The history of the discovery of blood circulation

The history of the discovery of blood circulation: unrecognized contributions of Ayurveda masters

Kishor Patwardhan

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

Circulation

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

of Ayurveda

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

(e-mail: patwardhan.kishor@gmail.com).

Adv Physiol Educ 36: 77–82, 2012;

doi:10.1152/advan.00123.2011.

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

Sushruta Samhita.

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

sequence

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

body.

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

pulmonary circulation.

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

regurgitation.

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.

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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

“breath.”

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,

3/18 –19).

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

(veins) segment.

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

veins (Sira).

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.

Inadequacies

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

Samhita

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

pulse.

•Described that “Samana Vayu” controls the transportation of the

blood (“Rasa”) toward the heart.

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Conclusions

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.

ACKNOWLEDGMENTS

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.

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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.

DISCLOSURES

No conflicts of interest, financial or otherwise, are declared by the author(s).

AUTHOR CONTRIBUTIONS

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

manuscript.

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Historical Perspectives

82 DISCOVERY OF BLOOD CIRCULATION: CONTRIBUTIONS OF AYURVEDA

Advances in Physiology Education • VOL 36 • JUNE 2012

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