Editor’s Note Part 1

Nasser Butt

editor’s Note I

t is very rare when you get an author, a philosopher, a poet, an artist, a medical practitioner, a martial artist with an impeccable pedigree, a veteran of the armed forces and above all a human being who in my opinion exemplifies the best of the human spirit - all roll into a singular person. Dr. Gregory T. Lawton represents all that and much more.

The following series of excellent articles on ‘Medical Implications of Combat T’ai Chi Ch’uan Techniques: Investigating Blunt Force Trauma’ by Dr. Gregory T. Lawton appeared in Volumes 13, 14 and 15 of Lift Hands Magazine in 2020. His expertise on the subject and knowledge are second to none!

In this ‘Extra Supplement’ of Lift Hands, I have compiled all three of the original articles into a singular body for folk to enjoy as well as a work of reference.

The covers of the original Volumes in which these articles were published appear below.

My gratitude to Greg, whom I am honoured to call a dear friend, for sharing his knowledge with us all.

Enjoy.

Gird up your loins and place upon your fingers your burial rings! The limbs of the strong and the meek shall quake and fear and trembling shall seize them all. Now is the time of calamity. Enter then the fortress and set the torch alight.

Scent of a Forgotten Flower

In 1968 Mr. Bruce Tegner published a book entitled,

“SELF-DEFENSE NERVE CENTERS & PRESSURE POINTS”. Mr. Tegner described his book as a “practical guide to the most efficient use of weaponless self-defense using the least possible force.” He went on to state that. “Modern knowledge of physiology and anatomy is applied to this subject which has long been much obscured by myth, superstition and legend. The so called “deadly" blows are evaluated. Fantasy and fact are separated.”

Although Mr. Tegner died in 1985 I want to thank him not only for promoting the martial arts worldwide, for his considerable contribution to martial arts literature, and also for writing what I will use as the introduction to this series of articles that will investigate the medical implications of Tai Chi Chuan techniques and the blunt force trauma that results from the strikes employed in Tai Chi Chuan and other martial arts. I find in Mr. Tegner’s 1968 book an excellent explanation of my intention in writing this article.

It is my intention to investigate the physiological effects of various strikes to the human body systems and their anatomical components. In writing this article I am drawing upon six decades of martial arts training, five decades as a health care provider, and five decades as a health science educator and author. As I cover the effects of, and damage caused by various strikes to the human body, I will organize this information by the anatomical region that contains the organs of the body system we are reviewing. Although I will Photograph 1 primarily examine the effects of the strikes of Tai Chi Chuan in terms of blunt force trauma, this review will include strikes that are commonly incorporated within the armamentarium of many martial arts. As was stated by Kenpo Grandmaster Will Tracey, “Before one begins..., a kick is a kick, and a punch is a punch, a block is a block. As one progresses, a kick is no longer a kick, a punch is no longer a punch, a block is no longer a block. But when he masters the system, he realizes a kick is a kick, a punch is a punch and a block is a block.”

It is my belief that every martial artist should have a solid background in human anatomy and physiology. There are eleven human body systems each comprised of anatomical parts or organs. For example, the human nervous system is organized into the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS is comprised of the brain and spinal cord and the PNS includes the nerves that leave the brain (twelve cranial nerves) and the spinal cord (thirty-one pairs). Each of the eleven human body systems is comprised of organs that in one way or another are critical to the maintenance of human life. Each of these eleven human body systems is vulnerable to blunt force trauma or physical stressors.

Dr. Gregory T. Lawton

The eleven organ systems of the human body include the integumentary, skeletal, muscular, nervous, endocrine, circulatory, lymphatic, respiratory, digestive, urinary, and reproductive systems. Each of these systems and their organs perform life critical functions which includes:

1. The integumentary system (skin) supports and protects the body and its organs, regulates body temperature, manufactures biochemicals and hormones, and acts as a sense organ. 2. The skeletal system supports and protects the body and its organs, facilitates body movement via joints and muscles, stores minerals and makes blood cells in the bone marrow. 3. The muscular system facilitates body movement, maintains posture, and produces heat through work. 4. The nervous system connects a person to the environment and integrates and controls how the body responds to the environment. 5. The endocrine system secretes hormones into the blood that serve to communicate with, integrate, and control body function and homeostasis. 6. The circulatory system transports blood and other substances through the body and to the cells, tissues and organs such as the brain and lungs. 7. The major functions of the lymphatic system are the movement of fluid (lymph) from tissues and back to the circulatory system and its critical role in the defense mechanism of the body against disease. 8. The respiratory system exchanges oxygen from the air for the waste product carbon dioxide in the blood. 9. The digestive system breaks down food, absorbs nutrients, and excretes solid waste. 10. The urinary system removes waste products from blood in the form of urine and maintains electrolyte balance, water balance, and acid-base balance. 11. The reproductive system produces sperm and ovum (egg cell), allows the movement of sex cells and sexual fertilization to occur, supports the development and birth of human offspring, nourishes the embryo through its developmental stages, and produces the sex hormones.

Over the years I have seen, read, and collected many articles, books, magazines, or videos on the “physics” of the martial arts. I must admit that if the material focused strictly on the mathematical formulae that calculates pressure (force), mass, speed, or other mechanical or Newtonian physics factors, I was often left unsatisfied because I knew from personal experience and as a doctor practicing physical medicine that these equations did not adequately explain the physiological trauma and damage inflicted to cells, soft tissues, organs, and the joint complex, or the disruption that occurs to the function of the autonomic nervous system and organ systems.

In addition, I have read, attended seminars, and reviewed countless videos of “expert” martial artists who lack medical training and credentials who offer various opinions regarding the effectiveness and effects of various martial arts strikes and techniques on the human body. Frankly, I think that if you have not actually witnessed, evaluated, and treated blunt force trauma that you really do not know much about it.

Any martial arts technique, regardless of the style or system, delivered to a vulnerable area of the body or body organ with enough force can cause blunt force trauma. In blunt force trauma the cause of death is often internal bleeding into the brain, abdominal cavity, or lungs. Most blunt force trauma injuries are directed to the abdominal organs. There may be fractures, such as a broken neck, and all these forms of trauma can cause death.

Blunt force trauma is direct physical damage to a body part or organ, whether by impact, falls, injury or physical attack. Blunt force trauma is the first step in a trauma cascade, from which develops more specific types of trauma such as contusions, abrasions, lacerations, hemorrhage, joint capsule destruction, organ rupture, and/or bone fractures. A simple form of blunt force trauma would be a “black eye” and a more extreme form would be a ruptured liver from a kick, punch, knee, or elbow strike to the liver.

Blunt force trauma is graded by degrees of clinically assessed organ, soft tissue, or bone damage, and the damage is the result of the pressure (force) that a body area or organ receives. Some body areas are more prone to damage than others and this is due to the role that protective aspects of body posture, the skin, connective tissues such as fascia, muscle, ligaments, bones, and body fat play in defending the body, its tissues and organs. Some areas of the body have a lot of protection and some areas do not have much.

In the upcoming parts of this series I will write in detail regarding specific strikes and the blunt force trauma that they can create from contusions to organ rupture, hemorrhage, or failure. The information that I provide will be based upon medical evidence and patient case histories of actual damage or death.

In this introduction to this series I want to look at three common misconceptions regarding Tai Chi Chuan strikes by examining attacks to a bone (bone breaks), the eyes, and the throat. Also, for the purposes of this article I am writing about blunt force trauma that is caused by “empty hand” techniques and not weapons. In our training classes we teach the use of many weapons including weapons of opportunity that are part of the physical environment where an attack might occur.

To offer a further definition, in our school we teach what we call “combat” Tai Chi Chuan. Our Tai Chi Chuan is primarily based upon the lineage of the Yang family, specifically, Yang Shao Hou, and Professor Huo ChiKwang the founder of the Chinese Cultural Academy. Our curriculum in Yang Tai Chi Chuan includes the following disciplines:

Yang Tai Chi Chuan forms (some Chen and Wu) Chi kung and dao yin San-sau, push hands, kumite Chin Na Shuai jiao Kempo Weapons training, sword, staff, spear

Established in 1980 our martial arts curriculum includes mixed martial arts techniques, Kali, escrima, and knife. We are a state licensed post-secondary school and all our training programs are approved by the state. We also offer an extensive array of classes in both traditional and contemporary healing arts including Asian medicine.

Photograph 2. Class held at the Academy.

Bone Breaks

In our form of Tai Chi Chuan (I am not attempting to speak for all systems of Tai Chi Chuan) our objective is not to employ joint locks. Instead we attempt to execute joint “breaks’ (Cuo gu or Tsuoh guu) which means that through extreme hyperextension of a joint we seek to destroy the joint complex which is composed of tendons, ligaments, cartilage, and the joint capsule. The “intention” in executing such a technique is different in that we are not attempting to employ a joint lock or control, but we are attempting to destroy the joint complex with as much speed and force as possible. In our Tai Chi Chuan we employ strikes, throws, and Chin Na. Our Chin Na is practiced so that it can be executed to its conclusion which is the effective destruction of the joint.

Examples of this technique would be driving your forearm through an opponent’s elbow joint creating extreme

hyperextension of the joint and a grade III sprain/strain which is a severe ligament/muscle tendon injury, this is the most serious among the three grades of ligament/muscle tendon sprains/strains. Most of the ligament/muscle tendon fibers will be torn. The ligaments and muscle tendons are completely torn or ruptured. The pain that results from such an injury is severe and incapacitating and may result in permanent disability.

Photograph 3. Normal elbow joint in flexion.

Photograph 4. Normal elbow joint in extension.

Photograph 5. Severely dislocated elbow joint.

However, let’s look at a simple bone break. I will not write about bone fractures that I have not had direct experience with or treated in my practice as the result of a martial arts injury. It is not easy to break a bone in the human body; they are tough and designed to withstand the tremendous repetitive and concussive forces applied to them. I have treated fractures of the clavicle, ribs, radial and ulnar bones, boxers’ fractures of the bones of the hand, fractures of the bones of the foot, mandible, maxilla, zygomaticus and nasal bones, spinal vertebra, and the tibia and fibula.

Let’s clarify an important point again, soft or connective tissue trauma is much more common in all forms of martial arts than are bone fractures. I have treated hundreds of cases of soft or connective tissue trauma and I am aware of only several dozen or so bone fractures over my martial arts training history spanning six decades.

The clavicle is one of the most accidentally fractured bones in the human body, mostly as a result of falls on an outstretched arm or on the shoulder. The medical evidence supports the fact that the clavicle is one of the easiest bones in the body to break. (1) The clavicle is one of the only bones that given the opportunity I would attempt to break. If I struck the clavicle and it did not break, I would simply move on to another technique. I have direct experience with one fracture of the clavicle related to a martial an elbow strike. I have witnessed and treated many clavicle fractures due to throws and falls and these occurred mainly among practitioners of Judo, Jujitsu, and Aikido. Frankly, you are more likely to cause a clavicle fracture with a throw than with a strike.

Photograph 6. Fracture of the clavicle.

The clavicle is easily accessed due to its position and location on the anterior superior shoulder area. When the clavicle breaks it usually breaks in one location, although multiple fractures of the clavicle are not uncommon. The clavicle is S shaped and the most common site of fracture is on the body of the clavicle in the direction of and closer to the shoulder. If you feel your own clavicle it will be the location away from the sternum at which point the clavicle is generally thicker and has a very strong arch shape and if you feel along the clavicle towards the shoulder you will find an area along the body of the clavicle that is thinner. This is the easiest breaking point of the clavicle and where most blunt force trauma clavicle fractures will occur. Like everything there are exceptions to the rule due to personal differences in anatomical structure, bone thickness and density.

One of the common criticisms of Tai Chi Chuan is due to a misconception regarding the use of palm strikes. Tai Chi Chuan critics often do not know the correct application of a Tai Chi Chuan palm strike. A palm strike might lead with a finger poke or gouge and end with the palm strike or a palm strike may involve the use of the pisiform carpal bone in the wrist. The pisiform carpal bone is commonly used to break boards, bricks, and/or concrete patio slabs. It is a sturdy bone for its size and accounts for less than one percent of all carpal bone fractures. Breaking bones or boards with a Tai Chi Chuan palm strike follows the same basic rules as any martial arts break. Breaking requires striking through the object that is to be broken with penetration (pung), force and speed.

One of the first lessons taught to beginning martial arts students is the concept of focusing pressure (force), mass, and speed into the object being struct. The analogy that one of my teachers used with me in the early 1960s was using an ice pick to break up a block of ice rather than a baseball bat. The more that the energy is

focused down to a one-inch square point of contact the more pressure there is that is being driven into a focused point on the object or body part.

My favorite Tai Chi Chuan “bone breaking” technique is High Pat on Horse. With High Pat on Horse the arm and palm (with the pisiform carpal bone as the point of contact) is brought directly down on the point of contact on a bony surface. This technique is most effective when directed at the nasal bone and cartilage, the zygomatic bone, the maxilla, lower eye socket, and upper teeth, or the mandible. In the United States, zygomatic fractures are the second most common fracture of the facial bones following nasal bone fractures. (2) For a fracture to occur in the zygomatic bone the severity of the injury is directly proportional to kinetic force of the impact. The zygomatic bone is strong as it serves as a buttress between the skull and the maxilla. However, its projection on the anterior surface of the face makes it particularly vulnerable to injury, especially when impact occurs on either side of the face. A common cause of zygomatic fractures is a physical altercation that results in a punch to the face.

Photograph 7. Normal clavicle showing point of contact for bone break.

There are several mechanical factors at play in bone breaking, pressure (force), mass (the entire arm), speed, torque, shearing, gravity, and angle of attack. This makes the mathematical equation in terms of Newtonian physics very complicated but all that I care about is does it work.

Photograph 8. Bone break to the clavicle showing contact with the pisiform bone.

High Pat on Horse, because it comes on a vertical line from above and strikes downward, surprises attackers and fighters who have never seen the technique, especially fighters trained in boxing and MMA who expect a jab, hook, or cross on a horizontal line.

Let’s take a pause here. At our school we teach personal self-defense and because we specialize in teaching and empowering women and teenagers who have been victims of rape, incest, and domestic abuse what we teach is violent and for the purpose of maiming or effectively stopping an opponent. We use combat Tai Chi Chuan as a vehicle for teaching effective self-defense techniques. We select our students carefully and we do not teach students who are violent or who want to hurt people, students who are emotionally unstable, students with a perverse character, students who will not work towards personal growth and self-improvement, or students who cannot learn or apply what we teach.

Here is the long list of techniques that mixed martial art fighters may not use in sport competition. This list is a list of the techniques that we teach in self-defense classes:

1. Butting with the head. 2. Eye gouging of any kind. 3. Biting. 4. Hair pulling. 5. Fish hooking. 6. Groin attacks of any kind. 7. Putting a finger into any orifice or into any cut or laceration on an opponent. (Gouging) 8. Small joint manipulation. 9. Striking to the spine or the back of the head. (Rabbit punch) 10. Striking downward using the point of the elbow. (Elbow (strike)) 11. Throat strikes of any kind, including, without limitation, grabbing the trachea. 12. Clawing, pinching or twisting the flesh. 13. Grabbing the clavicle. 14. Kicking the head of a grounded opponent. 15. Kneeing the head of a grounded opponent. 16. Stomping a grounded opponent. 17. Kicking to the kidney with the heel. 18. Spiking an opponent to the canvas on his head or neck. (Piledriver) 19. Throwing an opponent out of the ring or fenced area. 20. Holding the shorts or gloves of an opponent. 21. Spitting at an opponent.

The vast majority of my students do not want to compete in sports martial arts, ring or cage fighting and because of the high injury rate in mixed martial arts, especially Traumatic Brain Injury (TBI) and Chronic Traumatic Encephalopathy (CTE) a degenerative brain disease found in fighters who have experienced repetitive brain injury.

Eye Gouging

The next technique in this article is eye gouging, I prefer the descriptive term “eye gouging” to an eye poke because a poke may just irritate an opponent but a properly executed eye gouge may result in severe contusion of the eye, traumatic enucleation of eye from the eye socket, and/or temporary or permanent blindness.

There are three types of eye gouging. One involves pushing the fingers or the thumbs into the socket which while it creates a crushing trauma to the eye(s) it does not remove the eye from the eye socket and is too easily defended against since both of the opponents hands are available to defend against the technique. The second technique is called an eye hook and an eye hook is when a finger or fingers pushes into the medial aspect of the eye and drags across the eye laterally (from the tear ducts outward). The third eye gouge is the main technique that we teach, the traumatic enucleation of the eye. To execute a traumatic enucleation of eye the forefinger is used to enter the eye socket medially (at the tear ducts) and adjacent to the nasal bone. The right forefinger is used to remove the opponent’s right eye and the left forefinger is used to remove the left eye. The finger technique that we use in eye gouging is called One Finger Zen and it is a hand form that we practice in a chi kung exercise called Golden Bridge. It is also used immediately after the Commencement of our Tai Chi Chuan form and prior to Crossing the Heavens.

The forefinger is thrust forcefully and deeply into the eye socket in the location described above then the finger is “hooked” as the hand and finger are quickly pulled laterally (towards the outside of the head) and away from the eye socket. When the forefinger is thrust into the eye socket the remaining three fingers remain curved and flexed so that they are not injured when they strike against the zygomatic and maxilla bones of the face. 15

Photograph 9. This shows the location where the finger enters the eye socket.

Photograph 10. This showing the finger has penetrated the eye socket and the technique for “hooking’ the eyeball and ripping it out of the socket.

Crushing the Throat

Once again when it comes to blunt force trauma to the anterior (front) throat area there is a lot of misinformation from various “expert” sources. It is true that if an opponent is careful and keeps their chin down that the lower jaw (mandible), the sternum, and the sternocleidomastoid (SCM) muscles will protect the throat from blunt force trauma but saying that attacks against the anterior throat, larynx, and cartilage and bony structures of the neck cannot be effectively performed is not true. If this was true then neck cranks, chokes or the rear naked choke would be useless, and they are not. I am going to cover this topic in greater detail in a future article when I review blunt force trauma and direct strikes to the head and neck region and the organ systems and vessels that pass through the neck region. However, let’s look at the rear naked “choke”.

The rear naked choke is a “blood” choke (Dian Mai or Dian Xue) and it is commonly employed in several martial arts styles including MMA. In our style of combat Tai Chi Chuan we do not choke out opponents, we practice to directly crush the bones and cartilage of the throat. This technique is called a forearm throat crush or sealing the breath (Bi Qi or Bih Chi). To accomplish this action we move behind an opponent, perhaps after deflecting a punch, and immediately apply the radial bone of the forearm across the anterior throat area and then quickly and forcefully draw the forearm posteriorly (towards ourselves as we stand behind the opponent and drag them backwards to keep them off balance) and in a movement that is partly strangulation and partly a strike through the neck. Think of a fa jing movement of the forearm (radial bone) towards your own chest but moving through the opponent’s neck and you will get some idea of the force of this technique. The resulting

damage to the throat is catastrophic and may cause death by asphyxiation. (3) The medical implications of this technique are so obvious as to defy arguments that it will not work. If you can get into a position to choke an opponent, crushing the throat with the radial bone is much faster and less likely to fail.

Photograph 11. This shows the radial bone over the anterior throat in position for a fa jing strike into the throat.

Photograph 12. This image shows the bone and cartilage damaged by strikes to the throat. Not seen are the soft tissue, respiratory and digestive, nerve and blood vessels that are also damaged.

Conclusion

As I have mentioned, at our school, we teach martial arts and self-defense primarily to ordinary people, victims of traumatic abuse, abused junior youth and youth, and immigrants and refugees to the United States. We do not charge for self-defense instruction. We do not train people to fight professional fighters but rather to defend themselves when necessary in the street or in the home. Mostly, violence is not necessary but not everyone has been or will be that fortunate. The two primary concepts of self-defense are situational awareness and avoidance of conflict.