Ancient Persian medical views on the heart and blood in the Sassanid era
(224–637 AD)
The Sassanid Empire in Persia (224–637 AD) ruled one of the most influential eras in world history. They with the Romans and later the Byzantines were two global powers in ancient times. Medicine was well organized in the official Sassanid system. Hospitals, medical centers, and universities were developed throughout Persia during their reign. This study brings to light for the first time the era's medical views on the heart and blood, based on extant Sassanid Pahlavimanuscripts and documents. Although these documents are non-medical texts (because Sassanid medical texts were destroyed in attacks on Iran by neighboring powers, such as Alexander the Macedonian and leaders of the Arab Empire throughout history), some novel theories on the history of cardiology can be foundamong them. Physicians of that time made a preliminary description of pulmonary circulation. They knew about the role of blood circulation in feeding bodily organs. They believed that blood is a factor for spreading infection because of its invisible monsters (divan). Their beliefs can be considered as the first theories on infection due to an external living factor, today known as the microbe. Other Sassanid beliefs and findings about the heart and blood in medicine are described in this review.
萨珊王朝（公元224-637）统治着世界上最有影响力的地区之一。他们与罗马和后来的拜占庭人是当时世界上的两大强权。萨珊王朝的官方系统对药品的管理颇为精细。在该王朝统治时，医院，卫生系统和大学欣欣向荣。该文章基于萨珊巴列维手稿和文件，揭示了萨珊波斯人对血液心脏的理解。即使这些文件不是医疗记录（因为大部分的医疗记录毁于战火，如亚历山大大帝和阿拉伯皇帝的征服），一些记录心脏病史理论的小说可以支持假说。当时的外科医生认为血液供给营养给全身器官。他们认为感染是因为妖魔入侵了血液。他们的观点可以认为是感染的第一个理论，现在被认为是微生物的原因。本文还将描述一些萨珊波斯人的关于血液和心脏的理论和成果

The history of medicine in Persia (Iran) dates back thousands of years [1]. This area, from the beginning of history until 637 AD when Muslim Arabs conquered Persia and the Sassanid dynasty was overthrown, was known as Ancient Persia [2]. Zoroastrianism was the official religion of Persians for at least the last 1000 years of that period [3]. Three main Persian empires in ancient times were the Achaemenid (550–330 BC), Parthian (247 BC–224 AD), and Sassanid (224–637 AD) dynasties [1]. Although their well-organized civilization and global empires are well-known, unfortunately the existing information about their medical sciences is minimal, because most of their scientific documents were destroyed in invasions by neighboring rulers, such as Alexander of Macedonia and leaders of the Arab Empire. This lack of knowledge is also due to the weakness of current investigations [4]. Some recent studies, mostly of archeological findings and mythic, religious, and literary documents, show us some of the advanced aspects of the medical sciences in ancient Persia in such areas as pharmacy [5,6], surgery [7], psychiatry [8], gynecology [9,10], patients' rights [11], etc.
医药在波斯的历史可以追溯到几千年前 [1]。这个地区一直被称为古波斯[2]，从文明伊始，直到穆斯林阿拉伯人击败萨珊王朝（637AD）。在一千年中，沃教一直是古波斯的国教[3]。波斯人的三大王朝分别为阿契美尼德（ 550-330 BC ） ，帕提亚（公元前247 - 公元224 ） ，和萨珊王朝（公元224-637 ）朝代[ 1 ] 。比起他们创造的高度发达的文明，他们的医药鲜为人知。不幸的是，他们的医药留存下来的资料极少，因为大多数的资料都被附近的征服者摧毁了，例如亚历山大征服和阿拉伯入侵。现有知识的匮乏同样因为针对他们的研究极少。
最近的一些研究主要的考古发现和神话，宗教，和文学的文档，向我们展示了一些先进的古代波斯的医学科学领域的方面，，例如药房[5,6] ，手术[7] ，精神病学[ 8 ] ，妇科[9,10] ，病人的权利[11]等等。

Although the influence of Persian scientists of the Islamic era, such as Avicenna [12–16], Rhazes [17,18], Haly Abbas [19], and Akhawayni [20–22], on the progress of cardiology is indisputable, no comprehensive investigation into cardiology in ancient Persia has been done until now. The current study brings to light the views of ancient Persians of the Sassanid period on the medical aspects of the heart and blood. The Sassanid period (Fig. 1) was one of the most important eras in global history; it had a great political and scientific influence on history.
虽然伊斯兰时代的波斯科学家，例如阿维森纳[12-16]，Rhazes[17,18]，Haly阿巴斯[19]，并Akhawayni [20〜22]，在心脏学上的贡献不可磨灭，萨珊时代的心脏学科上的造诣直到近代才被超越。我们的研究揭示了古波斯时代的对心脏和血液方面的研究。萨珊时代是在世界历史上重要的时代，它对历史拥有巨大的政治和科学影响力。

2. Sassanid era
Ardeshir I, son of Papak (180–242 AD), was the first king of the Sassanid dynasty who defeated Ardevan V, the last king of the Parthian empire, and established his kingdom and dynasty in 224 AD (Fig. 2) [23]. He and other kings of the Sassanid dynasty established their empire based on politics, military strength, and science [24]. They defeated the Romans and Byzantines several times in theMiddle East. Theworld was bipolar for several centuries; Romans comprised the Western Empire and Persians (Parthians and later Sassanids) constituted the Eastern Kingdom. These two empires were at war for centuries, and throughout their history, neither could ever completely defeat the other [25]. Some of the most famous and powerful Sassanid kings were Ardeshir I, Shapur I (215–270 AD) (Fig. 3), Shapur II (309–379 AD), Khosrau Anushirvan or Kasra (501–579 AD) (Fig. 4), and Khosrau Parviz (The Victorious) (570–628 AD) [26]. During the Sassanid era, the Persians enjoyed an advanced and well-organized official structure and government system. Later, in medieval times, the Arab Empire adopted Persia's official organization [24]. Finally,MuslimArab invaders defeated Yazdegerd III, the last Sassanid king, in 637 AD and ended the ancient Persian era [26]. Although the Sassanids had a religious regimen based on Zoroastrianism, they had free views on science. Religious views and racismwere forbidden in scientific centers and universities like Jondishapour [4]. Jondishapour University and Hospitalwas themost important scientific center in its time of the world. Scientists of any religion or nationality were free to learn and teach various fields of science there [27–29]. In 529 AD, seven philosophers of the Athenian school suffering under the hard fanatical limitations of Justinian (the Byzantium Emperor) escaped to Iran and asked Khosrau Anushirvan for refuge. The Persian king welcomed them and made them teachers in Jondishapour University. Pressured by Khosrau, Justinian eventually guaranteed the philosophers'
safety and freedom, and they returned to their country [24].
萨珊时代 ArdesshirI，Papak之子。他在224ad击败了Ardevan V帕提亚的末代皇帝建立了自己王朝和国家是萨珊的第一位国王。他和其他的萨珊王朝的统治者建立了立足于政治活动军事力量和科学知识为根基的帝国。他们多次在中东击败罗马和拜占庭。数个世纪里作为世间的双极罗马构成了西方帝国波斯建立了东方王国。这两个帝国数个世纪在战争着，贯穿了他们的历史。两者都不能彻底击败对方。一些最著名的和最有权力的萨珊国王像ArdeshirIShapur，ShapurII，Khosrau Anushirvan和Kasra以及Khosrau Parviz。在萨珊时代，波斯享有先进的有组织的官僚体系和政府组织。晚些时候的中世纪，阿拉伯帝国采用了波斯的官僚体系。最后在637ADmsl阿拉伯入侵者击败了YazdegerdIII，萨珊的末代君主，终结了古波斯时代。然而萨珊立足于琐罗亚斯德教的宗教式的养生方法。他们自由的科学观。宗教观念和种族主义禁止进入学术中心和像Jondishapour那样的大学。Jondishapour大学和医院是当时世界上最重要的学术中心。来自各种宗教和民族的科学家自由的学习和教授的科学殿堂。在529ad。七个来自希腊学院的哲学家受困于狂热的Justinian统治下（拜占庭的皇帝），逃到伊朗向Khosrau Anushirvan寻求庇护。波斯皇帝欢迎了他们让他们在Jondishapour大学担任教师。来自Khosrau的压力，Justinian终于保证了这些哲学家的安全和自由，他们随后返回了他们的国家

6. Some Sassanid mythological beliefs about the heart, its vessels,and blood
In Persian mythology, Keyumars was the first man.When he died; tin was created from his blood. Another story says that when a mythical holy cow died, the grape (Koodake Raz in Sassanid language)was created from his blood; therefore, ancient Persians believed that wine prepared from grapes is hematopoietic [41]. They also believed that each organ belongs to an angel. Vessels and blood belong to the angels Ordibehešt and Khordād, respectively. At the resurrection, God will rebuild blood of deaths fromwater according to the Bundahišn, a Sassanid Pahlavi manuscript [41]. The Shapurgan (or Shabuhragan) is amanuscript of the earlySassanid erawritten by Mani, the prophet of the Manichaean religion. Init,Maniwrites that inside people, there is a holy light that is captured inbones, nerves, and vessels by greed and lust. This lightwill be freed at theresurrection [42].
在波斯神话中Keyumars是第一个人，他死的时候，他的血创造了锡，另一个故事说一个圣牛死后，他的血创造了葡萄。所以古波斯人认为葡萄酒从葡萄中榨出来是造血。他们认为每个器官都有天使守护，血管和血液属于 Ordibehešt and Khordād。复活后神会把水变成死亡之血。该Shapurgan（或Shabuhragan）是早期萨珊时代写的玛尼，摩尼教宗教的先知的手稿。起初，摩尼写道，里面的人，有是受贪婪和欲望捕获在骨骼，神经，血管和一个圣洁的光芒。光芒将被释放在复活的时候[42]。

Ancient Persians believed in microcosm, the concept that a human is a small version of the whole world. According to the Bundahišn, vessels and blood in the human body are equal to rivers and river water, respectively [41]. This comparison shows that the ancient Persians knew about blood circulation. In Vazidegihā-i-Zādisparam, another Pahlavi document,blood circulation is mentioned directly in the explanation ofElysian's body organs [29]. In chapter 30 of this book, we can see a preliminary theory of pulmonary circulation. It is noted that blood goes tothe liver and then to the heart where it causes heart palpitations.Then, it goes to the lung and comes back again to the heart [29,36].
古代波斯人相信缩影理论，他们认为人就是世界的缩影，由Bundahišn,可知，血管和血液相当于世界上的江河和水。这个比喻告诉我们波斯人知道血液循环。在Vazidegihā-i-Zādisparam,另一本pahlavi手稿中，血液循环直接在Elysian's的器官学说中提到，在该书30章，我们可以看到初级的肺循环理论。在上面提到血液进入肝脏然后进入心脏，心悸的病原。然后血液进入肺脏然后回到心脏。

Sassanids believed the liver to be the site of hematopoiesis. In the Bundahišn, it is mentioned that after food is digested, the good parts will be absorbed by the blood to feed the body's organs by circulation, and scum will be excreted via stool [36]. According to the Pahlavi texts, the liver was an important organ in blood preparation and circulation: “Each morning, blood goes from the liver to the brain and then comes back to the liver. Some amount of it flows in the vessels and the body power is caused by it.” [41]. It was also believed that the wetness in the eyes, nose, ears, and mouth is supplied by the blood in the head [36,41].
萨珊人相信肝有造血功能。在 Bundahišn中提到，当食物消化后，其有用部分将被吸收进血液，通过血液循环来供给器官，根据Pahlavi记载，肝是一个重要的血液循环和血液制造器官，“每个早上血液从肝到大脑然后再返回。一部分血液流进血管来提供能量。”人们相信口，眼，鼻的湿润是血液的供给

Blood and embryology
In contrast to the Greeks and Romans, Persians had correct information about the woman's menstrual cycle and the stages of fertility [10]. They believed pregnancy is due to the fertilization of the gametes of a man and woman [10,41]. The first report of uterine contractions during childbirth is written in the preface of the book Kalila and Dimna, written by Borzuyeh (a Sassanid physician) [43]. Persians believed that the creation of each organ belongs to the gametes of aman or a woman. Itwas believed that, according to the Bundahišn, blood is raised from the mother's gamete during pregnancy [41].
通过和希腊和罗马人的接触，波斯人纠正了其对女性月经和生育能力的观点。他们认为怀孕是因为男人和女人的配子结合。Kalila和Dimna记载着世界上第一份关于宫缩分娩过程的报告。该报告出自Borzuyeh（萨珊医师）之手、波斯人认为器官的创造来自于男人和女人的配子。从Borzuyeh记载来看，人们认为血液是来自于母亲的配子。

9. Heart and blood: health and treatment
Persians believed that the animal's spirit and mass are located in the heart; therefore, good nutrition and diet to support the heart are critical [44]. The medical paradigm of the Sassanid era was humoral medicine. They believed that an imbalance in any humor is harmful, except increasing blood humor, because the body always needs blood [44]. Persian documents mention that the quality of blood is related to the vital force of the human. In severe illnesses, if blood has enough vital forces, a physician can prescribe drugs and treat the patient [24].
Although indulgence and binging were prohibited by the Zoroastrian's beliefs, ancient Persians knew grape wine as being hematopoietic and the best drug for keeping the blood healthy [29,41].
波斯人认为动物的灵魂和重要部位都在心脏。因此，良好的营养和饮食，以支持心脏是至关重要的[44]。萨珊波斯的医疗科学是体液医学。他们认为任何一种体液不平衡都是有害的，特别是血液的上升。因为身体永远需要血液。波斯官方文件提到血液质量是关系到人的重要力量。在对付严重疾病中，如果血液拥有足够活力，药师可以开药治疗。
虽然纵欲和暴食是在沃教中被禁止的，古波斯人知道葡萄酒是造血和保持血液活力的良药

The role of blood in the spread of diseases through the body was known by the Sassanid physicians. The importance of keeping blood healthy and its role in health were mentioned in Pahlavi books [30]. Dating back to the Achaemenid empire (550–330 BC), the writings of Herodotus, the Greek historian known as the father of history, mentioned that, in contrast to the Greeks, Persians used clean bandages and myrrh balm to treat injuries and bleedings, because they knew that impurity can cause infection and putrefaction [45]. In Sassanid documents, it is mentioned that blood is polluted and unclean. In a Pahlavi religious document, namely “The Ravāyat of Ādur-Farrōbay ī Farroxzādān”, it is frequently emphasized that anything polluted by blood cannot be eaten. For example, if while cooking bread or drinking a beverage, the food or drink becomes bloody because of a hand injury, consuming it is a sin and strictly prohibited. If a coweats blood-polluted straw or bites a human and swallows his/her blood, its meat, milk, or any related products are forbidden to eat for one year. The washing of bloody injuries, even those in the mouth, was ordered. Such orders were also given for wet and purulent wounds [46]. Inter course with women on menses was forbidden and considered a major sin [30,46], because it can harm both the body and the soul [47].
萨珊人第一个发现在疾病蔓延至整个身体的过程中血液扮演的角色。追溯到阿契美尼德帝国时期，Herodotus的时代，希腊著名历史学家，提到相比于希腊，波斯人用干净的绷带和没药唇膏来治疗受伤和出血，因为他们知道该杂质可引起感染和腐烂[ 45 ] 。在一份萨珊文件中提到血液被污染和不洁。在一份叫“The Ravāyat of Ādur-Farrōbay ī Farroxzādān”的Pahlavi 圣谕中多次强调任何被血液污染的食物都不能吃。例如烤面包和做饮料时手划伤而使食物被污染是一种罪过，而且被严厉禁止。如果一个奶牛吃了被血污染的草或者咬了人并且咽下了他的血，这个奶牛的肉，奶，以及其他相关的产品在一年内不可食用。清洗流血的伤口，即使在嘴里都是必须的。这项要求同样适用于潮湿和化脓的伤口。与女性在月经期性交是禁止的，并且被认为是大罪[ 30,46 ] ，因为它会损害身体和灵魂[47] 。

Ancient Persians believed that, when a person dies, Divans (invisible monsters) enter into the body, multiply and increase, and cause putrefaction. They can also be found in blood, especially menstruation blood, and semen and result fromtheir uncleanness [48]. These can be considered the first theories of infection due to an external living factor now known as the microbe.
古代的波斯人认为，当一个人去世后，Divans（无形的怪物）进入体内，繁殖和增加，并导致腐败。 它们也可以在血液中被发现，尤其是月经血，和精液，和其引起的不洁物。这可以认为是第一个由于生活现象而提出的感染理论，现在被叫做微生物。

The Sassanid Empire had a well-organized and developed official system of medicine that greatly influenced the progress of medical sciences. The Sassanids had a strong relationship with other civilizations, such as Rome and India. It is surmised that science knowledge was transferred between them, especially in important medical centers such as Jondishapour. Unfortunately, nomedical documents of the Sassanids are accessible today. The current investigationwas based on nonmedical documents, yetwe can see some important notes about cardiovascular concepts reflected in their extant documents. This reviewis the first attempt to shed light on the Sassanids' knowledge about the heart and blood inmedicine. It seems that they had novel theories in this field, such as their preliminary theories on the role of blood in spreading infection, feeding bodily organs by blood, their description of pulmonary circulation, and their beliefs about infection occurring because of an external living factor. This data can help us find howcardiological concepts progressed through history. Obviously, finding new archeological documents andmanuscripts as well as deeper investigations is needed to clarify the Sassanids' knowledge of cardiology more than today.
萨珊帝国有一个良好的组织和官方发展药系统，它极大地影响了医学科学的进步。萨珊曾与其他文明的有很多密切关系，如罗马和印度。据推测，科学知识在他们之间流传，特别是在重要的医疗中心如Jondishapour 。遗憾的是没有医疗文件流传到现世。但是即使基于一些非医疗的文件，我们同样能看到一些关于心血管的重要注意事项概念，反映在他们的现存文件。本文是第一次揭示萨珊王朝的关于血液与心脏的医药知识。看来，他们已经在这个领域得到了许多新理论，如他们对血液传播感染中的作用的初步理论，血液供给身体器官养分，肺循环的描述，以及他们对发生感染的源于生活的理解。这些数据可以帮助我们找到如何心血管病的概念在历史上的发展。

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