-34. LI-18 raised the pain threshold where the leg-point combination did not, and did so alongside measured changes in the cervical spinal dorsal horn — reduced substance P, NK-1 receptor and COX-1 with increased 5-HT1A and 5-HT2A receptor activity (Zhen Ci Yan Jiu 2010;35(2):91–8, PMID 20626139), and reduced cAMP and CREB messenger RNA (Zhen Ci Yan Jiu 2012;37(3):191–6, PMID 22934388). Animal work, and about a surgical incision rather than about sore throat — but it is genuinely about this point.
• Clinical use in throat disease. A controlled study in 90 patients with chronic laryngitis used acupuncture at Fu Tu LI-18, Ren Ying ST-09 and Shui Tu ST-10 with cake-separated moxibustion at Yong Quan KI-01, against an oral herbal preparation, and reported a higher total effective rate (Zhongguo Zhen Jiu 2007;27(7):506–8, PMID 17722830). A multi-point protocol, unblinded and single-centre; recorded as documented use of the point rather than as evidence about it.

The honest summary: the thyroid-surgery literature is real, is point-specific and includes a properly controlled multi-centre trial, which is more than most minor points can claim. It says nothing about the traditional indications — the throat, the voice, goitre or cough have not been tested at this point in an adequately powered trial, and this site does not present the anaesthesia findings as though they had.

How does LI-18 compare with the points around it?

Tian Ding LI-17 lies below it on the same channel, at the midpoint of the line from LI-18 to Que Pen ST-12, and shares its throat and voice indications with a narrower range. Ren Ying ST-09 lies in front of it beside the carotid pulse, is also a Window of Heaven point and additionally a Point of the Sea of Qi, and is the better known of the two. Shui Tu ST-10 and Qi She ST-11 continue down the front of the neck; ST-11 is the point in this region for which measured cadaveric needle-path data actually exist. Tian Chuang SI-16 sits behind LI-18 on the posterior border of the same muscle, and Tian Rong SI-17 above it below the jaw. Tian Tu REN-22 lies medially in the suprasternal notch and shares both the throat indications and the hazard profile. And Lian Quan REN-23, above the voice box on the midline, is the local point for the tongue and speech where LI-18 is the lateral point for the throat and voice.

Source: Sacred Lotus sources & references (name, translation, category, the full Window of Heaven set, the ST-32 Fu Tu record, and the LI-17, ST-09, ST-10, ST-11, SI-16, SI-17, REN-22 and REN-23 records, all queried directly in the live point records); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 118); Chinese Acupuncture & Moxibustion (p. 144); Ling Shu, on the Windows of Heaven; PMID 29072015; PMID 34738207; PMID 21793385; PMID 21375018; PMID 20626139; PMID 22934388; PMID 17722830 — each verified resolvable and checked for retraction status before citation; cross-referenced against multiple online sources.