The history of the discovery of blood circulation
The history of the discovery of blood circulation: unrecognized contributions of Ayurveda masters
Department of Kriya Sharir, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi; and Institute of Ayurveda and Integrative Medicine, Bangalore, India
Submitted 29 November 2011; accepted in final form 13 February 2012
Patwardhan K. The history of the discovery of blood circulation: unrecognized contributions of Ayurveda masters. Adv Physiol Educ
36: 77–82, 2012; doi:10.1152/advan.00123.2011.—Ayurveda, the native
healthcare system of India, is a rich resource of well-documented
ancient medical knowledge. Although the roots of this knowledge date
back to the Vedic and post-Vedic eras, it is generally believed that a
dedicated branch for healthcare was gradually established approximately
between 400 BCE and 200 CE. Probably because the language
of documentation of these early textbooks is in Sanskrit, a language
that is not in day-to-day use among the general population even in
India, many significant contributions of Ayurveda have remained
unrecognized in the literature related to the history of medicine. In this
communication, the discovery of blood circulation has been taken up
as a case, and a few important references from the representative
Ayurveda compendia that hint at a preliminary understanding of the
cardiovascular system as a “closed circuit” and the heart acting as a
pump have been reviewed. The central argument of this review is that
these contributions from Ayurveda too must be recorded and credited
when reviewing the milestones in the history of medicine, as
Ayurveda can still possibly guide various streams of the current
sciences, if revisited with this spirit.
Indian medicine; cardiovascular physiology; Charaka Samhita; Sushruta
Samhita; Bhela Samhita
ALTHOUGH THE ROOTS OF AYURVEDA, the native Indian system of
healthcare, date back to the Vedic and post-Vedic eras, prominent
historians such as G. J. Meulenbeld and K. G. Zysk regard 400
BCE as the approximate period during which a systematic medical
theory started emerging (7, 24, 35). The knowledge base of
Ayurveda is documented in the form of compendia known as
“Samhitas.” These compendia are composed in Sanskrit, a language
that is not in day-to-day use among the general population,
even in India. Therefore, one needs to have a working knowledge
of Sanskrit, along with the associated sociocultural contextual
understandings to comprehend and interpret the documented material
sensibly. However, the many unclear and confusing translations
and interpretations of these compendia have given rise to
a general perception that the basic facts related to human physiology
were largely unknown when these compendia were documented.
This probably is also the reason why some of the
important contributions of Ayurveda have gone unnoticed and
unrecognized in the process of documentation of the history of
medicine. In this communication, the discovery of blood circulation
has been taken up as a case, and it is argued that Ayurveda
masters, who authored different compendia, such as the Charaka
Samhita, Bhela Samhita, Sushruta Samhita, Ashtanga Hridaya,
and Sharngadhara Samhita, too need to be credited for their
contributions in this area along with personalities like Hippocrates,
Aristotle, Erasistratus, Galen, Vesalius, Servetus, William
Harvey, and others.
Generally Documented Milestones of the Discovery of Blood
When examining the documented historical milestones, it becomes
evident that the expansion in the knowledge of human
cardiovascular physiology occurred in a stepwise fashion not
attributable to a single discoverer. It was William Harvey, who,
for the first time, compiled these different bits of information in a
logical sequence and drew a convincing big picture delineating the
complete process of circulation. In fact, before William Harvey
described circulation, there were many errors in the understanding
of the facts, and three of them were the most important ones: 1)
the arteries contained air that was derived through the act of
respiration; 2) the interventricular septum was porous and facilitated
the movement of contents between the left and right ventricles;
and 3) the veins, instead of bringing blood from the periphery,
carried it to all parts of the body (12).
William Harvey, in his work “On the motion of the heart and
blood in animals,” effectively refuted all these erroneous ideas
while supporting his arguments with a strong mathematical
model and with observations derived out of robust experiments
that he had conducted (11, 16, 21, 31). Table 1 shows the
prominent contributors who helped in resolving these errors.
These contributions are generally well recognized and are
mostly cited by authors when they review the history of the
discovery of blood circulation (1a, 4, 10, 12, 13, 19–23, 30).
However, upon careful consultation of the diverse sources of
mainstream medical literature in an attempt to list these prominent
contributions, one does not come across with any of the
contributions credited to Ayurveda literature. For instance, a
search on PubMed does not give any results that satisfy the
criteria of crediting Ayurveda literature for its contribution in
the process of the discovery of blood circulation when the
keyword “Ayurveda” is entered in combination with search
items such as “discovery blood circulation,” “circulation physiology,”
and “cardiovascular physiology.” This communication
is an attempt to review some of the important contributions
of Ayurveda masters to understandings related to blood circulation
in human beings.
A Brief Introduction to the Representative Compendia
Charaka Samhita. Charaka Samhita (17a) primarily deals
with the principles of internal medicine also known as Kayachikitsa.
Four authors have contributed to what is available as
Address for reprint requests and other correspondence: K. Patwardhan, C/1,
New Medical Enclave, Banaras Hindu Univ., Varanasi U.P. 221005, India
Adv Physiol Educ 36: 77–82, 2012;
1043-4046/12 Copyright © 2012 The American Physiological Society 77
Charaka Samhita today. The original source of this compendium
is Agnivesha Tantra, which was based on the teachings of
Punarvasu Atreya to his students, including Agnivesha. Charaka
(200 BCE) is said to have redacted this work, and, much
later, another scholar, Dridhabala (4th century CE), further
supplemented this by rewriting certain portions of the text and
by providing with some new sections (25). Therefore, it is clear
that the material available in this textbook today was documented
before 500 CE.
Bhela Samhita. In Charaka Samhita, it is stated that Bhela
was a direct disciple of Punarvasu Atreya and was one of the
six disciples who composed their own compendia. Therefore,
Bhela Samhita (20a) is to be placed in parallel to Charaka
Samhita from a historical perspective (14). The only problem
with this compendium, however, is that it is not available in its
entirety, and the available version contains many errors (20a).
Sushruta Samhita. The contributions of Sushruta are well
known in the field of surgery. This compendium, authored by
Sushruta, mainly deals with the clinical specialty called Shalya
Tantra, i.e., clinical surgery. At least three authors have contributed
to what is available as Sushruta Samhita (1) today. The
original textbook written by Sushruta (around 400 BCE) was
redacted by Nagarjuna (400–500 CE) and was later amended
by Chandrata (10th century CE) (25).
Ashtanga Hridaya. Ashtanga Hridaya (17b) is a summarized
work on all eight major clinical specialties of Ayurveda (25).
The author of this textbook was Vagbhata (600 CE), and the
contents of this text are largely based on Charaka Samhita and
Sharngadhara Samhita. Sharngadhara Samhita (20b) is a
comparatively recent textbook that was composed in 1300 CE
by the author Sharngadhara. This text, although dealing mainly
with the principles of pharmaceutics, also contains some information
on physiology and clinical methods (25).
Physiology and Ayurveda
Generally, physiology is considered to be the function of
biological structures. This structure-oriented definition of
physiology assumes that a function can be understood only in
terms of structures (anatomy). It is interesting, however, to
note that many of the descriptions on human physiology
recorded in Ayurveda literature are considerably accurate, even
though they are not based on a precise knowledge of anatomy
(18). Although Sushruta Samhita describes the method of
cadaveric dissection, the anatomic details available in this
textbook are not sufficient to draw a clear and convincing
picture of the human body (7). A few researchers have discussed
the subject of “human anatomy” as it was perceived in
Ayurveda at length, and interested readers may refer to their
works, as these details are beyond the scope of this communication
(5–7, 15, 32, 33).
Physiology in Ayurveda is essentially based on the theory of
three entities known as Doshas (often mistakenly translated as
the theory of “three humors” or “three fluids”), namely,
“Vayu” or “Vata” (often incorrectly translated as “wind”),
“Pitta” (often wrongly translated as “bile”) and “Kapha” (often
erroneously translated as “phlegm”).
In this context, it is to be noted that the scholars of ancient
Greek medicine considered the four humors to be the regulators
of all physiological processes: 1) blood, 2) phlegm, 3)
yellow bile, and 4) black bile. In fact, it is actually on this
similarity that historians compare Ayurveda theories with ancient
Greek medical theories (7, 34). Most of the historians
have suggested the possibility of various interactions having
taken place between the scholars of ancient Greece and ancient
India, especially when Alexander the Great (326 BCE) visited
the places around Taxila, one of the ancient seats of learning
(3). A few historians, on the other hand, have suggested that
Table 1. Prominent and recognized contributions in the history of the discovry of blood circulation in chronological
Author/Investigator Time Period Contributions
Egyptian physicians in medical papyrus 1500 BCE Proposed the importance of the arterial pulse, its character, and its force in understanding health.
Hippocrates 460–370 BCE A clear description of the ventricles, the vessels (recognizing the difference between arteries and
veins), and the semilunar valves is found in his writings.
Aristotle 384–322 BCE Described that the heart was central, mobile, and well supplied with structures that served to
communicate between it and the rest of the body.
Erasistratus 304–250 BCE Air, attracted by the lungs, passed into the pulmonary veins, from there into the left ventricle,
and from the left ventricle it passed into the arteries, which distributed it to all parts of the
Claudius Galen 129–217 CE Stated that the arteries contain blood, not air.
Ibn al-Nafis 1213–1288 Stated that the interventricular septum is not porous and proposed the existence of the
Leonardo da Vinci 1452–1518 He established through experiments that air doesn’t enter heart from lungs. He also proved
conclusively that the valves allowed the blood to pass in only one direction and prevented its
Andreas Vesalius 1514–1564 Observed that the interventricular septum is not perforated.
Michael Servetus 1511–1553 Described the pulmonary circulation.
Realdus Columbus 1515–1559 He independently discovered the pulmonary circulation. He also discovered that the heart’s four
valves permitted the flow of blood in only one direction.
Andreas Caesalpinus 1524–1603 Described the passage of the blood from the right heart through the lungs to the left heart and
used the term “circulation” to describe this process.
Hieronymus Fabricius 1537–1619 He discovered the valves in the veins. He noticed that the blood cannot move from the heart
toward the periphery through the veins.
William Harvey 1578–1657 Explained the complete process of circulation.
Marcello Malpighi 1628–1694 He established the presence of capillaries with the help of a microscope. He proposed that
capillaries are the connections between arteries and veins that allow blood to flow back to the
heart, thus completing the gap in the knowledge of circulation.
78 DISCOVERY OF BLOOD CIRCULATION: CONTRIBUTIONS OF AYURVEDA
Advances in Physiology Education • VOL 36 • JUNE 2012
such interactions must have taken place even before Alexander
the Great visited India (9, 17). One cannot deny the fact that there
are striking similarities between some of the theories in these two
streams of medical knowledge; however, the question as to
“which system got influenced by the other” has been a matter of
debate, as no system mentions these facts (7, 24, 34). Whatever
may be the case, it is to be noted that the theory of Tridosha is
not simply a “humoral theory”; rather, it is based on a considerably
precise understanding of homeostatic principles (29).
Cardiovascular Physiology in Ayurveda
In Ayurveda literature, the heart and the different vessels
attached to it have been described to transport the following
four vital entities: 1) “Rasa” (often wrongly translated as
“Chyle”), the nutrient fluid that nourishes rest of the tissues;
2) “Rakta,” the red fraction that is very essential for life; 3)
“Ojas,” a white fraction, the functions of which are closely
associated with immunity; and 4) “Prana,” a fraction that is
derived through the act of respiration. Therefore, the tissue
that is today known as “blood” should include all these
components, and, hence, one should be careful when translating
terms such as Rasa, Rakta, Ojas, and Prana. In this
context, however, it is to be noted that most of the prominent
translators have committed an error of translating only
Rakta as blood and not others. This is probably one of the
important reasons for some of the vital contributions of
Ayurveda having gone unnoticed.
Similarities between Ayurveda and Galen’s model of cardiovascular
system. There are some very important similarities
between ancient Greek theories of medicine, especially
those proposed by Galen, and Ayurveda with respect to the
physiology of cardiovascular system. Galen believed that
the digested food, called Chyle, reached the liver from the
intestines, and it was then converted into blood there. Galen
also described that the blood, after reaching the heart, was
carried to all parts of the body through veins and was then
converted into flesh. Thus, the blood got “consumed” in this
process and was not “conserved.” Furthermore, he believed
that the blood was continuously being produced from the
food that a person ingested. According to him, the vital
spirit, “Pneuma,” was derived through the act of respiration
and was mixed with the blood in the left ventricle, and a
portion of this passed through the septal pores into the
venous blood of the right ventricle. In fact, Galen proposed
that the function of arteries was to carry this Pneuma to the
different parts (10).
On similar lines, in Ayurveda, it has been explained that
“Ahara” (food), after undergoing complete digestion, gets
converted into the nutrient fluid called Rasa and that this Rasa
is then transformed into Rakta in “Yakrit” (the liver) and
“Pliha” (the spleen) (Sushruta Samhita, Sutra Sthana, 14/4-5;
Sushruta Samhita, Sutra Sthana, 21/10). Thereafter, Rakta
enters the heart (Sharngadhara Samhita, Purva Khanda, 6/9).
Prana derived through the act of respiration follows this Rakta
(Caraka Samhita, Sutra Sthana, 24/3; Sharngadhara Samhita,
Purva Khanda, 5/48-49). This Rakta is then transformed into
“Mamsa” (flesh) and other bodily tissues (Charaka Samhita,
Cikitsa Sthana, 15/16). On the basis of this similarity, scholars
often translate Rasa as Chyle. Similarly, Pneuma and Prana too
have a very close resemblance; however, the term “Prana” has
different contextual meanings as well, rather than simply
Despite of these similarities, it is to be noted that Ayurveda
goes a step further ahead and states that Rasa reenters the heart
once again, after being carried to all tissues. This explanation
is explicitly found in Bhela Samhita (Sutra Sthana, 20/3). In
addition, in Charaka Samhita (Chikitsa Sthana, 15/21), an
expression similar to that of “circulation” has been used while
explaining that the process of tissue nourishment may be
compared with a rotating wheel.
Circulation: Major Contributions of Ayurveda Masters
With this background, the prominent contributions of
Ayurveda masters (shown in Table 2) are described in the
following paragraphs. The information shown in Fig. 1 is an
effort to present a preliminary sketch of cardiovascular physiology
as understood in Ayurveda.
General organization of the cardiovascular system. In Charaka
Samhita (Vimana Sthana, 5/7) it is described that the heart
and the 10 prominent blood vessels attached to it form the basis
of cardiovascular system (“Rasavaha Srotamsi”), which is
responsible for the distribution of nutrients to all parts of the
body. Charaka explicitly explained the importance of the heart
as an organ: “Even a minor damage to the heart can lead to
fainting, and a serious injury can lead to death” (Charaka
Samhita, Sutra Sthana, 30/10 –11).
Vagbhata documented that the 10 prominent blood vessels
connected to the heart carry the essential principles called Rasa
and Ojas to different parts of the body (Ashtanga Hridaya,
Sharira Sthana, 3/18). He also described that the blood vessels
go on giving branches, and, as they do so, they go on becoming
narrower and narrower in a fashion similar to that observed in
the venation of the leaves (Ashtanga Hridaya, Sharira Sthana,
Control of circulation. Charaka describes that “Vyana
Vayu” a component of Vayu, continuosly ejects the blood out
of the heart and distributes it all over the body (Charaka
Samhita, Chikitsa Sthana, 15/36). Vagbhata, in Ashtanga Hridaya
(Sutra Sthana, 12/5), further clearly stated that the “Prana
Vayu,” located in the head, controls the activities of the heart.
In this context, Vyana Vayu and Prana Vayu denote the
nervous control of circulation because Vayu, in general, represents
all neural mechanisms (18, 29).
In Sushruta Samhita (Sutra Sthana, 14/3; and Nidana Sthana,
1/17), Sushruta explains that, after the complete digestion of
food, the absorbed material known as Rasa reaches the heart
and, thereafter, is distributed to all other parts of the body with
the initiating act of Vyana Vayu.
The heart as a pumping organ. The forceful ejection of Rasa
from the heart and the role of Vyana Vayu in making its
ejection possible further hint at a preliminary understanding of
the heart as a pumping organ (Bhela Samhita, Sutra Sthana,
20/3; Charaka Samhita, Chikitsa Sthana, 15/36; and Ashtanga
Hridaya, Sutra Sthana, 12/7).
The pattern of blood flow. Sushruta identified that “the
pattern of the blood [Rasa] flow is comparable with the
movement of sound, fire and water” (Sushruta Samhita, Sutra
Sthana, 14/16). It is interesting to note that the mean flow
velocity of the blood goes on decreasing as it flows from the
heart toward the periphery. Similarly, the sound moves fastest
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among the three symbols that Sushruta has used to compare the
movement of blood. The speed with which the fire spreads is
dependent on the velocity of the wind, which is less than that
of sound but greater than that of water.
The three segments of the vascular tree. Charaka documented
three different kinds of blood vessels: “Sirah” (vessels
that carry the contents without pulsating), “Dhamanyah” (vessels
that pulsate), and “Srotamsi” (vessels from which fluids
move out) (Charaka Samhita, Sutra Sthana, 30/12). This explanation
is important because it assumes the presence of three
distinct segments in the vascular tree: the pulsating (arteries)
segment, the exchange (capillaries) segment, and the transporting
Bhela too explained that the 10 great vessels called Dhamanyah
arise at the heart and then divide to give rise to another
set of blood vessels known as Sirah (Bhela Samhita, Sutra
Sthana, 20/1–3). Therefore, it may be inferred that Bhela
possibly knew the differences between arteries (Dhamani) and
Closed circuit. Bhela Samhita is important from a historical
perspective, because Bhela was the first individual in the
history of Indian medicine who described the process of greater
circulation explicitly for the first time. He said that “The blood
[Rasa] is first ejected out of the heart, it is then distributed to
all parts of the body, and thereafter, it returns back to the heart
through the blood vessels known as ‘Sirah.’”
Charaka also used an expression similar to that of circulation
when explaining that all parts of the body are nourished in a
circular fashion, similar to that of a rotating wheel (Charaka
Samhita, Chikitsa Sthana, 15/21).
Sharngadhara described that “Samana Vayu” helps in the
transportation of Rasa toward the heart (Sharngadhara Samhita,
Purva Khanda, 6/9).
Arterial pulse. In Sharngadhara Samhita (Purvakhanda,
3/1), Sharngadhara described the importance of examination of
the arterial pulse in clinical medicine, including a description
on various characters of the radial pulse.
Across all Ayurveda textbooks, the following inadequacies
are found in relation to cardiovascular physiology.
First, anatomic details pertaining to the chambers of the
heart, atrioventricular valves, and semilunar valves are
missing. Second, the presence of valves in the veins is not
mentioned. Third, the specific number, origin, and course of
the great blood vessels are not documented. Fourth, terms
(such as Sira and Dhamani) are often used interchangeably.
Fifth, the heart is considered to be the seat of higher mental
functions, although the “head” too received equal importance.
Hence, a few Dhamanyah have been described to be
carrying certain sensations, like hearing and smell. Sixth,
details of pulmonary circulation are not documented. Finally,
explanations are scattered at various places and are
not arranged in a sequence.
Table 2. Major contributions from Ayurveda to understandings related to circulation
Classical Textbook Author Time Period Vital Information on Circulation
Charaka Samhita Agnivesha Composed between 400 BCE and 500 CE
in several stages
•Describes that the heart and the 10 prominent blood vessels attached
to it form the basis of the cardiovascular system (“Rasavaha
Srotamsi”) responsible for the transportation of nutrients to all parts
of the body.
•Describes that “Vyana Vayu,” a component of “Vayu,” constantly
forces the blood out of the heart and distributes it.
•Explains that all parts of the body are nourished in a circular
fashion, similar to that of a rotating wheel.
•Proposes that three different kinds of blood vessels exist: “Sirah”
(vessels that carry the contents without pulsating), “Dhamanyah”
(vessels that pulsate), and “Srotamsi” (vessels from which fluids
can move out).
•Described that the breath (“Prana”) follows the blood in the body.
Bhela Samhita Bhela Composed in parallel with Charaka
Describes the systemic circulation explicitly. He says, “The blood
[Rasa] is first ejected out of the heart, it is then distributed to all
parts of the body, and thereafter, is returned to the heart through
the blood vessels known as ‘Sirah.’”
Sushruta Samhita Sushruta Composed between 400 BCE and 1000
CE in several stages
•Documented that “The successive manner in which the blood moves
is similar to the manner in which sound, fire and water move,”
hinting at the changes in mean flow velocity as the blood moves in
the cardiovascular system.
•Explained that after the complete digestion of food, the absorbed
material reaches the heart and, from there, is propelled to other
parts of the body.
Ashtanga Hridaya Vagbhata 600 CE •Described that 10 prominent blood vessels connected to the heart
carry the blood (“Rasa” and “Ojas”) to all parts of the body.
•Observed that blood vessels go on giving branches, and as they do
so, they go on becoming narrower and narrower in a fashion
similar to the one observed in the pattern of venation on the leaves.
Sharngadhara Samhita Sharngadhara 1300 CE •Described the importance of the clinical examination of arterial
•Described that “Samana Vayu” controls the transportation of the
blood (“Rasa”) toward the heart.
80 DISCOVERY OF BLOOD CIRCULATION: CONTRIBUTIONS OF AYURVEDA
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Despite some gross inadequacies pertaining to the anatomical
details of the heart and the blood vessels, it can be said that the ancient
Ayurveda masters had acquired considerable understanding related to
the blood circulation in the human body. Therefore, these masters
deserve to be recognized for their contributions in this area. It is also
suggested that efforts should be made to review and recognize other
contributions of Ayurveda to various streams of biology and medicine
in a systematic manner, as Ayurveda can possibly still guide
further advances in biomedical sciences, if revisited with this spirit.
The author thanks Namyata Pathak, Madan Thangavelu, Vishnu Joglekar,
and Medha Dongre for providing feedback on the various issues addressed in
Fig. 1. Preliminary sketch of Ayurveda perceptions of human cardiovascular physiology. Cha., Charaka Samhita; Su., Sushruta Samhita; A.H., Ashtanga
Hridaya; Sha., Sharngadhara Samhita; Bh., Bhela Samhita.
DISCOVERY OF BLOOD CIRCULATION: CONTRIBUTIONS OF AYURVEDA 81
Advances in Physiology Education • VOL 36 • JUNE 2012
this article. Himanshu Joshi helped in verifying the original references and in
conceptualizing the preliminary drawing. The author thanks the Department of
AYUSH and the Institute of Ayurveda and Integrative Medicine for the
assistance received under the Vaidya-Scientist Fellow program.
No conflicts of interest, financial or otherwise, are declared by the author(s).
K.P. conception and design of research; K.P. prepared figures; K.P. drafted
manuscript; K.P. edited and revised manuscript; K.P. approved final version of
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Advances in Physiology Education • VOL 36 • JUNE 2012