How was smallpox variolation performed in China?

In China, the historical practice of variolation against smallpox was primarily performed through a procedure known as nasal insufflation.1

According to accounts dating back to the 16th century, physicians would collect scabs from individuals suffering from a mild form of the disease. These scabs were dried and ground into a fine powder, which was then blown through a pipe into the patient’s nostrils. This method was believed to have been introduced to China by a holy physician or a spiritual figure living on a mountain, and it successfully reduced mortality rates significantly.12

While this early form of inoculation helped protect individuals, it carried the risk of causing a full-blown infection. It was eventually superseded by vaccination using cowpox, a safer technique discovered by Edward Jenner that became the foundation of modern immunization efforts.1