As a skeptical physician, I am slow to accept that this entertainment trope could be real. But the Death Touch has found its way as a trope into so many popular movies (Executioners from Shaolin, 1977; Clan of the White Lotus, 1980; Bloodsport, 1988; and, as the ‘five point palm exploding heart technique” in Kill Bill Volume 1 and 2, 2003 and 2004) that it is almost as well accepted as the familiar trope of the knockout punch to the head (short of a severe injury, rather than being asleep for 30 minutes, most people would be briefly stunned and woozy, then really mad after being punched in the head).
In the Touch of Death, practitioners achieve their goal either with one touch at a specific point or with a series of precise strikes. There can be instant death or, for better cinema, the victim survives for a short period to time, aware of his or her fate.
There is a subtype of the Touch of Death that is non-lethal, The Paralyzer. Any Star Trek fan is familiar with this, as Mr. Spock used this special technique (The Vulcan Nerve Pinch) to give his victims long, non-damaging naps.
Beyond entertainment, there are a number of historical and current practitioners of martial arts who have claimed knowledge of this closely guarded secret.
These practitioners take themselves very seriously and some have built a career surrounding teaching this mystical technique.
There are even Dim Mak masters who appear to be able to knock people down, non-lethally, without physically touching.
There are also websites that state that many of the special locations around the body that are used for healing purposes by practitioners of acupuncture and acupressure (“Stomach 7”, for instance) can also be exploited for the dark art of Dim Mak.
Here is a website selling charts of Dim Mak pressure points, complete with testimonials!
So, numerous popular movies and thousands of years of Chinese culture must be based on SOMETHING, right?
Well, this time, at least, the answer is a carefully qualified “yes.” The real Touch of Death is accidental and very tragic and is a condition called commotio cordis (Latin for “agitation of the heart”). Here is the definition of commotio cordis from a thorough review of the condition from the New England Journal of Medicine:
“Ventricular fibrillation and sudden death triggered by a blunt, nonpenetrating, and often innocent-appearing unintentional blow to the chest without damage to the ribs, sternum, or heart (and in the absence of underlying cardiovascular disease).”
Commotio cordis has been described in the medical literature since the 18th century, but has been largely unrecognized as recently as the mid 1990s. Since then, awareness of this condition has grown. Commotio cordis primarily affects children, adolescents, and young adults and most often occurs during participation in sports. For example, about 50% of cases have been reported during such competitive sports as baseball, softball, ice hockey, football, and lacrosse, typically (but not always) after a blow to the chest delivered by the projectile used to play the game. About 25% of cases occur during recreational sports, like playing catch or being struck by a snowball. The remaining roughly 25% of cases have been reported during non-athletic activities. Examples of these include blows to the chest from falling into a body of water, from an attempt to terminate hiccoughs, and from being struck by the head of a large pet dog.
Tragically, commotio cordis is usually fatal. In the first decade of this century, the survival rate was only 35%. However, it appears that survival rates have been increasing, as public awareness of this condition has risen, there has been more accessibility to automatic external defibrillators, and bystanders have been faster to initiate the “chain of survival” (call 911 or a similar rescue phone number, then start cardiopulmonary resuscitation, defibrillation, and other life support measures).
While this is not the theme of this article, there is an essential take-home point:
If you see someone collapse after a blow to the chest of any kind, DO NOT HESITATE TO RESPOND!
Commotio cordis, fortunately, can only occur under very narrow circumstances. The blow must be directly over the heart and it must occur during an electrically vulnerable period of 10 to 20 milliseconds when inhomogeneous dispersion of repolarization is greatest.
This brings me to the second, essential, take-home point:
Commotio cordis is NOT a game or something that anyone should EVER try to induce!
With regard to prevention of commotio cordis, a great deal of effort has been devoted to finding balls and pucks (projectiles) that are less dangerous but that will not change the nature of the games for which they are used. Effort has also gone into designing appropriate chest protectors. However, as of the time of the review that I have been using for this article (from 2010), suitable projectiles and chest protectors were not yet available.
So, how did commotio cordis become Dim Mak?
This question is open to speculation, but I think a pretty fair guess is that, during a sparring match, one ancient martial artist struck the other on the chest in the precise location and at the the precise moment to trigger commotio cordis. Having no knowledge of cardiology, and with no visible damage to the chest, this tragic death was deemed to have been caused by a mystical ability: “The Touch of Death.”
To accentuate the dramatic aspect of this condition, and make it even more suitable to be used as a trope, 20% of victims remain physically active for a few seconds after the blow that caused commotio cordis, with the transient ability to continue to walk, run, throw a ball, or speak, for example.
To be clear, the Touch of Death, Dim Mak, is accidental and tragic, involves no chi or other mystical energy, cannot be taught to be consistently performed (nor should any attempts be made in this regard), and cannot be performed without physical contact. Any other representation of Dim Mak is bullshido.
Please be safe.
Maron BJ and Estes III NAM, Commotio cordis. N Engl J Med 2010 Aug 18. 362(10):917-927.