SI-18 (Quan Liao) Cheek Bone Hole

What does SI-18 Quan Liao do?

Quan Liao SI-18 is the cheek point of the Small Intestine channel — a Meeting Point of the Small Intestine and Sanjiao channels, sitting in the hollow under the cheekbone — and its recorded work is to expel wind and stop pain, and to clear heat and reduce swelling. Sacred Lotus sources & references record both actions directly and confirm the meeting-point classification by direct query. Between them those two actions cover almost everything this point is used for: a face that has stopped moving properly, a face that hurts, and a cheek that is hot or swollen.

• Eliminates wind and alleviates pain — the first recorded action and the defining one. "Wind" in the classical account of the face is the sudden, one-sided, moving disorder: a mouth that has drawn to one side overnight, an eyelid that will not close, a cheek that twitches, a lightning pain across the face. SI-18 is the principal point of the cheek for all of these, and it is the point that reaches the middle third of the face — between the eye above and the jaw below.
• Clears heat and reduces swelling — the second recorded action. It covers the hot, swollen, distended cheek, toothache in the upper jaw, and the yellowed sclera our own indication record carries at this point. Where the first action is about movement and pain, this one is about the state of the tissue.
• Benefits the face and opens the channel across it — an extension of the first action rather than a separate one. As a Meeting Point of two channels, SI-18 is a place where the Small Intestine and Sanjiao channels are described as crossing, which is the classical reason a single point at the cheekbone is held to reach further than its own small territory.

Why does the meeting-point classification matter here?

Because it is the only classification this point carries, and it explains its reach. Queried directly, SI-18 holds no five-shu, yuan, luo, xi-cleft, back-shu or front-mu classification and no element — what it holds is the designation Meeting Point of the Small Intestine and Sanjiao Channels. A meeting point is a place where two or more channels are described as converging, so that needling it is understood to act on all of them rather than on one. The face is full of such points, because it is where the yang channels of the hand and foot terminate and cross: Ting Gong SI-19 just in front of the ear is a Meeting Point of the Small Intestine, Sanjiao and Gallbladder channels; Ju Liao ST-03 on the cheek meets the Yang Motility Vessel; Ying Xiang LI-20 beside the nose meets the Large Intestine and Stomach channels; Yi Feng SJ-17 behind the earlobe meets the Sanjiao and Gallbladder channels. All are held here and all were queried. SI-18's particular crossing — Small Intestine with Sanjiao — is the one that puts the cheekbone on the same line as the ear and the side of the head.

Source: Sacred Lotus sources & references (existing action record, reformatted here as a list; channel confirmed as the Small Intestine Channel of Hand Tai Yang, the meeting-point classification and the absence of other categories and element queried directly, alongside the SI-19, ST-03, LI-20 and SJ-17 classifications); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 246); Chinese Acupuncture & Moxibustion (p. 173); cross-referenced against multiple online sources.

What is SI-18 Quan Liao used for?

Quan Liao SI-18 is used above all for facial paralysis and for pain in the face — it is one of the small handful of points named in every published facial-palsy protocol — and after that for twitching of the eyelid and cheek, for toothache in the upper jaw, and for swelling of the cheek. The indications carried in Sacred Lotus sources & references are facial paralysis, twitching of the eyelids, pain in the face, toothache, swelling of the cheek and yellowish sclera; the standard reference literature sets them out more fully below. These describe traditional use, not proven treatment.

• Facial paralysis — the defining indication, and the one the modern literature is built on
• Deviation of the mouth and eye
• Twitching of the eyelid
• Twitching and spasm of the cheek and lips
• Pain in the face — including the sudden, severe, one-sided pain of trigeminal neuralgia
• Toothache, particularly of the upper teeth
• Swelling and distension of the cheek
• Pain and swelling of the gums of the upper jaw
• Yellowing of the sclera — the whites of the eyes
• Redness and swelling of the eye
• Pain in the eye that will not let it be looked out of
• Sequelae of facial palsy, including synkinesis — unwanted linked movement of the face
• Trismus and difficulty opening the mouth (with the jaw points below)

Why the indication list is so tightly focused, and why that is a strength. Unlike most points on this channel, SI-18 carries almost nothing systemic — no digestive indications, no internal-organ pattern, nothing away from the head. Everything on the list is within a few centimetres of the point, or is a disorder of the nerve that supplies that area. The one apparent exception, yellowish sclera, is a heat sign read from the eye rather than a treatment of the eye itself, and it belongs to the point's second recorded action. Keeping this list short is the accurate thing to do; a longer one would be padding.

Source: Sacred Lotus sources & references (existing indication record, reformatted here as a list from a bare comma-run); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 246); Chinese Acupuncture & Moxibustion (p. 173); PMID 19222110; PMID 3412001; cross-referenced against multiple online sources.

Where is SI-18 Quan Liao, and how is it used in practice?

Quan Liao lies in the hollow directly under the cheekbone, on a line dropped straight down from the outer corner of the eye. In our own words: find the outer corner of the eye, drop a finger straight down until it meets the hard ridge of the cheekbone, and then slip just off the lower edge of that ridge into the soft depression beneath. The bone is above and behind the fingertip; the hollow is small and usually distinct. Sacred Lotus sources & references hold two location records for it and they agree closely, both placing it directly below the outer canthus at the lower border of the zygomatic bone. There is no discrepancy between them to flag.

Which points is SI-18 combined with?

• With Jia Che ST-06 and Di Cang ST-04 — the two great points of the lower face, both held here and both queried. ST-04 sits at the corner of the mouth and ST-06 over the muscle of the jaw; together with SI-18 at the cheekbone they cover the mouth, the jaw and the mid-face, and that trio is the backbone of almost every published facial-paralysis protocol. Our ST-06 record carries the Sun Si-miao Ghost Point classification and describes the ST-04-to-ST-06 threading technique from its own side; SI-18 is the point most often added above them.
• With Yi Feng SJ-17 — in the hollow behind the earlobe, a Meeting Point of the Sanjiao and Gallbladder channels, held here and queried. SJ-17 lies where the facial nerve emerges from the skull, which is why it is the point of the region most consistently used at the root of a facial palsy while SI-18 works over the nerve's branches on the cheek. The two are used together constantly, and a randomised trial of electroacupuncture at Yi Feng SJ-17 and Feng Chi GB-20 for moderate-to-severe peripheral facial paralysis in the acute stage shows how much attention that proximal pair attracts in its own right (Zhongguo Zhen Jiu 2026;46(5), PMID 42116775).
• With the extra point Qian Zheng — "Pulling to the Right Position", held here and queried, sited in front of the earlobe and used for nothing but a face that has pulled to one side. Qian Zheng and SI-18 are the two points of the cheek whose whole purpose is facial deviation, one behind and one in front; our Qian Zheng record treats it as an extra point with no channel and therefore no channel-theory action, while SI-18 carries the channel reasoning. Naming both lets a reader see which does which.
• With Si Bai ST-02, Ju Liao ST-03, Xia Guan ST-07 and Ying Xiang LI-20 — the Stomach and Large Intestine points that share the cheek with SI-18. ST-02 sits below the eye, ST-03 below that on the same vertical line, ST-07 in front of the ear at the jaw joint, LI-20 beside the nostril. All are held here. In practice a facial treatment picks two or three of this group according to which part of the face is affected, and SI-18 is chosen when the trouble is at the cheekbone or in the middle third of the face.
• With He Gu LI-04 at the hand — the classical distal point for the face and mouth, held here as the Yuan-Source point of the Large Intestine channel, a Gao Wu Command Point and a Ma Dan-yang Heavenly Star Point. The old rule of thumb that "the face and mouth are gathered at He Gu" makes LI-04 the standard distal partner for any local facial point, SI-18 included.
• For toothache of the upper jaw — with Xia Guan ST-07, Jia Che ST-06 and He Gu LI-04. SI-18 sits over the upper jaw and is the local point of choice when the painful teeth are the upper ones; ST-06 is preferred for the lower.
• Along its own channel — with Tian Rong SI-17 and Ting Gong SI-19. SI-17 lies below the angle of the jaw and is a Point of the Window of Heaven; SI-19 is at the ear and is the channel's final point and a three-channel meeting point. Both are held here and both were queried. SI-18 is the middle of that short facial run.

What does the published facial-palsy literature actually recommend?

SI-18 is named as a first-choice point in the only published attempt to derive a standard acupuncture procedure for facial paralysis from trial evidence. That analysis screened 386 articles, included 33 randomised controlled trials of relatively higher quality, and extracted the meridians, acupoints, stimulation types and treatment durations they used. Its conclusion listed the best acupoint options as Di Cang ST-04, Xia Guan ST-07, Jia Che ST-06, Cheng Jiang REN-24, Ying Xiang LI-20, Quanliao SI-18, Yi Feng SJ-17, Yang Bai GB-14, Si Bai ST-02, Feng Chi GB-20, Shui Gou DU-26, Yu Yao and He Gu LI-04, with manual stimulation or electroacupuncture combined with moxibustion, once daily, ten treatments to a course (Zheng H, Li Y, Chen M, Am J Chin Med 2009;37(1):35–43, PMID 19222110). Every one of those thirteen points is held in this library, and every one was queried. The honest caveat belongs with it: this is a synthesis of what trials did, not a demonstration that any single point works — it describes prescribing consensus, not effect.

Source: Sacred Lotus sources & references (both location records; the ST-02, ST-03, ST-04, ST-06, ST-07, LI-04, LI-20, SJ-17, SI-17, SI-19, REN-24, DU-26, GB-14, GB-20, Yu Yao and Qian Zheng records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 246); Chinese Acupuncture & Moxibustion (p. 173); PMID 19222110; PMID 42116775 — each verified resolvable and checked for retraction status before citation; cross-referenced against multiple online sources.

Where is SI-18 located?

• A Manual of Acupuncture (p. 246): Directly below the outer canthus, in the depression at the lower border of the zygomatic bone.
• Chinese Acupuncture and Moxibustion (p. 173): Directly below the outer canthus, in the depression on the lower border of zygoma.

How is SI-18 Quan Liao needled, and what lies beneath it?

Stated plainly: SI-18 is a comparatively low-hazard point. It sits on the face over the solid bone of the cheek and the upper jaw, with no body cavity, no lung and no great vessel in the ordinary needle path. What the anatomy does put directly beneath it is a nerve branch that moves the face and a pair of vessels that bleed readily — so the realistic events at this point are bruising and, much more rarely, a transient effect on facial movement, not organ injury. Everything below is recorded as neutral reference data describing what the textbooks and the published anatomical 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 perpendicular insertion of 0.5 to 0.8 inch. No moxibustion figure is carried in our own needling record for this point, and moxibustion is generally avoided over the visible face.
• Deadman & Al-Khafaji (p. 246) and Chinese Acupuncture & Moxibustion (p. 173) record a comparable perpendicular range under the zygomatic bone, together with oblique and transverse options directed along the face toward neighbouring points — the threading technique that the facial-palsy literature relies on.
• For comparison within our own holdings. Queried directly, our facial points cluster in the same shallow band: 0.3–0.5 inch at the periorbital points such as Zan Zhu BL-02 and Si Zhu Kong SJ-23, and comparable figures at the cheek and jaw points. Depth figures in this literature track the structure underneath, and over the maxilla the bone arrives quickly.

The measured anatomy — and exactly what it measured

• A cadaveric study measured SI-18 by name, and the figure needs its context stated. Fifteen adult male cadavers (30 sides) fixed in formalin were dissected from the surface inward at three points on the side of the face — Xia Guan ST-07, the extra point "Die'e", and Quanliao SI-18 — and a Kirschner wire was driven from each toward the sphenopalatine ganglion, with the corresponding exit points measured by coordinate location. The measured distance from SI-18 to the sphenopalatine ganglion was 46.6 mm, along a path directed posteriorly, medially and upward; the comparable figures were 49.9 mm from ST-07 and 46.9 mm from Die'e, and the surface distance from SI-18 to Die'e was 21 mm (Wang ZF et al., Zhongguo Zhen Jiu 2009;29(4):289–292, PMID 19565737). State what that figure is and is not. It is a measurement of a deep path to a named ganglion inside the skull's pterygopalatine fossa, made in cadavers, for a specialised technique. At roughly 46 mm it is about three times the perpendicular depth our own record carries for ordinary needling at this point. It is not a safe-depth figure, it is not the ordinary technique, and it should never be read as one. It is included because measured anatomy at a named point is worth more than a vague warning, and because it tells a reader precisely how far the deep structures of the face are from this surface landmark.
• The zygomatic branch of the facial nerve crosses this region. It is one of the five terminal branches of the facial nerve and it supplies the orbicularis oculi — the muscle that closes the eye — so it is both the nerve most relevant to the point's principal indication and the nerve most exposed to the needle. Transient local weakness or an odd sensation across the cheek after needling here is described in the reference literature as a local event, not an injury.
• The transverse facial artery and vein run horizontally across the cheek below the zygomatic arch, roughly between the arch and the parotid duct, arising from the superficial temporal vessels. They are small, superficial and easily nicked, which is the anatomical reason bruising is the ordinary event at this point. A bruise on the cheek is conspicuous and slow to fade, and it is materially more likely in anyone taking a blood-thinning or antiplatelet medicine.
• The infraorbital nerve emerges from the maxilla a little medial and superior to the point, through the infraorbital foramen below the eye. It supplies sensation to the cheek, the side of the nose and the upper lip, and it is the nerve that accounts for much of the region's sensitivity.
• The masseter and the zygomaticus muscles lie in the neighbourhood — the masseter behind and below, running from the zygomatic arch to the angle of the jaw, and the zygomaticus major arising from the cheekbone itself. Under and deep to all of them is the maxilla, which is what bounds the depth.

What the published safety literature says

• No imaging study of a safe needling depth at SI-18 could be located, and the cadaveric figure above is expressly not one. Where our sources are silent we say so rather than borrowing another point's numbers.
• No published case report of injury at SI-18 could be sourced, and none is asserted.
• Two general facts about depth. Two systematic reviews of the safe-depth literature — 33 studies in the first, 47 in the second, by MRI, CT, ultrasound and cadaveric dissection — both concluded that measured depths for the same point vary 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). Neither reports a figure for this point.
• Risk in proportion. A meta-analysis of prospective clinical studies estimated serious adverse events in acupuncture at approximately 1 per 10,000 patients and about 8 per million treatments, with roughly 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). A 2024 review of acupuncture safety reaches the same conclusion about where the small number of genuinely serious events arise — the chest, the abdomen and contaminated technique — rather than the face (Am J Chin Med 2024;52(6):1555–1587, PMID 39460372). Systematic reviews of the Chinese case literature place the clustering in the same regions (He W et al., PMID 22967282; Zhang J et al., Bull World Health Organ 2010;88(12):915–921C, PMID 21124716, PMC2995190). SI-18 is not in those groups.
• What the clinical trials report about tolerance. A single-blinded randomised controlled pilot trial of acupuncture for intractable facial paralysis, which included a formal safety evaluation, reported no serious treatment-related adverse events (Front Neurol 2025;16, PMID 41180525). That is a small study and a limited claim, but it is the kind of evidence that belongs in a safety section rather than a warning inferred from a different region of the body.

Source: Sacred Lotus sources & references (existing needling record; the ST-07, BL-02 and SJ-23 needling records queried directly for comparison); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 246); Chinese Acupuncture & Moxibustion (p. 173); PMID 19565737; PMID 21417806; PMID 23935678; PMID 34489268; PMID 39460372; PMID 22967282; PMID 21124716 (PMC2995190); PMID 41180525 — each verified resolvable and checked for retraction status before citation.

What does the name Quan Liao mean?

Quan Liao means "Cheek Bone Hole" — quan, the cheekbone or zygoma, and liao, a bone-hole, crevice or foramen. Sacred Lotus sources & references translate it exactly that way; it is also met as "Cheek Bone Crevice" and "Zygomatic Bone Hole". The name is a location instruction in two characters: the hollow at the cheekbone. Liao is one of the most useful characters to recognise in the whole repertoire, because it always means the same thing — a point sited in or beside a hole, notch or hollow in bone — and the library holds a whole family of them, every one of which was queried here: Ju Liao ST-03 ("Great Bone Hole") on the cheek below the eye, He Liao LI-19 ("Grain Bone Hole") below the nose, Tong Zi Liao GB-01 ("Pupil Bone Hole") at the outer corner of the eye, Tian Liao SJ-15 ("Celestial Bone Hole") on the shoulder, and Ci Liao BL-32 ("Second Bone Hole") in the second sacral foramen. Learning the character once unlocks all of them.

How is SI-18 different from the points around it?

Ju Liao ST-03 is the point most often confused with it and the comparison is worth making carefully. Both are liao points on the cheek; both are used for facial paralysis, twitching and toothache. But ST-03 lies directly below the pupil, level with the lower border of the nostril, on the Stomach channel, and is a Meeting Point with the Yang Motility Vessel — while SI-18 lies further out and higher, below the outer corner of the eye, at the lower edge of the cheekbone, on the Small Intestine channel, meeting the Sanjiao. In practice ST-03 is the point for the inner cheek and the region of the nose and upper lip; SI-18 is the point for the outer cheek and the cheekbone itself. Si Bai ST-02 sits above ST-03 just below the eye. Xia Guan ST-07 is behind SI-18 at the jaw joint and is the point for the joint itself and for the ear. Jia Che ST-06 is below and behind it over the muscle of the jaw, and is the point for the lower jaw and the teeth of the lower arch where SI-18 serves the upper. Yi Feng SJ-17 behind the earlobe is at the trunk of the facial nerve rather than its branches. The extra point Qian Zheng in front of the earlobe is the region's other facial-deviation point and belongs to no channel. On SI-18's own channel, Tian Rong SI-17 below the jaw and Ting Gong SI-19 at the ear are its neighbours. All are held in this library and all were queried.

Is there research on SI-18 Quan Liao?

Yes, but it needs sorting carefully. There is one old point-specific clinical report, one strong piece of measured cadaveric anatomy, a place in the recommended point set for facial paralysis, and a body of laboratory work in mice and rats. There is no modern randomised trial of this point on its own.

• Trigeminal neuralgia — the one report about this point alone. A clinical report titled "37 cases of trigeminal neuralgia treated by acupuncture of point quanliao" appeared in the English-language Chinese literature (Cui SG, J Tradit Chin Med 1988;8(2):101–102, PMID 3412001). The limits are severe: no indexed abstract, 37 cases, no control group, no blinding, and a period with no trial standards. Nothing is claimed from it. It is recorded because it is the only indexed publication naming SI-18 as the sole treated point, and because it corroborates the facial-pain indication our own record carries from an independent direction.
• Its place in the recommended point set. The evidence-based synthesis for peripheral facial paralysis described under practice, drawn from 33 higher-quality randomised trials out of 386 screened articles, named Quanliao SI-18 among its thirteen best acupoint options (PMID 19222110). Again: that is a statement about what trials selected, not about what the point achieves.
• Measured cadaveric anatomy. The 15-cadaver, 30-side dissection study that measured 46.6 mm from SI-18 to the sphenopalatine ganglion, with the direction of that path recorded (PMID 19565737), is set out in full under needling. It is the most precise published fact about this point, and it is anatomical rather than clinical.
• Laboratory work in animals, labelled as such. Electroacupuncture at "Sibai" ST2 and "Quanliao" SI18 in male C57BL/6J mice increased c-Fos-positive cells and the proportion of c-Fos with calcium/calmodulin-dependent protein kinase II co-labelled cells in the somatosensory and primary motor cortex, and fibre photometry showed raised calcium activity in excitatory neurons during stimulation that fell again afterwards (Zhen Ci Yan Jiu 2024;49(5):480–486, PMID 38764119). An older rat study examined c-Fos protein expression in the central nervous system after electroacupuncture of "quanliao" (Zhen Ci Yan Jiu 1993, PMID 8082274). Both are animal experiments, the first uses two points together, and neither says anything about clinical effect in people. They are recorded so a reader meeting them knows exactly what they are.
• The trials it appears in are protocol trials. A multicentre randomised controlled trial of acupuncture for intractable facial paralysis (Chin J Integr Med 2025;31(9):773–781, PMID 40707804) and a single-blinded randomised pilot trial with a formal safety evaluation (Front Neurol 2025;16, PMID 41180525) are recent examples of the facial-palsy literature in which SI-18 appears as one point among many. Nothing in their results is attributable to it alone.
• A trap worth naming, because point-code searches are how this literature is found. Database searches on the romanised name of this point return a large number of papers that have nothing to do with it — the string appears as part of Chinese personal names and place names. Every study cited on this page was read rather than counted, and each names Quanliao or SI 18 as an acupoint.
• What is not here. There is no sham-controlled trial of SI-18, and no modern study in which it is isolated against a credible control for facial paralysis, facial pain or anything else. In the facial-palsy trials it is one point among eight or twelve, most often with ST-04, ST-06, ST-07, SJ-17, GB-14 and LI-04. That is stated flatly rather than papered over.

Source: Sacred Lotus sources & references (name, translation, channel, the meeting-point classification and the absence of other categories queried directly; the ST-02, ST-03, ST-04, ST-06, ST-07, LI-19, GB-01, SJ-15, SJ-17, BL-32, SI-17, SI-19 and Qian Zheng records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 246); Chinese Acupuncture & Moxibustion (p. 173); PMID 3412001; PMID 19222110; PMID 19565737; PMID 38764119 (mouse study); PMID 8082274 (rat study); PMID 40707804; PMID 41180525 — each verified resolvable and checked for retraction status before citation; cross-referenced against multiple online sources.