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Volume 32, Number 10—October 2026

Historical Review

Variolation Techniques, Medical Explanations, and Dissemination in Late Imperial China

Linyu Guan1, Shenjia Gu1, Yunhai Pan, Lance E. Rodewald, and Chuanxi FuComments to Author 
Author affiliation: Zhejiang Chinese Medical University, Hangzhou, China (L. Guan, S. Gu, Y. Pan, C. Fu); Chinese Center for Disease Control and Prevention, Beijing, China (L.E. Rodewald)

Main Article

Figure 2

Logical progression underlying intranasal variolation in study of variolation techniques, medical explanations, and dissemination in late Imperial China. Schematic outlines the cognitive evolution of smallpox in traditional Chinese medicine that gave rise to variolation, spanning from the introduction of smallpox (25–55 CE) to recognition of its transmissibility, formulation of fetal toxin etiology, and eventual formalization of intranasal variolation. Developmental trajectory underpins the indigenous originality of variolation in China. Screenshots of ancient medical texts from China are shown at the top, sequentially sourced from references (21), (22), (23), and (7). Direct excerpts from original ancient medical text are outlined in red, serving as the primary source supporting the summary descriptions at the bottom. Schematic is only an analytical simplification and does not imply a unidirectional or deterministic progression.

Figure 2. Logical progression underlying intranasal variolation in study of variolation techniques, medical explanations, and dissemination in late Imperial China. Schematic outlines the cognitive evolution of smallpox in traditional Chinese medicine that gave rise to variolation, spanning from the introduction of smallpox (25–55 CE) to recognition of its transmissibility, formulation of fetal toxin etiology, and eventual formalization of intranasal variolation. Developmental trajectory underpins the indigenous originality of variolation in China. Screenshots of ancient medical texts from China are shown at the top, sequentially sourced from references (21), (22), (23), and (7). Direct excerpts from original ancient medical text are outlined in red, serving as the primary source supporting the summary descriptions at the bottom. Schematic is only an analytical simplification and does not imply a unidirectional or deterministic progression.

Main Article

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1These first authors contributed equally to this article.

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