REN-23 (Lian Quan) Ridge Spring

What does REN-23 Lian Quan do?

Lian Quan REN-23 is the point of Chinese medicine for the tongue. Sacred Lotus sources & references record two actions for it — it benefits the tongue, and it descends qi and alleviates cough — and the first of those is the reason the point exists. It sits on the midline of the throat just above the hyoid bone, the small horseshoe of bone that anchors the muscles under the chin, and the tongue root lies directly above and behind it. Our records also classify it as a Meeting Point of the Conception Vessel and the Yin Linking Vessel.

• Benefits the tongue — the primary recorded action, and an unusually literal one. This covers a stiff, swollen, deviated or immobile tongue, loss of speech, slurred speech, and the drooling that follows when the tongue and swallow no longer coordinate. Almost every classical indication for the point is a tongue indication.
• Descends qi and alleviates cough — the second recorded action, following the Conception Vessel's route down the front of the body. Qi rising when it should fall presents here as cough, as a sense of qi rushing upward into the throat, and as breathlessness.
• Benefits the throat and opens the swallow — the action behind its use for difficulty swallowing and for a sense of obstruction in the throat. This is the indication that has carried the point into modern hospital practice.
• Clears heat and reduces swelling below the tongue — the recorded basis for its use in swelling and pain of the region under the tongue, and in mouth and tongue ulceration.
• Regulates fluids of the mouth — the classical reading of the name. Quan is a spring, and the point is described in the tradition as governing the welling-up of saliva and fluid beneath the tongue, in both directions: profuse drooling on one side, a parched mouth on the other.

Source: Sacred Lotus sources & references (channel, the Conception and Yin Linking Vessel meeting classification, and the existing action record — whose broken list markup is corrected here); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 523; Chinese Acupuncture & Moxibustion, p. 241; cross-referenced against multiple online sources.

What is REN-23 Lian Quan used for?

Lian Quan REN-23 is used for disorders of the tongue, of speech and of swallowing — above all for the loss of speech and swallowing that follows a stroke. The indications carried in Sacred Lotus sources & references are swelling and pain below the tongue, salivation with paralysis of the tongue, loss of speech with a stiff tongue following windstroke, sudden hoarseness, and difficulty swallowing. The standard reference literature sets the range out as follows. These describe traditional use, not proven treatment, and this point carries the safety considerations recorded under needling.

• Difficulty swallowing — dysphagia, including post-stroke dysphagia
• Loss of speech with a stiff or immobile tongue following stroke
• Slurred, unclear or effortful speech
• Paralysis or deviation of the tongue
• Swelling and pain of the region beneath the tongue
• Excessive salivation and drooling
• Sudden loss of the voice; hoarseness
• Sore and painful throat; a sense of obstruction in the throat
• Ulceration of the tongue and mouth
• Dry mouth and thirst
• Cough with copious phlegm; rising of qi into the throat
• Choking and coughing on food or drink

Two things stand out in that list. First, it is unusually coherent — nearly every item concerns the tongue, the swallow or the voice, which is rare in a point repertoire where most points carry a scatter of unrelated uses. Second, the swallowing indications are the ones that have been carried furthest into modern practice: REN-23 appears in essentially every published acupuncture protocol for post-stroke dysphagia, and the evidence for that use is set out under research.

Source: Sacred Lotus sources & references (existing indication record, reformatted here as a list); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 523; Chinese Acupuncture & Moxibustion, p. 241.

Where is REN-23 Lian Quan, and how is it used in practice?

Lian Quan sits on the midline of the front of the neck, in the hollow immediately above the hyoid bone — above the Adam's apple, in the soft depression under the chin where the floor of the mouth begins. To find it, the hyoid is the landmark: a small U-shaped bone that can be felt moving upward when a person swallows, and the point lies in the dip on its upper edge. It is the second-highest point of the Conception Vessel, below only Cheng Jiang REN-24 in the groove beneath the lower lip, and above Tian Tu REN-22 in the notch at the top of the breastbone.

In practice REN-23 is used almost exclusively as a local point, and almost always for the tongue and the swallow. What distinguishes it from most local points is the direction of the technique: the reference texts record the needle being angled upward toward the root of the tongue rather than straight in, so that the stimulation is delivered to the muscles of the floor of the mouth rather than to the skin of the throat. That is set out as reference fact under needling.

Which points is REN-23 combined with?

• For post-stroke loss of speech and swallowing — with Ya Men DU-15, "Mute's Gate", at the top of the neck behind, which is the classical partner for loss of speech; with Feng Fu DU-16 above it; with Feng Chi GB-20 beneath the occiput, which the modern data-mining literature identifies as the single most frequently used point in this indication; and with the extra points Jin Jin Yu Ye beneath the tongue, pricked to bleed, which our own record describes as the point for a swollen tongue and for restoring speech. All are held in Sacred Lotus sources & references.
• With Shang Lian Quan — the extra point held here on the neck, one cun below the midpoint of the lower jaw in the depression between the hyoid and the jawbone, whose own record describes it as restoring speech in a stiff or swollen tongue and stopping profuse salivation. The two are the closest neighbours in this library and are used together and interchangeably in modern tongue-and-swallow protocols. One difference in our own records is worth flagging: moxibustion is recorded as applicable at REN-23 and as contraindicated at Shang Lian Quan.
• For loss of voice and throat obstruction — with Tian Tu REN-22 below it in the suprasternal notch, and the distal pairing He Gu LI-04 and Zhao Hai KI-06, the classical combination for the voice.
• For drooling and facial involvement — with Cheng Jiang REN-24 below the lip and the facial points Di Cang ST-04 and Jia Che ST-06, both held here.
• For cough and rising qi — with Tian Tu REN-22 and Shan Zhong REN-17 on the chest, and Feng Long ST-40 for phlegm.
• Along the Yin Linking Vessel — REN-23 is one of the points where the Conception Vessel and the Yin Linking Vessel meet, which links it to Nei Guan P-06, the Confluent point of the Yin Linking Vessel at the wrist. (Our library codes the Pericardium channel P-06, P-07, P-08.)

Where does REN-23 sit among its peers?

It is the tongue point, and it has no real competitor for that role among the channel points. Sacred Lotus sources & references classify it as a Meeting Point of the Conception and Yin Linking Vessels — the same classification held by Tian Tu REN-22, its neighbour below, which is the only other point in our records to carry it. The Yin Linking Vessel is one of the eight extraordinary vessels and is described as linking the yin channels and governing the interior; the two points at which it meets the Conception Vessel are both on the front of the neck, which is a small, tidy piece of the system and easy to remember.

Two comparisons help place the point. Where REN-22 reaches the windpipe and the throat proper — cough, asthma, loss of voice — REN-23 reaches the tongue and the swallow above it. And where the extra point Jin Jin Yu Ye is applied to the underside of the tongue itself by pricking to bleed, REN-23 reaches the same territory from outside the mouth with an ordinary needle. The three form the classical tongue-and-throat group of this library, and all three are held.

Source: Sacred Lotus sources & references (location, the Conception and Yin Linking Vessel classification, and the REN-17, REN-22, REN-24, DU-15, DU-16, GB-20, LI-04, KI-06, ST-40, P-06, Jin Jin Yu Ye and Shang Lian Quan records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 523; Chinese Acupuncture & Moxibustion, p. 241; PMID 35403412; cross-referenced against multiple online sources.

Where is REN-23 located?

• A Manual of Acupuncture (p. 523): On the anterior midline of the neck, in the depression above the hyoid bone.
• Chinese Acupuncture and Moxibustion (p. 241): Above the Adam's apple, in the depression of the upper border of the hyoid bone.

How is REN-23 Lian Quan needled, and what is the risk?

Stated plainly: REN-23 lies on the front of the neck and the needle is recorded as travelling upward toward the root of the tongue. The structures that matter are therefore the hyoid bone, the muscles of the floor of the mouth, the lingual artery and vein that supply the tongue, the hypoglossal nerve that moves it — and, deeper and behind, the airway. Sacred Lotus sources & references record oblique insertion of 0.5 to 1.0 inch directed toward the tongue root, with moxibustion applicable. Everything below is recorded as neutral reference data describing what the textbooks and the published clinical literature state. It is not instruction, this page does not teach technique, and needling is carried out only by a qualified, licensed practitioner.

The angle and depth the texts record

• Sacred Lotus sources & references record oblique insertion of 0.5 to 1.0 inch, directed toward the root of the tongue, with moxibustion applicable. The direction is the substance of that record: the recorded path runs upward and backward into the muscle mass beneath the chin, not perpendicularly inward toward the neck.
• Deadman & Al-Khafaji (p. 523) and Chinese Acupuncture & Moxibustion (p. 241) record the same obliquely upward insertion toward the tongue root in a comparable range. The reference literature also records that needle sensation at this point commonly travels into the tongue itself.
• For comparison within our own records: the extra point Shang Lian Quan, a short distance above between the hyoid and the jaw, is recorded here with oblique insertion of 0.8–1.2 cun toward the root of the tongue and with moxibustion contraindicated. Two adjacent points on the same anatomy with different moxibustion records is a real difference and is stated rather than smoothed over.
• What the recorded angle avoids. Angling upward keeps the needle within the suprahyoid muscle group, with the floor of the mouth above it and the body of the hyoid below. The direction the texts do not describe — straight back into the neck — is the one that points toward the airway.

The anatomy beneath the point

Between the skin at REN-23 and the root of the tongue lie, in order: the platysma; the mylohyoid muscle forming the floor of the mouth, with the geniohyoid above it and the anterior bellies of digastric on either side; and then the genioglossus, the great fan-shaped muscle that makes up the bulk of the tongue's root and whose contraction pulls the tongue forward. These are the suprahyoid muscle group, and they are the muscles that lift the hyoid and the larynx during a swallow. That is precisely why this point is used for swallowing disorders: the recorded needle path runs into the machinery of the swallow itself.

The structures that make the region require care are vascular and neural rather than visceral. The lingual artery, a branch of the external carotid, runs forward toward the tongue deep to the hyoglossus muscle at about the level of the hyoid bone; the hypoglossal nerve, which supplies all the tongue muscles, runs forward above it; and the region is richly supplied with veins. The recorded consequence in the clinical literature is bruising and local haematoma rather than catastrophic injury — and that has been measured, as set out below. Deeper and posterior to all of this lies the pharynx and the airway, which is why the recorded technique keeps the needle angled up into the muscle rather than back into the neck.

What has actually been measured

• Bruising rates in the anterior neck, measured directly in a randomised trial. This is the most useful published safety figure for this region and it is worth stating precisely. A randomised controlled trial in 120 patients with pharyngeal dysphagia after stroke compared three arms: ultrasound-guided electroacupuncture of the suprahyoid muscle group; conventional acupuncture at a group of points comprising Lian Quan CV-23, Wan Gu GB-12 and Feng Chi GB-20; and electroacupuncture of the suprahyoid muscles located by surface anatomy alone. The recorded incidence of subcutaneous haematoma afterwards was 0 per cent (0/40) in the ultrasound-guided arm, 20.0 per cent (8/40) in the conventional acupuncture arm that included CV-23, and 47.5 per cent (19/40) in the landmark-guided suprahyoid arm (Zhongguo Zhen Jiu 2022;42(3):251–6, PMID 35272399). State the limit precisely: the 20 per cent figure belongs to a three-point protocol, not to CV-23 alone, and a subcutaneous haematoma is a bruise rather than a serious injury. But the direction of the finding is unambiguous and directly relevant: this is a well-vascularised region, bruising there is common rather than rare, and imaging guidance reduced it to zero in this trial.
• A second measured adverse-event rate. A randomised trial of 104 patients with post-stroke dysphagia which used deep needling at Lian Quan CV-23 and Yi Feng SJ-17 as its main points recorded adverse reactions in the acupuncture arm as regional haematoma in 3 of 52 patients and pain in 2 of 52, an overall rate of 9.62 per cent, against 11.54 per cent in the control arm (which was choking and coughing during swallowing training) (Qin L et al., Zhen Ci Yan Jiu 2019;44(2):144–7, PMID 30945493). Again a protocol rather than a single point, and again the recorded events are bruising and soreness.
• Research depths exceed textbook depths, and that should be read carefully. Several published trials at this point describe deep needling into the tongue root under hospital conditions with specialist supervision — the trial above is explicitly of "deep acupuncture" at CV-23. These are recorded here as facts about what the research literature describes in a hospital research setting, emphatically not as depths attaching to ordinary practice.
• Honest limit of what we can source. No published study measuring a safe needling depth at REN-23 by imaging or dissection was located, and none is invented here. The chest and upper-back points of this library have such studies; this one does not. What is recorded instead is the bounded depth and specified direction the reference texts give, the named anatomy the recorded path passes through, and the two measured adverse-event rates above.
• No single agreed safe depth exists for any point. Two systematic reviews of the safe-depth literature — 33 studies in one, 47 in the other, using MRI, CT, ultrasound and cadaveric dissection — concluded that measured depths for the same point differ greatly between subject groups and measuring methods, and that "safe depth" has never been standardised (J Altern Complement Med 2011;17(3):199–206, PMID 21417806; Evid Based Complement Alternat Med 2013;2013:740508, PMID 23935678).

What we will not claim

No published case report naming Lian Quan REN-23 as the point at which a serious injury or death occurred was located, and no such claim is made here. Serious acupuncture injuries are documented in the general literature — a systematic review of the Chinese case-report literature from 1956 to 2010 identified 1,038 adverse-event cases across 167 articles with 35 deaths (He W et al., J Altern Complement Med 2012;18(10):892–901, PMID 22967282), and a companion review of 115 articles reported 479 events including 14 deaths (Zhang J et al., Bull World Health Organ 2010;88(12):915–921C, PMID 21124716, PMC2995190) — but neither review identifies individual points, and neither has been read here as evidence about this one. The honest position is the one the measured data supports: the recorded hazard at REN-23 is bruising, it is common, and the anatomy that would make anything worse is the airway behind the recorded needle path rather than in it.

Risk in proportion. A meta-analysis of prospective clinical studies estimated serious adverse events in acupuncture at approximately 1 per 10,000 patients and around 8 per million treatments, with about half of all recorded events being bleeding, pain or flare at the needle site (Bäumler P et al., BMJ Open 2021;11:e045961, PMID 34489268). At this point, that "about half" is the relevant category.

Source: Sacred Lotus sources & references (existing needling record; the Shang Lian Quan record queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 523; Chinese Acupuncture & Moxibustion, p. 241; PMID 35272399; PMID 30945493; PMID 21417806; PMID 23935678; PMID 22967282; PMID 21124716 (PMC2995190); PMID 34489268 — each verified resolvable and checked for retraction status before citation.

What does the name Lian Quan mean?

Lian Quan means "Ridge Spring" — lian, a ridge, edge or angular corner, and quan, a spring or welling source of water. Sacred Lotus sources & references translate it as Ridge Spring. Both halves are descriptive. The ridge is the anatomy: the point sits against the upper edge of the hyoid bone, on the ridge formed where the underside of the chin meets the front of the throat. The spring is the function: the fluid that wells up beneath the tongue. The classical literature treats saliva as one of the body's fluids with a source of its own, and this point is named as that source's opening — which is why the point's recorded indications run in both directions, covering profuse drooling and a dry, parched mouth alike.

The name also explains a piece of the point's history that catches students out. There is a second point in this library called Shang Lian Quan — "Upper Ridge Spring" — held as an extra point on the neck, one cun below the midpoint of the lower jaw. It is named for its relationship to this point, not the other way round, and it does very much the same work.

Why does the Yin Linking Vessel classification matter?

The Yin Linking Vessel (Yin Wei Mai) is one of the eight extraordinary vessels — the reservoirs that run between and across the twelve regular channels rather than belonging to an organ. It is described as linking the yin channels of the body and as governing the interior. Sacred Lotus sources & references record only two points as Meeting Points of the Conception and Yin Linking Vessels: Tian Tu REN-22 and Lian Quan REN-23, neighbours on the front of the neck. Its Confluent point — the distal point through which the whole vessel is accessed — is Nei Guan P-06 at the wrist, which is why that point appears in treatments aimed at the chest and throat far from where it sits. The classification is one of the tidier pieces of the extraordinary-vessel system: two adjacent points, one vessel, one distal key.

Is there research on REN-23 Lian Quan?

Yes — and unusually for an individual acupuncture point, some of it is genuinely point-specific and published in high-profile journals. REN-23 is the standard stimulation site in the modern research on post-stroke dysphagia, and both a randomised trial of the point needled alone and a mechanistic study in Nature Communications exist. It should be represented honestly, including its limits, so what follows separates what tested this point from what tested a protocol containing it.

Studies of this point specifically

• A randomised trial of CV-23 needled on its own. Sixty-four patients with post-stroke dysphagia were randomised to a lateral needling technique at CV-23 alone, without needle retention, once daily, or to conventional swallowing rehabilitation training, both for four courses of one week. The CV-23 group improved more than the training group on both the Kubota water swallowing test grade and the standardised swallowing assessment score (both P < 0.05). Video fluoroscopic swallowing study in the CV-23 group showed increased hyoid bone movement displacement and shortened pharyngeal delivery time after treatment (Liang XS et al., Zhongguo Zhen Jiu 2022;42(7):717–20, PMID 35793878). This is a small, single-centre, unblinded trial from one research tradition and should be read as preliminary — but it isolated the point, it used an objective imaging outcome, and the mechanism it reports is a mechanical one that can be checked.
• A mechanistic study of electroacupuncture at CV-23, in Nature Communications. Working in a mouse model of post-stroke dysphagia created by focal ischaemia of the primary motor cortex, the authors identified a cluster of excitatory neurons in layer 5 of the primary motor cortex that regulates swallowing by modulating the mylohyoid muscle, showed that the model reproduced impaired water consumption and abnormal mylohyoid electromyography, and found that this dysfunction was rescued by electroacupuncture at CV-23 in a manner dependent on those contralateral cortical neurons and on activation of the parabrachial nuclei and the nucleus tractus solitarii (Yao L et al., Nat Commun 2023;14(1):810, PMID 36781899, PMC9925820, DOI 10.1038/s41467-023-36448-6). The paper's opening premise is stated flatly — stimulation at CV-23, at the depression superior to the hyoid bone, has been shown to be beneficial in dysphagia, and the neurological mechanism was unknown. This is animal work, and animal work does not establish clinical effect. But it is a serious, well-published attempt to explain a specific point rather than acupuncture in general.
• A second mechanistic study, at the hypoglossal nucleus. The same research group traced the brain regions projecting to the tissues around CV-23 in mice and found direct projection from the hypoglossal nucleus — the brainstem nucleus that drives the tongue muscles. Electroacupuncture at CV-23 improved vocal fold movement and swallowing electromyography in the post-stroke model, and chemogenetic inhibition of the hypoglossal nucleus abolished that improvement; the upstream regions projecting to it included the nucleus tractus solitarii and the intermediate reticular nucleus (Di WH et al., Zhen Ci Yan Jiu 2025;50(8):862–871, PMID 40854852). Animal work again, and from the same tradition as the paper above.

Studies of protocols in which this point is central

• Deep needling at CV-23 within a protocol. A randomised trial of 104 patients with post-stroke dysphagia compared deep needling of the main points Lian Quan CV-23 and Yi Feng SJ-17, plus conventional needling of GB-20, DU-16, GB-12, LU-07, Jin Jin and Yu Ye and electroacupuncture across CV-23 to DU-16, against conventional swallowing rehabilitation training. The acupuncture arm did better on the standardised swallowing assessment and the water swallowing test, with a reported total effective rate of 88.46 per cent against 61.54 per cent (PMID 30945493). A protocol, not a point.
• CV-23 after surgery for laryngeal cancer. A study of a three-tongue-needle technique at Lian Quan CV-23 and He Gu LI-04 combined with swallowing training reported improved quality of life in laryngeal cancer patients with dysphagia after surgery (J Tradit Chin Med 2022;42(4):632–637, PMID 35848979). A different population from the stroke literature, and worth noting because it is not stroke.
• The point-selection literature places CV-23 at the centre of this indication in both directions. A data-mining analysis of 191 acupuncture prescriptions for neurogenic dysphagia drawn from classical Chinese medical texts from the pre-Qin to the late Qing found Lian Quan CV-23 among the top five most frequently prescribed points, after ST-06, ST-04 and LU-07 and alongside DU-26 (PMID 32869602). A modern equivalent, analysing 87 papers and 89 prescriptions for pseudobulbar palsy dysphagia published between 1990 and 2021, concluded that modern practice selects local neck points, "especially Feng Chi GB-20 and Lian Quan CV-23", with needles directed toward the site of disease (PMID 35403412). Ancient and modern practice agree about this point, which is not true of most points.

What the overall evidence for the indication shows — and what it does not

The systematic review literature on acupuncture for post-stroke dysphagia is large and broadly positive, and it should be read with its limits attached. A meta-analysis of 29 randomised trials in 2,190 patients found a higher effective rate for acupuncture than for non-acupuncture treatment (relative risk 1.33, 95% CI 1.25 to 1.43), rated the included studies as medium quality against the STRICTA reporting checklist, found acupuncture intensity and outcome-measurement method to be the main sources of heterogeneity, and recorded no severe adverse events (Chin J Integr Med 2018;24(9):686–695, PMID 30022468). A meta-analysis of 17 studies in 1,479 patients found acupuncture combined with swallowing training superior to swallowing training alone on effective rate (RR 1.26, 95% CI 1.19 to 1.34) and on swallowing function scores, but found no difference in quality of life and detected some evidence of publication bias on the effective-rate outcome (Li LX, Deng K, Acupunct Med 2019;37(2):81–90, PMID 30843423). More recent meta-analyses continue in the same direction, including one of aspiration specifically (Front Neurol 2024, PMID 38915795) and one examining optimal electroacupuncture parameters (Front Neurol 2025, PMID 41602993).

The honest reading is this. These reviews test acupuncture protocols for post-stroke dysphagia, and REN-23 is in nearly all of them — but a protocol result is not a point result, the trials are overwhelmingly from Chinese centres and unblinded, "effective rate" is a soft composite outcome, and publication bias has been detected. What can be said without overstating it: this is one of the better-evidenced indications in acupuncture; REN-23 is the point at its centre in both the classical and the modern record; one randomised trial has isolated the point and found an effect with an objective imaging outcome; and two mechanistic studies have identified plausible neural pathways for it. That is a considerably stronger position than most acupuncture points can claim, and it is still not proof.

How does REN-23 compare with the points near it?

Tian Tu REN-22 lies below it in the notch at the top of the breastbone, shares its Conception and Yin Linking Vessel classification, and is the throat-and-windpipe point where REN-23 is the tongue-and-swallow point; it is also far more hazardous, because its recorded technique takes the needle down behind the breastbone. Cheng Jiang REN-24 lies above it in the groove below the lower lip and is the Conception Vessel's face point. Shang Lian Quan, the extra point held here, sits between REN-23 and the jaw and covers almost the same indications — with moxibustion recorded as contraindicated there and applicable here. Jin Jin Yu Ye, the paired extra points on the veins beneath the tongue, reach the same territory from inside the mouth by pricking to bleed. Ya Men DU-15, "Mute's Gate", on the back of the neck, is the classical partner point for loss of speech and carries its own strong caution because of what lies beneath it. Feng Chi GB-20 below the occiput is the point the modern dysphagia literature uses most often alongside this one. All are held in Sacred Lotus sources & references.

Source: Sacred Lotus sources & references (name, channel, categories, and the REN-22, REN-24, DU-15, GB-20, P-06, Jin Jin Yu Ye and Shang Lian Quan records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 523; Chinese Acupuncture & Moxibustion, p. 241; PMID 35793878; PMID 36781899 (PMC9925820); PMID 40854852; PMID 30945493; PMID 35848979; PMID 32869602; PMID 35403412; PMID 30022468; PMID 30843423; PMID 38915795; PMID 41602993 — each verified resolvable and checked for retraction status before citation; cross-referenced against multiple online sources.