A 16-year-old baseball player from northern New Jersey died after being hit in the chest by a pitch during practice, MyFoxNY.com reported.

Xxxxx xxxxxs, who was a sophomore at Garfield High School, went into cardiac arrest following the incident on Friday night. He was pronounced dead about an hour later at St. Joseph's Regional Medical Center in Paterson.

At the time of the accident, Adams, a catcher, was practicing with a pitcher. He was wearing a chest protector, and the teen’s father said his son was in good health and had no known medical conditions.

Xxxxs was practicing with a Paterson-based traveling team that was preparing for a tournament in Florida later this month. His teammates have decided to play in the tournament, deciding it was the best way to honor his memory.

What does this have to do with the concept of Dim Mak, an ancient Chinese method, known only to certain highly skilled masters who can properly perform this "death touch"? Or, more accurately translated from the Chinese as "press artery"? Well, as we'll see, probably more than has been discussed.



The Dim Mak Chart of death points. Supposedly related to Chinese TCM acupuncture points.

Wikipedia defines Dim Mak as "The Touch of Death or Death Touch refers to any martial arts technique that can kill using seemingly less than lethal force targeted at specific areas of the body. The concept known as Dim Mak,  literally "press artery";  traces its history to Traditional Chinese Medicine Acupuncture. Tales of its use are often found in the Wuxia genre of Chinese martial arts fiction. Dim mak is depicted as a secret body of knowledge with techniques that attack pressure points and meridians, said to incapacitate or sometimes cause immediate or even delayed death to an opponent." But a more interesting, and detailed analysis of Dim mak comes from a Dr Kelly (DO), who not only elaborates on it both thoroughly and well, but has even written a book about it. The following is quoted from his website, which is devoted to the study of Dim mak, and, in my opinion, selling his book.

Dim mak (death touch)  is an ancient martial art that consists of striking certain points on the body to cause illness or death. The points are usually called dim mak points, but they are also referred to as vital points and pressure points. The majority of these points correspond to the same locations as acupuncture points. Dim mak is an extremely dangerous martial art, which can cause a great deal of damage to the human body. The effects of attacking the dim mak points include knockout, death, and a delayed death. Many have seen videotapes and seminars where a subject looses consciousness after being struck on certain points. Although this is a very dramatic demonstration method, it could have dangerous consequences.

Many believe that dim mak was created centuries ago by the same man who is believed to have developed the original tai chi form. Some have postulated that this form contained the founder's methods of attacking the most dangerous dim mak points. According to legend, this knowledge spread rapidly and influenced the development of many Chinese martial arts. These martial arts then influenced the ancient Okinawan martial art called karate. It is believed by many that the traditional katas of the Okinawan martial arts also contain the secrets of striking the dim mak points. This is interesting because Okinawan karate has had a major impact on the martial arts of Korea and Japan. Thus, it is conceivable that the traditional katas of these other martial arts could also contain the secrets of dim mak.

In the past, this knowledge was only taught to the most advanced and trusted students. As the martial arts spread around the world, the knowledge of dim mak (pressure point fighting) remained in seclusion. Thus, the true nature of many martial arts remained shrouded in secrecy. Recently this tradition of secrecy has been broken and there are martial arts masters who teach the methods of attacking the points to the public. This information is now available at seminars, in books, and on videotapes. Although this has had a positive effect on the martial arts, it does raise the issue of safety.

In most instances, dim mak is explained and taught using ancient theories based on acupuncture. Although this has been the tradition for many years, it has led to a great deal of skepticism and confusion. Because of this, many have disregarded the warnings about dim mak and started to experiment with the points. This practice could have tragic consequences. If the dangerous effects of dim mak could be explained scientifically, the warnings about the points might have more credibility. There is a definite need for a reference on dim mak that is based on modern medical science.

Dr. Michael Kelly has spent years studying the medical effects of dim mak and has found a great deal of medical research that provides evidence of dim mak's lethal effects. He has compiled all of his research into a new book, which explains the effects of dim mak on the nervous and cardiovascular systems. Topics such as the delayed death touch, knockouts, and attacking the internal organs are explained in detail using modern medical science. The book has been written in a format that will assist one in finding the dim mak applications contained within the traditional forms of many styles.

The initial chapter starts off with a brief introduction to the history of dim mak, and then goes on to explain the essential elements of neuroscience needed to understand the remaining chapters. Dr. Kelly then takes his reader through a comprehensive explanation of the relationship between dim mak and medical science. Included are separate chapters on knockouts, attacking the internal organs, and dim mak's effects on the heart. The last couple of chapters explain the medical science behind the revival techniques and attempt to tie all the information together so that the reader can start to find the dim mak applications contained within their own style. This book is a must have for all serious students of the martial arts and anyone with an interest in the diabolical art of dim mak. The book is titled, Death Touch: The Science Behind the legend of Dim Mak and is now available.

And there's more, which relates dim mak to acupuncture:

According to the ancient theories of acupuncture, the body has a circulating life force (chi or ki) that travels through invisible channels called meridians. According to this theory, all diseases are the result of disruptions in the flow of one's life force or chi. Acupuncture points are located on the meridians and represent areas where the flow of energy can be altered. There are multiple methods of manipulating the acupuncture points including finger pressure, burning herbs, and inserting needles. The acupuncturist inserts needles into different points depending on the illness or complaint. Dim mak evolved from this theory and different points are attacked to cause different effects. According to the ancient theory behind dim mak, attacking the points disrupts the flow of energy, which results in illness or death.

There is no questioning the effectiveness of dim mak. Anyone who has ever been struck hard on a dim mak point or witnessed a pressure point knockout can attest to dim mak's effectiveness. However, there are many who question the ancient explanation of dim mak's effects. Although the previously mentioned theory has been in existence for centuries, modern medical science can provide a new scientific explanation for dim mak's effects. Almost all of the points are located in areas where the one can attack a vulnerable portion of a nerve. In fact, many of the points can be linked neurologically to the internal organs that they are believed to affect. Consequently, attacking the nervous system can disrupt many of the body's functions resulting in illness or death. This new medical explanation of dim mak can be found in Dr. Kelly's new book.

www.dimmak.net  Dr. Kelly

A lot of information, but as I read all of this, I'm not sure there's a lot of science. Further analysis of the concept of dim mak comes from other students of the system; the following is a very careful analysis of dim mak relevant to related Chinese traditions:

A great deal has been said and written about the Death Touch (Dim Mak) by many people who proclaim themselves experts of this almost forgotten art from the rich traditions of Chinese Martial Arts. Very few of these self-proclaimed "experts" can really explain or perform this feat.

There are great similarities in theory between the studies of Dim Mak and accupuncture. Dim Mak, however, uses a special set of vital pressure points which must be co-ordinated with various secret times of the day, night and seasons.

The Wing Chun secret script states that the vulnerability of a defined vital pressure point depends on the different time and different season and, if damaged, can determine a person's life or death. Such damage can cause serious illness such as convulsions, cramps, coughing of blood, lack of energy and insomnia. A person injured by the Death Touch must seek proper medical treatment, or it would certainly cost him his life. Some would take less than a day, some up to six months. This is why the Dim Mak is also called the Delayed Death Touch.

The Death Touch or Dim Mak is a specialised technique requiring the striking of a particular vital pressure point at a certain time of day and season. This deadly art was developed by the highly skilled Kung Fu practicioners through the centuries, and is based on the similar principles of the relationship between the vital pressure points to various organs and the life sources.

Because Wing Chun style was developed by a woman, the emphasis is on the efficiency of the strike, and Dim Mak is one of its secret specialities. Nevertheless, a lot of the training is devoted to healing the victims of the Death Touch with the use of different combinations of herbal formulae and pressure point massage.

According to the Wing Chun Death Touch secret, a person has some 18 prime vital pressure points, and 54 secondary vital pressure points, to make up 72 vital pressure points. The different seasons (Spring, Summer, Autumn and Winter), and the different times of the day, determine the vulnerability of the pressure point. Some of these pressure points are selected from the 34 known meridians, and some are not.

There is a special way of striking and applying the force to obtain the optimum result. Usually one would use a Phoenix Knuckle as a weapon for striking. A more advanced practioner might be able to use his finger as a weapon.

Wing Chun has a unique Dim Mak system. The following are two ancient diagrams for the front and the back of the body. Referring to the doctrine the vulnerable pressure points circulate according to four seasons - spring, summer, autumn, winter. Each day is divided into twelve segments of time equivalent to two hours. Striking on the vital pressure points corresponding to the timetable will cause serious injury or can lead to death. Hence the meridians correspond to the vital organs. If the Chi in the meridians is blocked due to injury from the Dim Mak strike, the corresponding organ will cease to function. Further, with the law of the five elements, this will lead to the collapse of all other organs. If the victim is not treated properly, death will be inevitable. Therefore it is called Delayed Death Touch.  (Unknown author)


Great stuff. And, a great way of tying it all into traditional Chinese medicine and thought. But how much of this is really based upon modern day medical science and fact? Well, probably none of it. But, this so called "death punch" does occur, but, not by altering qi, or any of that other Chinese traditional nonsense. Let's look at a not so well known medical phenomena, which seems to occur on a fairly regular basis. If you watch the news, you'll find at least one of these events published in the media every month. It's unfortunate, but it's a relatively simple concept, one which is easier to cause than you might think. Let's look at an analysis of a recent medical case. in this evaluation, you'll discover the medical and scientific proven concept of commotio cordis.

The emergency department (ED) receives a paramedic call reporting a 10-minute estimated time of arrival for a 17-year-old boy who was found in cardiac arrest after a blow to the chest. The patient has regained spontaneous circulation and is currently awake and alert. A rhythm strip faxed to the ED before the patient's arrival shows ventricular fibrillation, with subsequent conversion to a normal sinus rhythm after defibrillation with 200 Joules. The prehospital personnel further report that the patient, a center outfielder for a local baseball team, was trying to catch a baseball when one of his teammates accidentally ran into him, elbowing him in the middle of his chest. The patient immediately dropped to the ground, was unresponsive, and showed no spontaneous movement.

His coach immediately initiated cardiopulmonary resuscitation (CPR) after no pulses were palpated. The paramedics arrived 5 minutes later and, as noted on the rhythm strip, found the patient to be in ventricular fibrillation. One 200-J countershock was administered, converting the ventricular fibrillation to a normal sinus rhythm. The patient slowly regained consciousness. He was confused initially and was amnestic to the event.

Upon arrival at the ED, the patient reports mild anterior chest-wall pain but no shortness of breath, palpitations, weakness, or feelings of confusion. He states that he has never before fainted. The patient and his mother report no significant past medical or family history, including any arrhythmias, unexplained sudden deaths, or cardiac structural diseases. He states that he does not have a lower exercise tolerance than his teammates and also denies any smoking, drinking, use of medications, illicit substance abuse, or doping practices.

On physical examination, the primary survey of his airway, breathing, and circulation is unremarkable. The patient has a blood pressure of 130/71 mm Hg and a heart rate of 106 bpm, with a normal rhythm. His respirations are 28-30 breaths/min. The initial oxygen saturation is 83% while the patient is breathing room air, but it corrects to 98% with a non-rebreather mask. Soon after, his saturation improves to 99% with a 2-L nasal cannula. His mentation is normal and he is alert, with a Glasgow coma scale rating of 15. The skin examination reveals mild ecchymosis just anterior to his sternum. The lungs are clear to auscultation bilaterally, and the cardiac examination reveals a regular rate, with normal S1 and S2 heart sounds and no clicks, gallops, rubs, or murmurs. The abdominal and neurologic examinations are unremarkable. No hyperflexibility or marfanoid appearance is noted.

The patient is placed on a cardiac monitor upon arrival at the ED. A 12-lead electrocardiogram (ECG) reveals sinus tachycardia at a rate of 110 bpm, with mild right-axis deviation. The QRS complex, QT interval, ST/T waves, and P waves are all normal. A portable, upright chest x-ray shows no signs of fractures, widening of the mediastinum, cardiomegaly, effusion, or pneumothorax. A complete blood count is normal except for a mildly elevated white blood cell count of 13.6 ×103/µL (13.6 ×109/L). A metabolic panel is normal, including normal potassium and magnesium findings. The initial troponin I level is 0.04 ng/mL (0.04 µg/L; normal range, 0.02-0.04 ng/mL; indeterminate range, 0.05-0.30 ng/mL). A urine drug screen is negative. Computed tomography of the chest is remarkable only for mild pulmonary and periportal edema. The patient is admitted to the pediatric intensive care unit (PICU) for continuous cardiac monitoring and cardiology consultation. An echocardiogram ordered in the ED is to be done in the PICU.

Commotio cordis (which is Latin for "disturbance of the heart") is, in essence, a concussion of the heart. Initially described as early as 1857, it is defined as an instantaneous cardiac arrest produced by a witnessed, nonpenetrating blow to the chest, in the absence of preexisting heart disease or identifiable morphologic injury to the sternum, ribs, chest wall, or heart. Commotio cordis is a diagnosis of exclusion. Other causes, such as myocardial infarction, electrolyte abnormality, long-QT syndrome, and hypertrophic obstructive cardiomyopathy (HOCM), must first be ruled out with examinations such as serial assessment of cardiac biomarkers and electrocardiography, electrolyte level testing, and echocardiography.

Although reported as the second most common cause of sudden cardiac arrest in young athletes (behind HOCM), commotio cordis is believed to be underreported and underrecognized. The US Commotio Cordis Registry (USCCR), in Minneapolis, Minnesota, reported that as of September 2001, only 180 cases had been documented. Up to 62% of these cases involved engagement in organized, competitive sports, 66% of the patients were younger than 16 years of age, and 80% were male. The oldest reported case was that of a 20-year-old man struck in the chest by a baseball, and the youngest case was that of a 7-week-old crying infant struck in the chest by his frustrated father. Eighty-one percent of cases involved a blunt, precordial blow from a projectile object propelled against a stationary chest wall, resulting in a relatively localized area of contact. It is notable that those who are most susceptible to commotio cordis are young athletic males. This is probably the result of the fact that there is less protection of the heart by subcutaneous fat, muscle bulk, and fully ossified ribs, all of which become more common in adulthood.

A review of the USCCR data revealed that most of the 180 reported cases were caused by a blow to the chest from an object used during an organized youth sporting event. A baseball accounted for 53 of the cases, with a softball and a hockey puck the next most frequent, at 14 and 10 cases, respectively. Other documented sporting cases have been caused by blows delivered by body parts, such as an elbow, knee, foot, or fist hitting the anterior chest wall (5-6 cases of each). Finally, daily activities, including parent-child discipline (5 cases), and even a fall from monkey bars (1 case), can lead to commotio cordis. Regardless of the mechanism, impacts resulting in commotio cordis are typically of low energy and velocity. The victim may collapse immediately after the blow, but in up to 50% of cases, there is a short delay between the impact and collapse.

In 1930, George Schlomka was the first to describe the factors that can lead to arrhythmia after a moderate precordial impact. He believed that the force, location, and type of object causing the impact determined the type of injury and the subsequent risk for arrhythmia. The force transmitted to the heart is directly related to the hardness of the striking object. Madia and colleagues reported that the threshold speed of impact at which a standard baseball can cause ventricular fibrillation is between 25 and 30 miles per hour. When the speed is over 50 miles per hour, however, the likelihood of ventricular fibrillation actually decreases, although the possibility of myocardial contusion becomes greater. Furthermore, the authors stated that the impact must be directly over the heart near or just to the left of the sternum in order to instigate ventricular fibrillation. Impact on the center of the heart induced ventricular fibrillation in 30% of reported cases, compared with 13% and 4% at the left ventricular base and apex, respectively.

The use of a standard baseball leads to the incidence rate reported above, but if the core of the ball is softer, then the rate for ventricular fibrillation drops. Link and colleagues reported that changes to the cores of baseballs to make them softer led to a decrease in the rate of ventricular fibrillation with commotio cordis from 70% to 19%. As such, the use of safety baseballs with rubber cores of different degrees of hardness has been advocated to reduce the risk for such traumatic injury in young athletes.

Not all impacts to the anterior chest will lead to the ventricular fibrillation observed in commotio cordis. The impact must be delivered 10-30 milliseconds before the peak of the T wave in the cardiac cycle in order to induce ventricular fibrillation. Induction is probably secondary to the activation of potassium-carrying ion channels via mechanoelectric coupling. The activation of these ion channels generates an inward current, thus locally augmenting repolarization and resulting in premature ventricular depolarization and the initiation of unstable ventricular arrhythmias. If impact occurs during other portions of the cardiac cycle, different conduction disturbances, such as heart block, bundle branch block, or transient ST segment elevation, may be induced.

Regardless of the cause, if a young athlete goes into sudden cardiac arrest, CPR should be implemented immediately. Among sports-related cases of commotio cordis documented in the USCCR, 15% of patients survived. When CPR was instituted within 3 minutes of the impact, 68% of patients survived; however, if CPR was delayed by more than 3 minutes, only 3% of patients survived. Animal studies have shown that CPR instituted within the first 3 minutes of injury can increase survival rate by up to 25%. Concomitantly, early use of an automatic external defibrillator (AED) device has been proven to increase survival rates. With an AED recognizing ventricular fibrillation at a sensitivity of 98% and a specificity of 100%, defibrillation within the first 3 minutes can increase the survival rate by an additional 50% or more in animal models, yielding a survival rate of 46% at 4 minutes and 25% at 6 minutes. The USCCR has recommended that all athletic venues have an accessible AED. Preventive measures for commotio cordis include parental education, softer baseballs, and protective padding of an athlete's precordium. Secondary prevention may involve avoidance of certain sports until the age of 18 years or older.

While the patient in this case was in the PICU, he was placed on continuous cardiac monitoring for 24 hours, and no incident of arrhythmia was noted. An echocardiogram revealed a normal left ventricular systolic ejection fraction, with no structural abnormalities, valvular disease, or hypertrophy. A repeat 12-lead ECG showed no changes from the previous one, and subsequently, the serial troponin measurements decreased from 0.25 to 0.04 ng/mL. A pediatric cardiologist consultation was unrevealing. The patient was transferred to the pediatric floor the next day, and he was discharged 2 days after initial admission, with no signs of postarrest sequelae. His final diagnosis was commotio cordis.  (MEDSCAPE and other journals)



There is nothing in the medical journals that supports a strike, blow or non penetrating trauma to any of these dim mak "death points" causing immediate or delayed state of being deceased. Nothing. Other than the concept of commotio cordis, whereby a blow to the sternum, during a certain and very brief part of the relaxation phase of the ventricles of the heart, can cause a dysrhythmia known as ventricular fibrillation. Ventricular fibrillation causes cardiac arrest, and if patients are not successfully resuscitated soon after the event, death will occur. "Delayed death", in terms of hours, is generally not possible, unless the blow to the sternum and the underlying heart was serious enough to cause cardiac contusion, a focus of heart damage that itself gives rise to an arrythmia that leads to ventricular fibrillation. The blow to the chest must occur during a certain phase of cardiac relaxation, and that phase is a very brief part of the cardiac cycle. It must be of a certain energy, usually five joules or more, and over a certain part of the heart, generally in the sternal area. Non penetrating trauma to these other so called "dim mak death points", from a current medical and scientific viewpoint, are just not possible, with the exception of rib fracture and possible resultant tension pneumothorax.


This is an important concept, one which should be well understood given the propensity for martial arts enthusiasts to spar. Contact sports can lead to dangerous conditions, and one of the critical concepts one should take from this, is that there is a danger to central chest strikes. The risk of causing a serious adverse event is low, but considering that the result can be death, should give all to believe that proper sparring equipment be used during contact martial arts training, and, more importantly, that central chest strikes can be very dangerous.