Why Did Ancient Emperors Live So Short? Doctor Luo Dalun Explains Why Imperial Physicians Shouldn’t Take the Blame — the Real Reasons Are Social

Opening: People always challenge Chinese medicine with “the emperors died young”

People often say to me: “The imperial physicians of ancient times were highly skilled, right? Yet the emperors all lived very short lives. Doesn’t that prove the imperial physicians — and Chinese medicine itself — weren’t very good?”

💬 Note from Doctor Luo: Many friends have asked me this question. I used to work in medical history — I studied ancient Chinese medicine specifically, so I know a fair amount about this subject. Today let’s talk about why ancient emperors so often died young. I’ll mainly use the Qing dynasty emperors as examples. My conclusion is this: this is a sociological problem, and it doesn’t have much to do with the skill of the imperial physicians. Let’s go through it point by point.

Part One: Why did the founding emperors live long? Horseback emperors versus pampered heirs

If you line up the lifespans of the emperors and their children, you’ll notice something: at the start of the Qing dynasty, the lifespans were longer; the later you go, the shorter they get, generation after generation. This pattern appears in other dynasties too. Why?

💬 Note from Doctor Luo: The first important reason is exercise. Founding emperors were usually “horseback emperors” — they rode horses, shot arrows, led troops into battle, and were extremely active. Their physiques were good and their lifespans relatively long. Later generations? They were increasingly pampered and waited on hand and foot; they no longer fought wars or opened new territory, and the royal sons’ bodies got worse and worse. Some people say, “Ah, the Qing dynasty’s fortune had run out.” It’s not that mystical — it’s a very ordinary reason: lack of exercise.

Part Two: 120 dishes per meal — how rich food ruined their health

The second reason for the short royal lifespans is usually diet.

💬 Note from Doctor Luo: A great deal of research now shows that the more you eat, the more your lifespan suffers. Foreign scientists ran experiments with mice: one group was fed extremely well, always full — those mice had short lifespans and became fat, bloated, and unwilling to move. Another group was fed less — just slightly hungry but not starving — and those mice lived exceptionally long. This is backed by animal experiments: eating too well is not a good thing.

So what was royal dining like? Rich, fatty, sweet delicacies (fei gan hou wei). According to Qing dynasty regulations, how many dishes was the emperor supposed to have at each meal? 120 dishes — that was the standard rule. Frugal emperors cut back and still ended up with several dozen dishes. An emperor like Qianlong, who understood something about health, added bird’s nest to his dishes and so on — his lifespan was excellent; he was the longest-lived of all the emperors. The others, who knew nothing about this and only cared about good flavor? That went badly. By the late Qing, the rules grew ever more elaborate, the dishes multiplied, and by Cixi’s time, even 120 dishes might not be enough.

💬 Note from Doctor Luo: The problem is — were all 120 dishes cooked fresh? No. The palace ran on procedures and workflows; cooking everything fresh would have been impossible. The dishes the emperor loved were made fresh for him; some dishes were just for show — kept simmering on the stoves, brought out the moment the emperor announced his meal, placed far away on the table, never touched. Some dishes everyone knew would not be eaten were simply reheated meal after meal. The Guangxu Emperor himself had little authority, so only the few dishes nearest to him were fresh; the ones far away were brought back up from previous meals over and over. So was eating 120 dishes actually good? Not necessarily. The imperial diet was not as health-friendly as we imagine — it often actively damaged health. Could the imperial physicians control any of this? No. There was a dedicated Imperial Kitchen with its own palace rules, and the physicians couldn’t get a word in edgewise.

Part Three: The Zhengde and Xianfeng emperors — physicians could treat the illness, but not the lifestyle

The third factor is lifestyle habits — and the emperor’s lifestyle was beyond any physician’s reach.

💬 Note from Doctor Luo: Take the Ming dynasty’s Zhengde Emperor, for example. He loved to play. He built the Leopard House (Bao Fang) in the suburbs of Beijing — all kinds of amusement venues stocked with tigers, leopards, and rare animals — and he gathered beauties from everywhere. According to the records, his collection was extraordinarily broad: golden-haired, blue-eyed beauties from the Western Regions, beauties from Korea — all summoned, for day-and-night pleasure. Think about it, friends: for a man from the Central Plains, one golden-haired Western beauty is probably manageable; but ten, dozens, a hundred? That body is finished. The imperial physicians wore themselves out trying to treat him.

Who was the Zhengde Emperor’s imperial physician at the time? The famous medical scholar Xue Ji (Xue Lizhai), who was the director of the Imperial Medical Academy (Tai Yi Yuan) — in other words, its dean. Xue Ji wrote in his own notes that attending and serving the emperor exhausted him so badly that he fell ill and had to treat himself.

💬 Note from Doctor Luo: Why was he so exhausted? Because the emperor wouldn’t listen. You say, “Your Majesty, you should abstain from sexual indulgence.” What does the emperor say? “What are you doing? Don’t you want to live?” He goes right back to playing, and when he’s done, he tells you: “Prescribe me some aphrodisiac tonic to strengthen the kidneys.” Do you prescribe it or not? If you don’t, you can’t just watch him die; and if you do, he only grows bolder. So being an imperial physician was extraordinarily hard — Xue Ji ruined his own mood and his own health, and had to write prescriptions to fix himself. Where is there justice in that?

The Qing dynasty’s Xianfeng Emperor was the same — he died at 31. Xianfeng had a weak personality, and he reigned during a time of internal disorder and external threats — the Opium War — so he was deeply troubled inside. How did he relieve his worries? One way was drinking; the other was collecting beauties, and he especially favored Han Chinese women. Qing imperial marriages normally selected Manchu or Mongolian women, but Xianfeng loved Han beauties, so he sent eunuchs out to find them and even went to Jiangnan to collect them. In the company of all these beauties, his body deteriorated, and before he died he was already extremely weak, coughing up blood constantly.

💬 Note from Doctor Luo: What does all this have to do with? Wine and lust. Things like this really have little connection to the imperial physicians. Would you dare tell the emperor, “The three palaces and six courtyards are inappropriate — you should be monogamous”? Say that and you’re asking to die. So the imperial physician’s work was essentially this: on a piece of rotting wood, patch and mend as best you can, so it rots a little more slowly. Within the overall environment, the physician’s work was extremely limited.

Part Four: Consanguineous marriage and incest — the genetic problem the Manchu royal family could not escape

What else shortened the Qing royal lifespans? Consanguineous marriage and incest — a subject far beyond what we modern people can imagine.

💬 Note from Doctor Luo: Before entering the pass, the Manchus were nomadic tribes, and after entering the pass they still kept many nomadic customs. In those days, women were regarded as property. The nomadic tribes had a custom: when a chief died, his many wives were inherited by his son or divided among his brothers. Today this seems beyond belief, but in the ancient nomadic tribes of China it was normal — the Xiongnu had this custom. This was more pronounced in the early Qing before entering the pass; after entering the pass and absorbing Han culture, it was somewhat adjusted.

The Qing emperors had another problem: political marriage — whom you married was a way of winning over her tribe. Take Hong Taiji: his first five consorts, all five women, came from a single Mongol tribe — the Borjigit family. What was the relationship among three of these consorts? Aunt and niece: the girl married Hong Taiji, and her aunt married him at the same time. A modern person finds this unacceptable, but to the ancients it was perfectly normal.

💬 Note from Doctor Luo: Another example: the Shunzhi Emperor took two wives, both daughters of his maternal uncles — in other words, his own cousins. Later, a grandniece of Empress Dowager Xiaozhuang also married Shunzhi — a member of the younger generation. We now know that consanguineous marriage causes genetic problems, so the children fell sick in very large numbers. This is one of the important reasons the Qing royal clan grew physically weaker as time went on. Could the physicians decide this? No, they couldn’t.

Part Five: Married at twelve or thirteen — the price of early marriage and early childbirth

The fifth reason is early marriage and early childbirth.

💬 Note from Doctor Luo: The girls of the royal family generally married at twelve or thirteen, sometimes even earlier — before the age of twelve. Hong Taiji once issued a personal decree on this: if a girl married before twelve, that was unacceptable and must be severely punished; she had to wait until twelve. Just think — in those days, that already counted as “late marriage.” Did everyone comply? No, they didn’t — Hong Taiji himself didn’t comply. His own daughters married extremely early: his eldest daughter, the Gulun Princess, married before she turned twelve; his second daughter married before she turned eleven; his fourteenth daughter married at just over nine.

(An aside: the marriage of an imperial princess is called “xia jia” — “marrying downward.” It has nothing to do with goods being taken off the shelf — it means she marries down, into a family below her rank.)

💬 Note from Doctor Luo: Early marriage necessarily brings early childbirth. The body is not yet formed — at nine or ten years old, when the body has not fully developed, giving birth is an extraordinarily severe assault on a woman. So why did the children of the royal clan so often fall ill at a young age, and why did some die at birth? Many people say it was the physicians’ lack of skill — it had nothing to do with the physicians. Generation after generation of consanguineous marriage and early childbirth inevitably produced poor physical quality, even congenital disease — none of it was something an imperial physician could intervene in.

Everyone knows the Shunzhi Emperor: he ascended the throne at six, had an empress from the start, and married very young — he fathered his first son at fourteen. Shunzhi lived only 23 years altogether; between the ages of 14 and 23, he fathered 8 sons and 6 daughters.

💬 Note from Doctor Luo: With such a young emperor matched with empresses and consorts who were also very young, none of their bodies fully grown — what was the quality of the children? I can tell you plainly: it was not good. The first son, born when the father was 14, lived only two months; the first daughter lived a year and seven months; the second son did all right, living to 50 — by the standards of the time that counted as long-lived; the second daughter lived to 32, reaching adulthood, which was decent; the third daughter died at just 5; the third son was the Kangxi Emperor, who lived to 69, a long life by the standards of the day; the fourth daughter died at 7, the fifth at 6… Overall, the quality of life was very poor, and it had a great deal to do with youthful early marriage and early childbirth. This was the custom of the royal clan at the time; it was simply not something the imperial physicians could intervene in. When children are born with low quality to begin with, no amount of treatment can easily fix it.

Part Six: Cixi’s death — a Wu Mei Wan prescription “reviewed to death” by the Grand Council

Besides all this, there is one more reason — prescribing for the emperor and empress was not simply a matter of medical skill; many complicated forces were at work.

💬 Note from Doctor Luo: How did Cixi actually die? She contracted severe diarrhea, drained herself until she was utterly weakened, and died from the weakness. The imperial physicians attending her did take her condition into account. One physician, Shi Huan, had just been recruited from outside — the Qing court believed all the famous physicians of the nation should be summoned to Beijing, and Shi Huan was one of the men brought in. When he arrived, he said: this should be treated with Wu Mei Wan (Mume Pill).

I have explained Wu Mei Wan before: it is extremely effective for diarrhea, especially the cold-heat complex (han re cuo za) — a condition of simultaneous cold and heat. The formula contains hot herbs — Fu Zi (aconite root), Gan Jiang (dried ginger), and so on — and also cold herbs — Huang Lian (Coptis), Huang Bai (Phellodendron bark), and so on. It regulates cold and heat together.

💬 Note from Doctor Luo: But when the prescription was submitted, the Grand Council (Jun Ji Chu) looked at it and said: this formula is extremely pungent and bitter; the medicinals are a bit fierce. Who is going to take responsibility for this? What if it goes wrong? So the prescription was passed around among the grand councilors, and no one would approve it. Do you understand now? The prescription for the emperor was not actually decided by the physicians — in the end, it was decided by the bureaucratic system. Everyone said, “This formula won’t do. We must write something milder, blander, something that can’t cause trouble, and submit that.” So they went through the motions and wrote a perfunctory formula. And Cixi died — she too was delayed and harmed by this bureaucratic system; she never got to take a good prescription.

Part Seven: Du Zhongjun comes to Beijing — even the best formula could not be carried through

At the time, the court summoned famous physicians from all over the country to Beijing to treat Cixi and Guangxu. In Jiangnan there was a doctor named Du Zhongjun — a man of great learning whose treatments were very effective. He was summoned to Beijing to attend the emperor and empress, and he later wrote a book recording the whole experience.

💬 Note from Doctor Luo: The moment he took Guangxu’s pulse, the emperor said: “You diagnose well. Write your prescriptions according to this approach — do not change it, and do not listen to anyone else.” In other words, he was told to stick to his own method and never let the bureaucrats alter the formula. But problems soon appeared. The physicians worked in shifts: two physicians took the pulse together one day, and the next day two different physicians took it. Du Zhongjun discovered that the consequence of this rotating system was: your formula was changed at once; it simply could not be carried through. He said of it himself: “We came to the capital to cure the emperor, full of hope that we would cure him and win great fame. Now it is clear we will win no fame at all — and not only no fame, we had better make sure nothing goes wrong.”

So he went to an official named Lu Runxiang — a man from a family of physicians whose father understood medicine. Lu himself had passed the imperial examinations as a zhuangyuan (the top scholar), and was an official in Beijing. Because of his zhuangyuan status the emperor valued him highly and often discussed medicine with him. Du Zhongjun said to Lu Runxiang: “Lord Lu, you understand medicine, and your family’s medical skill is superb. Tell me — is this any way to practice medicine? Treated like this, not only will the emperor never be cured, but I will be the one held responsible later. How can this be?”

💬 Note from Doctor Luo: How did Lu Runxiang answer him? “The palace rules have always been this way. When everyone sees patients, you just have to avoid causing trouble. Go in and take the pulse every day — that’s going through the motions. Don’t say any more about this matter — inside the palace, saying too much does you no good.” Do you see? This was a rigid, rotten management system; the imperial physicians simply could not display their talent. As for Du Zhongjun — he was actually present when Guangxu died, and it is a great pity that he never got to use his skill at all. Was the physician’s level poor? No, it wasn’t.

Part Eight: One dose for Yuan Shikai — the true skill of an imperial physician

Later, when the Republic of China was established, Yuan Shikai fell ill and summoned Du Zhongjun to Beijing, keeping him there for a year. At the time Yuan Shikai had stomach disease — very severe.

💬 Note from Doctor Luo: Du Zhongjun went up, gave one dose, and Yuan Shikai’s stomach ailment was basically resolved at once. Yuan Shikai found it miraculous: “My stomach problem is not something from a day or two. So many doctors have failed to cure it, I’ve seen all the Western doctors, nobody could do anything, and you solve it with a single dose.” So he kept Du Zhongjun at his side for a year and made him an official. In the end Du Zhongjun returned to practicing among the people, in Beijing.

Some of you may know Du Zhongjun’s descendant — she is the CCTV host Du Xian, whose husband is the actor Chen Daoming. Du Zhongjun wrote down the story of taking the pulse for the emperor and empress (that book, Record of Taking the Pulse for Emperor Dezong / De Zong Qing Mai Ji), and from it you can see that attending the emperor and empress was extremely difficult — much of it was beyond his own control.

💬 Note from Doctor Luo: Were the imperial physicians skilled? Yes, they were — at the very least, they ranked among the upper tier of the nation’s doctors at the time. Every province sent its most famous physicians, all locally renowned — yet once they entered the palace, the management system made it impossible for them to realize their ambitions or use their skills. Moreover, after spending years in the Imperial Medical Academy, the physicians gradually developed a style of writing “bland, get-by-if-you-can” prescriptions — because they wanted above all to avoid trouble and keep their heads on their shoulders. Hence the folk saying: “the essays of the Hanlin Academy, the prescriptions of the Imperial Medical Academy” (Han Lin Yuan de wen zhang, Tai Yi Yuan de yi fang) — meaning neither is as brilliant as people imagine. Think about it: even this was the product of that rotten management system.

Conclusion: Look at problems from all sides — don’t drill into the tip of a horn

💬 Note from Doctor Luo: So people often ask: why did the emperors live so short? Is that the “achievement” of Chinese medicine? I have gone through the whole matter from beginning to end, and now you understand: to look at a problem, you must place it inside the social environment of its time — see how these various factors worked and how they produced this result. Only then can you view it comprehensively and fairly. Otherwise, you ignore many factors and seize on just one — what is that called? Drilling into the tip of a cow’s horn (zuan niu jiao jian) — obsessing over a single point. Plunge in from one angle and you easily become one-sided; this way of thinking can get you into trouble in other matters too.

Everything in this world happens through the combined action of many factors. If we can weigh every matter from every angle and every side, we see things more comprehensively, and the conclusions we draw are more correct.

💬 Note from Doctor Luo: This little question seems simple, but once it’s fully explained you discover: looked at this way, you can reach a much more balanced judgment. Alright, that’s all for today. When I get the chance, I’ll tell you more stories about Chinese medicine and the bygone days of the medical tradition. Thank you for listening — see you tomorrow!

(Compiled from Doctor Luo Dalun’s lecture series)