Part 2

In this introduction to The Medical Implications of Combat Tai Chi Chuan Techniques, Investigating Blunt Force Trauma I have briefly covered three combat Tai Chi Chuan blunt force trauma techniques; the bone break, the eye “gouge," and the throat crush. I consider bone breaks the least effective of these three techniques because they are unpredictable, and I will cover the application of extreme hyperextension to the joint complex involving traction, torque, and shearing forces directed at joints in a future article. I will also cover blunt force trauma leading to organ damage, haemorrhage, rupture, and failure in a future article as well.

The martial arts were originally created to be violent, to maim, and to kill. The techniques, movements, postures and principles of Tai Chi Chuan were designed to accomplish the same objectives and the early practice of Tai Chi Chuan was commonly associated with martial chi kung, Chin Na, and various hand, foot, and body conditioning exercises. It was later in the historical development of Tai Chi Chuan (by the third and fourth generations of the Yang system) that Tai Chi Chuan began to be practiced as a “health” exercise and became less and less an effective martial art. Our schools’ approach to combat Tai Chi Chuan is an attempt to restore the martial roots and practices of Tai Chi Chuan as was intended by its original founders.

References:

1. Incidence and mechanism of injury of clavicle fractures in the NEISS database: Athletic and non-athletic injuries, Steven F. DeFroda, Nicholas Lemme, Justin Kleiner, Joseph Gil, Brett D. Owens Journal of Clinical Orthpaedics and Trauma, Elsevier, September–October 2019 2. Etiology and incidence of zygomatic fracture: a retrospective study related to a series of 642 patients, Ungari C, Filiaci F, Riccardi E, Rinna C, Iannetti G. European Review for Medical and Pharmacological Sciences. 2012 Oct;16(11):1559- 1562. 3. Fractured Larynx: Classification, Symptoms, Diagnosis, Treatment, Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA, https://www.epainassist.com/face-mouth-throat/fractured-larynx

...and foolishly I asked, “How will I know when I am a master?”, and the answer came, “When you have mastered all aspects of your life as a man, a husband, and a father, as a citizen, and in all things as a true servant of humanity. Then will you be a master.”

Scent of a Forgotten Flower

Part 1 of this series on The Medical Implications of Combat

Tai Chi Chuan Techniques, Investigating Blunt Force Trauma was an introduction to several techniques which included sealing the blood, sealing the breath, displacing the bone, bone fractures, and gouging or hooks and the significant medical consequences of these techniques.

Liu Jin Sheng is the co-author of the book Chin Na Fa which was written in collaboration with Zhao Jiang. The first edition of the book was issued in July of 1936 as a manual for the Police Academy of Zhejiang province. Liu Jin Sheng stated, "...if you are in command of this technique, you can sway the destiny of the enemy. You can kill your enemy, cause unbearable pain, tear his muscles and sinews, break his bones or make him unconscious for some time and completely disable him to resist. Even a woman or a physically weak man who mastered this technique can curb a strong enemy. This technique demands deftness and skill, not brute force. It is necessary to train oneself daily to make the body flexible and nimble, but "hardness" must be hidden inside this “softness."" (1)

Once again, I have found my central theme in a book written by a former martial arts master because I fully attest to Liu Jin Sheng’s statement.

It is not often that I find myself in total agreement with a martial arts author, but Liu Jin Sheng’s statement on Chin Na is both accurate and brilliant. I remember first reviewing and purchasing this book in the Peking Book Store in Evanston, Illinois in 1976.

Photograph 1

Every martial art that I have studied over the last six decades has contained Chin Na (“Devil’s Hand or Poison Hand”) training to a greater or lesser degree and the knowledge of the instructor was largely dependent upon the depth of their training. I found that American black belts who had trained in Korea, Japan, or Okinawa during their one or two years of military service in those countries had limited exposure to, and training in, Chin Na but that native born black belts from these countries had extensive training and expertise in Chin Na (even though they used different terminology). My first Kenpo instructor (1963) was highly proficient in Chin Na but he was a US Army Ranger tactical combat instructor who received part of his training at the Kodokan in Japan.

Chin Na means to seize, catch, stop, or immobilize and can be within itself a separate and complete martial art system or simply a group of techniques within another martial arts system. Virtually every Chinese martial art that I have studied Tai Chi Chuan, Pa Kua, Hsing Yi, Shaolin Long Fist, and Kempo/Chuan Fa, have all included Chin Na. Chin means to seize or trap and na means to lock or to break. Chin Na is the father and mother of Jujitsu, Judo, and Aikido. I was introduced to Judo in 1962 by a police officer who taught me the three “forbidden” strikes of Judo that would be applied to a downed opponent, a blow to the throat, the solar plexus, and the groin.

1.

2.

3.

4.

5. "Fen Jin” or "Zhua Jin” (dividing the muscle/tendon, grabbing the muscle/tendon) - Fen means "to divide,” zhua is "to grab" and Jin means "tendon, muscle, sinew". They refer to techniques which tear apart an opponent's muscles or tendons. "Cuo gu" (misplacing the bone) - Cuo means "wrong, disorder" and gu means "bone". Cuo gu therefore refers to techniques which put bones in wrong positions and is usually applied specifically to joints. "Bi qi" (sealing the breath) - Bi means "to close, seal or shut" and qi, or more specifically kong qi, meaning "air". "Bi qi" is the technique of preventing the opponent from inhaling. This differs from mere strangulation in that it may be applied not only to the windpipe directly but also to muscles surrounding the lungs, supposedly to shock the system into a contraction which impairs breathing. Dian mai" or "dian xue" (sealing the vein/artery or acupressure cavity) - Like the Cantonese Dim Mak, these are the technique of sealing or striking blood vessels and chi points. "Rou dao" or "rou shu dao" (soft techniques) which generally refers to the techniques deemed safe for sparring and/or training purposes.

I find this list limiting in that some books on the topic of Chin Na for Tai Chi Chuan practitioners and other martial artists omit blunt force trauma to certain vulnerable organs such as the liver and information and techniques specific to major nerve tracks and nerve plexuses of the autonomic nervous system.

I stated in Part One of this series that knowledge of human anatomy, not metaphysical anatomy, but detailed human anatomy was important to a well-trained marital artist. Many early martial artists were farmers who acquired their knowledge of human anatomy not from books, but from the raising and slaughtering of animals for meat. The well-trained martial artist should be very familiar with the human skeletal system and bony architecture, muscle formation and structure, the placement and composition of major body organs, as well as, the anatomy of the nervous and circulatory systems. The competent application of Chin Na is based upon how to attack and destroy these anatomical structures and how to inflict damage to body organs located within body cavities such as the thorax, abdomen, and pelvis.

Chin Na is a far older than many martial arts, including Tai Chi Chuan. The first known written record of this Chin Na dates from the Spring and Autumn period of the Warring States era (475 – 221 BCE). Historically, martial artists have trained in Chin Na, evolving and perfecting their skills and contributing to the compendium of martial arts knowledge. Chin Na is based upon more than technique and requires expert abilities in anatomy, physiology, and kinesiology or body movement. Knowing how the joints move and in what directions and to what degree is known as the science of kinesiology and range of motion (ROM). In Chin Na when applying fen jin or cuo gu the martial artist will move a joint into a position that is beyond the kinesiological ROM and this will result in destruction of the tendon, ligaments, and joint capsule. This causes great pain and destroys the function of a joint. We will cover these Chin Na attacks in greater detail in the next part of this series.

Chin Na has been and continues to be the most effective method and tactical martial art for Chinese military personnel and police officers. In the military Chin Na is taught and used to maim or to kill, in the law enforcement branches it is taught and used to control civilians and criminals with the least amount of damage to the individual possible.

In our school’s curriculum we teach Chin Na on the military model. We also teach these principles:

1. 2. 3. 4. 5. 6. Situational awareness and intuition Razor sharp focus and concentration Pre-emptive attacks when necessary Strike without hesitation Escalate the attack until the attacker is no longer a threat Remain alert and protect yourself and others

The state that our school is established has a “First Strike” law which means that if a person reasonably believes that their personal safety or life is in danger, they can strike preemptively to protect themselves or others. An example of a legal preemptive first strike against an attacker would be if an attacker stated, “I am going to kill you," you would be within your legal rights to use any means possible, including defensive weapons, to stop the attacker. You do not have to wait to be assaulted.

We teach many Chin Na applications that come directly from the Tai Chi Chuan, Pa Kua, and/or Hsing Yi forms but we caution students to keep their use and application of these techniques simple. A few well honed and practiced techniques a student feels competent in executing are far better than an encyclopedic knowledge of techniques. In addition, we train our students to literally act in the “blink of an eye”. A blink of an eye is about 300 to 400 milliseconds. There are 1000 milliseconds in each second, a blink of an eye takes a bit more than .33 of a second. We train students using a stopwatch and some of our Chin Na techniques take only .25 of a second to execute.

We train students according to their physical and psychological capacity. A physically frail student will not be able to execute techniques that require strength against a large opponent, or a student may not be psychologically capable of performing a technique such as an eye gouge which may lead to blindness. There is no point in teaching or learning techniques that will not carried out with expertise and decisiveness should the need arise.

In Part One I introduced a few simple concepts related to joint “breaks’ (Cuo gu or tsuoh guu), “seal the blood” choke (Dian mai or dian xue), sealing the breath (Bi qi or bih chi), and “eye gouging”. If you have not yet read that article, I encourage you to do so because the material in this article will make more sense to you. In Part One I included several images that illustrated the techniques that I described in the article. The images included the application of High Pat on Horse for the purpose of breaking (fracturing) several bones in the face including the zygomatic, nasal, and maxilla. I want to expand upon that information with a breaking technique for the mandible.

Photograph 2. The Mandible

The mandible is susceptible to fracture in several locations and in the area between the thumb placement in Photograph 2. It is also susceptible to dislocation and fracture at the temporomandibular joint (TMJ). Photograph 3 shows the common mandible fracture sites. Note, that I am suggesting blunt force trauma at two common fracture sites that together account for 50 to 60 percent of all mandible fractures.

The temporomandibular joint is a synovial joint which means that it has a joint capsule, an inner disc, synovial fluid in the capsule, and it is richly innervated with sensory and motor nerves. Blows to the mandible and directly to the TMJ frequently result in dropping an opponent to the ground and/or unconsciousness. The mandibular nerve (third branch of the trigeminal nerve) provides the main nerve supply of the temporomandibular joint. Additional innervation comes from the masseteric nerve and deep temporal nerves. The anterior division of the auricular nerve sends branches around the TMJ. This rich neurological innervation is what makes attacks to the mandible an effective location for knocking an attacker out. (2) Photograph 4 shows the pathways of the major nerves that innervate the TMJ.

Photograph 3. Mandible fracture sites (Source: Wikipedia)

Photograph 4. By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body

I previously recommended High Pat on Horse for breaking bones in the face and I am now suggesting both High Pat on Horse and a Descending Fist (Hammer Fist or Fist Descends from Heaven). When using Descending Fist, the fist, like High Pat on Horse, is moving downward from above the contact point into the point on the mandible. The striking surface on your hand is located at the lateral edge of the knuckle of the fifth metacarpal (little finger). The fist is held loosely (Tai Chi Chuan fist), and the side of the knuckle contacts the mandible or the other suggested contact points on the face as are illustrated below in Photographs 5, 6, and 7.

Photograph 5. Striking point for zygomatic bone fracture.

Photograph 6. Striking point for zygomatic bone fracture.

Photograph 7. Striking point for zygomatic bone fracture.

Photograph 8 below demonstrates the application of an upward palm heel strike directly to the angle of the mandible. This is one of the “knock out” points on the jaw. Photograph 9 shows the exact location and contact point at the angle of the mandible.

Photograph 8. Upward palm heel strike to the angle of the mandible.

Photograph 9. The angle of the mandible!

Let’s review Chin Na from the context of attacking acupuncture points and/or meridian pathways. In Part One of this series I stated that the ability to reliably break bones, and I gave an example of the clavicle, are not supported by statistical evidence gleaned from the combative sports and were therefore in my opinion unreliable. Since I teach self-defense to victims of rape, incest, and domestic abuse I will not teach techniques that I do not feel are reliable or that my students will not be able to execute consistently. My opinion regarding attacks to acupuncture points and meridians is similar - they are not reliable or consistent.

Many acupuncture points, and I am writing as both a martial artist and an acupuncturist, while they may inflict temporary pain on an attacker are not reliable as a means of immediately incapacitating an attacker. Pain is not a reliable method for stopping attackers. People have different pain thresholds and pain tolerance levels; endogenous endorphins and the hormone adrenalin are natural pain mediators in the human body. An attacker may be intoxicated by alcohol or street drugs and their ability to withstand pain even severe pain may be very high. I do not recommend attempting to rely upon pain to stop an attacker. What we teach in our school are techniques that result in total incapacitation.

For example, a wrist lock with thumb pressure applied at Large Intestine 4, while potentially painful, has different effects on different people. A new student may cry out in pain and a seasoned fighter or drugged attacker may care less. In our kumite training we teach low “cut” kicks to and through the leg with an attempt to make bone on bone contact with Spleen 6. Spleen 6 is one of the more sensitive acupuncture points on the human body, but once again a fighter conditioned to pain may be only mildly annoyed by a kick to this point.

Acupuncture points are not “pain generating” they are points through which chi is thought to pass. Nerves, nerve endings (nociceptors), nerve trunks, and nerve plexuses are pain generators. Chances are the acupuncture point that you may believe is the cause of incapacitation sits on top of a major nerve, a bundle of sensory nerves, a nerve trunk or plexus. Or perhaps the point is located over an airway or a major blood vessel. The carotid artery, like most major blood vessels is richly innervated with nerves and contains baroreceptors in the carotid sinuses and aortic arch which are a part of the vascular system’s auto-regulation in the setting of hemodynamic (blood pressure) changes. Carotid artery injuries caused by blunt force trauma often cause thrombosis (blood clots/stroke) and delayed neurologic deficits and are associated with death in forty percent of the victims who experience this trauma. (3) Striking a specific acupuncture point on a cooperating student in a martial arts class, training seminar, or video is easy, but hitting an acupuncture point on a mugger or during a street attack with any accuracy or effectiveness is very difficult. As Mike Tyson said, “Everybody has a plan until they get punched in the mouth.”

In your Chin Na or Dim Mak training you may have been trained to attack acupuncture point Stomach 9 to stop an opponent. Stomach 9 is located on the neck, lateral to the Adam's apple, on the anterior border of the sternocleidomastoid muscle (SCM), where the common carotid artery pulsates. This is one of the acupuncture points, Stomach 9, that is responsible for the mythology of Dim Mak delayed death strikes. It was even implicated in the death of Bruce Lee who died as a result of cerebral edema thought to related to pain medication that he was taking. There are numerous documented deaths related to blunt force trauma to the carotid artery (remember the death rate for this injury is forty percent). The normal progression in blunt force trauma to the carotid artery is damage to the artery that causes swelling of the inner muscular walls of the artery resulting in a stoppage or serious reduction of blood flow to the brain and the formation of a blood clot(s) (thrombosis).

Photograph 10. Gray’s Anatomy Common Carotid Artery

Also, in Photograph 10 you will see the Vertebral Artery running parallel to the Common Carotid Artery. The Vertebral Artery because of its circuitous route through the cervical vertebrae is subject to “traumatic dissection” (ruptured and torn) if the head is bent backwards (hyper-extension) and the neck is rapidly and violently rotated (hyper-rotation) past the point of normal range of motion. Photographs 11 and 12 show the anatomical skeletal model posed in cervical flexion and flexion with hyper-rotation.

Photograph 11. Hyperextension of the head and neck.

Photograph 12. Cervical hyperextension and hyper-rotation of the head.

Let’s discuss the brachial stun. The brachial stun is so named because some people are of the opinion, and one theory exists, that a strong blow to the brachial plexus temporarily overwhelms and confuses the nervous system resulting in neurovascular shock (a stun) which can cause an attacker to drop to the ground, render the attacker unconscious or disoriented and confused. There are numerous well documented examples of the effectiveness of the brachial stun and it is taught by many military units and police training academies. I have taught and applied the brachial stun to probation officers and police officers in law enforcement and tactical training classes.

There are at least four different theories regarding how the brachial stun effects the human body physiologically but no good medical studies that examine how it works in a physiological sense. Opinions on how the brachial stun works include:

1.

2.

3.

4. Sudden overload due to compression and stretching of the sensory nerves of the brachial plexus nerve trunks located in the neck. Sudden overload of the Great Auricular Nerve and its branches located by and around the sternocleidomastoid (SCM) muscle. (See photograph 13.) Sudden stimulation of the baroreceptors of the Common Carotid Artery causing a neurogenic vasomotor response with a drop in blood pressure. All the above.

For what my professional opinion is worth, I lean towards theory three listed above and possibly theory four, all the above. Regardless of how it works, the brachial stun is effective. In reviewing research on the brachial stun, it became evident that many martial artists are confusing the anatomical location of the brachial plexus with the anatomical location of the carotid baroreceptor and many practitioners are attacking both areas at the same time. A well-executed penetrating blow to the carotid baroreceptor location on the neck would, at the same time, contact the auricular nerve and possibly the superior trunk of the brachial plexus. I have seen and experienced “pure” blows, properly executed, to the inferior trunk of the brachial plexus repeatedly fail to “stun” an opponent, especially an opponent with a well-developed upper trapezius muscle.

The brachial plexus is a network (plexus) of nerves (formed by the anterior ramus of the lower four cervical nerves and first thoracic nerve (C5, C6, C7, C8, and T1) and is therefore located from the middle region of the neck downward towards the base of the neck. Some martial arts instructors demonstrate a brachial stun applied above the fifth cervical vertebral, on the upper aspect of the sternocleidomastoid muscle, below the ear and the angle of the mandible. The brachial plexus, as is explained above lies below this striking point.

Photograph 13. Illustration of the path of the Greater Auricular Nerve overlying and around the SCM muscle.

There are several ways in which to strike the side of the neck where the SCM muscle, the carotid baroreceptors, and great auricular nerve are located. Various types of palm and forearm strikes are commonly used in striking this area. At our school we teach the forearm strikes using either the ulnar or radial bones of the forearm to strike this area of the neck. Photograph 14 below demonstrates the use of the ulnar bone of the forearm. Several Tai Chi Chuan postures allow for the application of a brachial stun including Commencement (as is found in San Sau training), Partition of the Wild Horses Mane, Brush Knee and Twist Step, and Ward Off.

Photograph 14. Position of the ulnar bone used in a brachial stun.

Blunt force trauma is the leading cause of death of individuals from age one to fifty-five in the United States and results in 100,000 deaths per year. In reviewing research on knockouts that occurred in street fights and how they were accomplished the palm heel strike to the mental aspect of the mandible (chin) was a potent source of consistent knockouts, but so were any form of hand attack to the mandible that was executed with sufficient force. In our training program we discourage punches to the head in favor of open hand or palm strikes to the head, face, neck, and throat. We recommend not punching to the face and head because of the risk of fracture to the bones of the hand.

A strike to the mandible can cause temporary paralysis or seizures, mild concussion, and unconsciousness. The mandible acts as a lever that can relay the force of a blunt force trauma to the back of the brain (medulla) where the cardiac and respiratory mechanisms are regulated and controlled.

The five major physiological causes of knockouts that we teach in our program include:

1. 2.

3. 4. 5. Direct brain trauma and concussion. Blunt force trauma that causes a disruption of the function of the central nervous system via an overload of the autonomic function of the peripheral nervous system. Termination of regular blood flow in the neck and to the brain. Blunt force trauma to a body organ such as the abdomen or liver. Trauma to any other part of the body that causes a disruption of the function of the central nervous system via an overload of the autonomic component of the peripheral nervous system.

The anatomical location of the chin, jawbone, or mandible is a potent location for rendering an attacker unconscious.

Of course, for an individual to be capable of defending themselves from attack they need to have some degree of physical and aerobic conditioning. Of all the many martial arts Tai Chi Chuan is supreme at maintaining the health of the human body provided that the practitioner does not destroy their health through bad health habits. Tai Chi Chuan is an excellent choice for individuals looking to maintain their health over their lifetime and it is even more beneficial when it is combined with Dao Yin and Chi Kung exercises.

Some forms of marital art, specifically those that involve extreme methods of training and full contact fighting result in early trauma to the musculoskeletal system and the autonomic functions of the central nervous system. The autonomic nervous system regulates body process that occur without conscious effort. The autonomic system is the part of the peripheral nervous system (sympathetic/parasympathetic) that is responsible for regulating involuntary body functions such as heartbeat, blood flow, and breathing. Fighters that compete in “reality” based sports contests are considered “washed up” by the age of thirty to thirty-five. Arthritis is common among practitioners that use practice methods that cause sustained repetitive stress and strain to the musculoskeletal system and Parkinson’s and Alzheimer’s diseases risk increases by twenty-five to thirty-three percent in sports with head trauma such as mixed martial arts. In a study entitled, “Dangers of Mixed Martial Arts in the Development of Chronic Traumatic Encephalopathy” the following was reported:

“A systemic review and meta-analysis of the epidemiology of injuries in MMA revealed that head injuries accounted for the highest distribution of injuries by anatomic region, with data ranging from 67.5% to 79.4% [19]. The authors also found that the injury pattern in MMA was quite similar to that of professional boxing, unlike other combat sports such as judo [20] or taekwondo [21], where blows to the head are outlawed. It is concerning that head injuries account for the highest proportion of injuries sustained by the competitor during the bout, and this became even more worrying after video analysis of 844 telecasted UFC MMA bouts revealed that about 90% of TKOs were a result of repetitive strikes. When the TKOs secondary to repetitive strikes were examined further, the 30 seconds before match stoppage was characterized by the losing competitor being hit by a series of multiple strikes to the head that increased in frequency [22]. Few would argue that when a contestant experiences a KO, he would meet the criteria for concussion, which is a type of traumatic brain injury.” (4)

Some mixed martial artists have been publicly critical of Tai Chi Chuan and other internal or “Kung Fu” martial arts systems. I do not concern myself with their negativity or the controversy because it has been my experience that only a rare few MMA fighters last beyond a few years in the sport. Their injury rates from training and fighting are so high that few have either the genetics or the luck to sustain long-term training.

When I attend martial arts seminars, training camps, and gatherings it is evident that too many aging traditional martial artists and instructors (by their fourth or fifth decade of life) are physically deconditioned and they are 28