“Forty Drops of Blood Make One Drop of Semen”

Variants of the well-known folk-medical aphorism “forty drops of blood make one drop of semen” have been widely reported in the anglophone medical–anthropological literature on dhat syndrome (dhātu doṣa) since the mid-1950s. Routinely cited as summing up the distressing ethnophysiology behind said syndrome, the conveyed idea of high cost of fluid loss has been widely regarded as quintessentially Indian or “Hindu,” and widely associated with ancient Ayurveda, although it has also been recorded among Muslim Indians/Indian Muslims. It is not obvious where this dictum originated, however. Dhat syndrome experts typically either identify it as a prevalent “myth” or “belief,” or too generally refer to Vedic/Ayurvedic texts of old. Sudhir Kakar (1938–2024) associated it with “Indian metaphysical physiology,” while N.N. Wig (1930–2018) only generally noted that “This belief system can be traced back to the holy scriptures,” for instance.1^,2 Wig wrote elsewhere that “It is a fairly widespread belief that 40 drops of blood are needed for one drop of marrow, and 40 drops of marrow for one drop of semen; which in effect means that one drop of semen represents 1600 drops of blood”—a considerably more distressing idea.3 Reported variants are many and reportedly regional. For instance, a 1971 study documented “a common belief” being rather than “100 drops of blood are used to make one drop of fat, and that 100 drops of fat are needed to make one drop of semen.”4 Another author spoke of “one drop of semen to seven (or forty, depending on area) drops of blood.”5 A female analogy, of more recent attestation, is the idea that “from 100 drops of blood only one drop of safed panni [i.e., vaginal discharge] is formed.”6

Belief in these aphorisms is often mentioned but rarely studied, however. A 2007 study reported on the prevalence of the male “40 drops” concept in Bangalore medium college students: 18.7% of boys agreed, 62.1% were “not sure.”7 I have not seen other quantitative approaches.

The idea of a cascade of transformations—with food, blood and semen among the consecutive steps—is common to ancient Western, ancient Chinese, and ancient Indian physiology. However, mention of an exchange factor pertinent to one or all steps does not seem to occur in the Carakasamhitā, Suśrutasamhitā, Bhela-samhitā, Aṣṭāṅgahrdayasamhitā, Aṣṭāṅgasaṅgraha, or Kāma-sūtra. The first two mentioned texts notably do discuss sukrameha (“spermaturia,” “seminal diabetes”), an arguable forerunner for the late nineteenth-century disorder called dhātu-dourbalya. Thus, in 1983, Edwards characterized the “40 drops” concept as a folkloric elaboration of the transformation-of-substance theory found in the Suśrutasamhitā.8

This leaves the questions of the aphorism’s dating and dissemination. One of the earliest medical–anthropological mentions in the Indian context appears in a work by Mussoorie-born Morris Carstairs, who noted that all of his informants presenting with sexual anxiety in the early 1950s, “in different degrees of complexity according to their education” related to the idea that “from every 40 drops of blood one drop of semen is laboriously formed.”9 Various anglophone Indian texts seem to confirm this. The earliest mention in India I could locate is one in a health guide by Jamnagar pharmacist Vaidya Shastri Manishankar Govindji (Manicaṅkar Kōvintaji) first published in 1903, intended to push pills combating “debility consequent on onanism” and “spermatorrhoea” (the use of two Western terms is notable).10 The aphorism also shows up in later materials written by yoga gurus. A 1939 text by Swami Sivananda (1887–1963) entitled Yogic Home Exercises interestedly asserted a difference of opinion: “One drop of semen is manufactured out of 40 drops of blood according to medical science. According to the Ayurveda, it is elaborated out of 80 drops of blood.” A 1960s anthropologist confirmed the latter view for the Buddhist Sinhalese (present-day Sri Lanka): “Semen (kere or dhatu) is eighty drops of blood.”11 (Later anthropologists, including Gananath Obeyesekere, mention the number of sixty).

Avicenna

Aphoristic allusions of this variety were well-known even in vernacular European medical works of the sixteenth century, via Avicenna (Ibn Sīnā, c.980–1037 CE), specifically his Book on Animals (Ketāb al-ḥayawān, c.1027). In it, Avicenna attempted to update Aristotle’s biology with Galen’s. Michael Scot’s translation (finalized c.1215 and first printed c.1495) has the following: “And when a man loses semen he becomes quite pale and his body is weakened more than if forty times as much blood were to flow from it” (“Et quando de homine exit sperma multum discoloratum et debilitatur suum corpus magis q[uam] si quadragies exiret de suo corpore sanguis tantus […]”).12 The passage was widely disseminated via a paraphrase in Albertus Magnus’ On Animals (finalized during the 1360s, first printed in 1476), as well as via minor texts, examples being the anonymous thirteenth-century tract Questiones de coitu, and Giacomo Albini’s early fourteenth-century De sanitatis custodia.13^-15

The early modern dissemination of the aphorism was widespread but not unproblematic. In some sources, attribution is either missing or incorrect. Franciscan Servasanctus of Faenza (d. c.1300) already misattributed it to Galen, for instance.16 It was an uncredited aphorism in Joannes Diurius’ Scrinium medicine (1519), a book often cited as a source.17 Most European vernacular languages have attestations before the end of the sixteenth century. An early English mention sounds as follows (the “s” is a “long s”): “And Auicen in his boke De Animalib. sayth: If seede passe from vs aboue natures measure, it doth hurt vs more, then if forty times as much blood were auoided.”18 An earlier English translation of a French work on the plague advanced the same reference (“…for euerye suche excesse [‘excesse of women’] weakeneth more the body, then yf ye shulde be let blood .xl. tymes somuch as wytnesseth Auicenna…”).19 The original French, interestingly, had made a similar argument but not this precise reference, and speaks rather of “[more than] one bloodletting” (q[ue] ne seroit une saignee).20 One encounters the reference in French as well in the 1539 translation of the work of Parisian scholastic Bartholomaeus Anglicus (d.1272),21 and subsequently in well-read medical works including by Nicolas de Nancel22 and André du Laurens,23 a 1578 work on marriage,24 and a scientific section in a 1616 work on chastity by Belgian Jesuit Antoine de Balinghem (1571–1630),25 among numerous other texts.26^,27 Gioseffo Daciano (fl.1576), likewise in a work on the plague, similarly opined that the toll of coitus was 40 times the bloodletting amount (“la vacuazione fatta per un coito piùnoce et più indebolisce il corpoche se quaranta volte tanta quantità di sangue li fussi dalla vena estratto”: “the evacuation caused by intercourse is more harmful, and weakens the body more, than if forty times the quantity of blood were extracted from the vein”).28

This “very Hindu” wisdom, in other words, was ubiquitously recognized as authoritative Arab lore across early modern Europe. The number 40 has Cur’anic connotations of “full maturity”; Avicenna concluded that Aristotle’s Metaphysics remained prohibitively opaque after “reading it 40 times,” in other words, a substantive enough number. The blood-semen exchange rate was, moreover, widely disputed, perhaps already in premodern Europe. The Salernitan Questions (c.1200) asked, “Why is a man more weakened by doubled [i.e., repeated] intercourse than in the letting of a single pound of blood?” (“Queritur quare aliquis magis debilitatur in duplicato coitu quam in emissione unius libre [i.e., librae] sanguinis”; the libra was twelve unciae or ounces).

During the seventeenth century, attributions became more uncertain and often absent. According to Reinier de Graaf (to whom the Graafian follicle is credited), for instance, “Some even think that a single drachm of semen is the equivalent of twenty of blood.”29 Perhaps the best-known favorable mention of the aphorism is that by Samuel-Auguste Tissot, the great Swiss anti-masturbation authority. Psychiatrist–anthropologist Alain Bottéro (1954–2014) recorded his puzzlement over this mention in a footnote to a 1991 article on Indian concepts of semen loss: “A pure coincidence?”30 The missing link is clearly Avicenna, and the puzzlement arose in Tissot’s referencing. In his 1758 Latin tract, Tissot originally cited Galen as the authority on “40 drops” (“…ut, monente jam GALENO, semi uncia amissa majorem viribus inferat labem, quam quadraginta unciarum sanguinis detractio”: “…so that, as GALEN has already warned, the loss of half an ounce [of semen] inflicts a greater damage on the body than the loss of forty ounces of blood”).31 In the expanded and revised 1760 French edition, however, he reconsidered his sources and now ascribed the wisdom to “Doctors of all eras” (“…les Medecins de tous les siecles ont cru unanimément, que la perte d’un once de cette humeur [i.e., semen] affoiblissoit plus, que celle de quarante onces de sang”: “…Doctors of all eras [lit.: centuries] have unanimously believed that the loss of an ounce of this humor [i.e., semen] weakens more than that of forty ounces of blood”).32 Often with little interest in its origin, the aphorism went on to be widely exploited in the European masturbation, spermatorrhea (semen loss), purity, and chastity literature of the later eighteenth and nineteenth centuries. During the nineteenth century, these sources increasingly ranged from quack advertisements to health guides of the “family physician” variety, suggesting ongoing popularization as well as growing medical disreputability. Leading physiologist Albrecht von Haller (1708–1777) was notably skeptical of the wisdom of “the Arabs” at this point: weakness arose more from the neurological fallout from orgasm than the quantity of semen lost, he opined.33

As for a bit of context, comparable aphorisms were also widely disputed in this timeframe. Examples include “Man is all semen” (“totus homo semen est”), attributed to Jean Fernel (1497–1558), and Van Helmont’s 1648 opinion that “by reason of the womb alone, a Woman is that which she is.” Like Avicenna, Van Helmont here contributed to an ongoing, often loyal, reception of the ancients and various contemporaries agreed about uterine hegemony. For instance, Johannes Heurnius (born Jan van Heurne, 1543–1601) had earlier written: “Muliebritas est in mensibus” (Femininity resides in the menstrual blood), and ultimately, “Fundamentum itaque naturæ muliebris est vterus” (The womb is the foundation of female nature).34 Pierre Petit’s (1617–1687) commentaries on Aretaeus of Cappadocia (edition supervised by Boerhaave) cited concurring passages, apropos one of Aretaeus, by Hippocrates, Galen, and Charles IX’s physician Louis Duret (1527–1586).35 Van Helmont’s opinion was notably turned into an aphorism in 1800 by Charles-Louis Dumas (1765–1813) and subsequently emended by various people in favor of the ovaries. One of these emendations is that of English obstetrician James Blundell (1790–1878), a University of Edinburgh Medical School alumnus better known for his first description of a blood transfusion (in 1829). Blundell interestingly also misattributed the original phrase, to Van Helmont’s intellectual predecessor Paracelsus:

If the ovaries exist in perfection, the womanly changes occur, and to omit the developement [old spelling] of the external system, the hips spread, the bosom swells, and the charms and graces which embellish the sex are found to gather about the whole person; the mind also, from unknown causes, undergoing that consentaneous change, whereby it becomes not insensible to corresponding desire. From the ovaries, as their centre, all these effects are emanating, and their manifestation is the best proof that these important organs exist. Propter sola ovaria mulier est quod est [A woman is what she is solely because of her ovaries]; to the maxim of Paracelsus, thus modified, I heartily assent.36

To return to our present puzzle: it remains to be established whether Avicenna may have been amalgamating Greek and Indian wisdom. He was clearly focused on the former, but both were available to him in Arabic.37 Avicenna’s Shifā’, presumptively including Al-Ḥ ayawān, made it to India early on in manuscript form.38 The aphorism likely resonated significantly over the centuries, resulting, at some point, in its popularization by brahmacharya and yoga proponents, perhaps primarily as relayed in much later European sources. European modern medicine evidences an amalgamation of ancient–medieval aphoristic ideas about semen derived in particular from Hippocrates and Avicenna and modern concepts of semen resorption. In India we may be looking at even more intricate colonial and nationalist amalgamations of Western and Eastern lore.39 As seen, our aphorism was current in early twentieth-century Western texts on continence as well as anglophone advertisements of nostrums by contemporaneous Ayurvedic druggists treating diseases identified by their Western name, “spermatorrhea.”

Implications

More research seems indicated here, by both historians and sociologists of health. With regard to the dissemination of aphoristic lore probed above, historians will be interested in probing the Asian, colonial-era reception of Tissot (“onanism”) and of Claude François Lallemand (“spermatorrhea”), as well as the reception of European proto-endocrinological theories of semen, and ultimately of endocrinology. Elucidating these subjects should be helpful in assessing the perhaps pan-Asian amalgamation of Eastern and Western sexual physiology (and when it comes to “dhat syndrome,” medical psychology) before the mid-twentieth century. China presents a case study perhaps very comparable to the Indian experience. A mid-nineteenth-century Chinese translator of Christoph Wilhelm Friedrich Hufeland’s Makrobiotik (1797) reportedly added that, in his opinion, “one coitus equals the loss of six ounces of blood, and one ejaculation equals the loss of six times more blood than coitus.”40 Much later, self-proclaimed sexologist Chai Fuyuan asserted the classic “40 drops” thesis in his 1928 Xingxue ABC (ABC of Sexology). He reportedly “quoted modern Western doctors”—yet “to broach the continuing relevance” of his views “stemming from traditional Daoist conceptions of sexual health and longevity.”41 Tissot was not far off the mark in saying that wisdom of this kind was held by “Doctors of all eras.”

Second, the current Dhat syndrome literature does not excel in studies pinpointing how and where popular knowledge concerning semen is acquired, discussed, or contested. During the past quarter-century, Internet access has revolutionized and internationalized access to sexual lore as well as sex research. The consequences are of clear relevance to sexual health professionals globally. Of particular interest are global differences and convergences in how sexual lore and anxieties are capitalized on in marketing strategies, a perennial concern in the history of Dhat syndrome (India had 886 million active internet users in 2024).39 For instance, shilajit, ashwagandha (Indian ginseng), and gokshura are presently sold in India as purported remedies for “spermatorrhea/dhat.” But in the Western world they are sold as purported testosterone (“hormonal balance”) and libido (“sexual function”) boosters. How young adults interpret these advertised notions of loss, unbalance, and dysfunction, is unclear. Such knowledge will benefit general sex-educational efforts in the present Internet age. Moreover, it may have a practical local use in psychoeducational approaches to Dhat syndrome. Psychoeducation in this applied sense has been taken to mean “imparting knowledge about the nature of Dhat syndrome, its cultural context, and the distinction between myths and medical facts.”42 This may include history lessons, provided their delivery is culture-sensitive.