A Night of Anxious Reflection

On a bitterly cold evening in the winter of 1874-1875, Prince Gong, one of the most powerful figures in the Qing imperial court, found himself pacing alone in his reception hall after a meeting with Ronglu, a trusted military commander. The prince was consumed by thoughts that stretched back thirteen years to the beginning of the Tongzhi Emperor’s reign. He remembered how auspicious the reign name “Tongzhi” had seemed at its selection – meaning “joint rule” to signify unity between the emperor and his ministers, while also echoing the reign name of the Shunzhi Emperor who had presided over more prosperous times. The cruel irony now haunted him: the Tongzhi Emperor, like Shunzhi before him, lay dying of smallpox.

The prince contemplated the grim parallels between the two monarchs’ fates. While Shunzhi had at least left two sons to secure the succession, the current emperor had no heir. This realization plunged Prince Gong into deeper anxiety about the impending crisis of succession. He felt isolated in his concerns, unable to share them even with his close associate Baojun. His most trusted confidant, Wenxiang, lay seriously ill, unavailable for counsel. The prince wondered whether his brothers had considered the monumental question of succession and what candidates they might favor. These troubling thoughts kept him awake long into the night, until his wife finally sent maids to urge him to rest before his early morning court appearance.

The Weight of Imperial Responsibility

After barely sleeping, Prince Gong rose before dawn to prepare for his palace duties. The winter cold cut through him like a blade as he stepped toward his sedan chair, causing him to hesitate momentarily. In that instant, he felt the enormous weight of his responsibilities pressing upon him. He recognized that the current crisis might prove even more challenging than the Xinyou Coup of 1861, when he had helped secure the throne for the young Tongzhi Emperor. During that earlier crisis, he could at least count on the cooperation of Empress Dowager Cixi. Now, he suspected she had become part of the problem rather than the solution.

Prince Gong understood that any appearance of weakness or fatigue on his part would only embolden the ambitious empress dowager. He straightened his posture, steeled himself against the cold, and proceeded to the palace. Upon arrival, he immediately reviewed the emperor’s medical reports and daily records. The news was troubling: the emperor’s condition had worsened slightly, with persistent swelling, a weak and slow pulse, and a new symptom of frequent urination throughout the night.

The Medical Crisis Unfolds

Prince Gong consulted with Ronglu, who had been attending to the emperor overnight. Ronglu reported the emperor’s extreme lethargy and shared the physicians’ concerns about his depleted vitality, suggesting a need for warming tonics. Baojun, another official present, questioned whether the lead physician Li Dezuan possessed sufficient surgical expertise and proposed seeking additional medical opinions from either the Imperial Hospital or outside specialists.

Ronglu confirmed that the empress dowagers had similar concerns and that Li Dezuan himself had expressed willingness to consult other physicians. Prince Gong recognized the troubling implication behind Li’s apparent openness to assistance: the physician might be preparing to share responsibility because he lacked confidence in his ability to cure the emperor. The prince understood that a confident physician would never voluntarily relinquish such a prestigious assignment.

Deliberations with the Empresses Dowager

Prince Gong recommended that Li Dezuan remain at the palace to await further instructions and be available for direct consultation. When the prince met with the empresses dowager, he found Empress Dowager Ci’an with tear-streaked cheeks and Empress Dowager Cixi looking pale and distressed. They expressed urgent concern about the emperor’s worsening condition and asked about involving a surgical specialist named Han from the Imperial Hospital.

While acknowledging Han’s reputation, Prince Gong cautiously suggested maintaining Li Dezuan as the primary physician to avoid diffusing responsibility. The empresses dowager ultimately agreed, authorizing Li to decide whether to consult with the surgical specialist. Faced with mounting pressure and his own limitations, Li eventually summoned Han Jiu tong, the surgical expert from the Imperial Hospital.

A Desperate Medical Intervention

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That night, the emperor grew increasingly restless, complaining of thirst and experiencing repeated dry heaving. When summoned again, Li Dezuan found the emperor exhibiting signs of excessive yang energy and insufficient yin fluids—a dangerous imbalance in traditional Chinese medicine. Alarmed by this development, Li abruptly changed course, abandoning the warming tonics in favor of cooling, moistening formulations.

Mounting Concern Among the Imperial Council

When the imperial princes reviewed the medical reports the next day, they were shocked to find the treatment approach had completely reversed course. The shift from warming tonics to cooling medications signaled a grave development in the emperor’s condition. Questioned about this radical change, Li Dezuan could only explain that the previous treatment had proven ineffective and possibly harmful. His new strategy aimed to nourish yin energies and neutralize toxins, hoping merely to stabilize the emperor’s condition while awaiting further developments.

Historical Context: The Tongzhi Restoration

To understand the significance of these events, we must examine the broader historical context. The Tongzhi Emperor had ascended to the throne as a child in 1861 following the Xinyou Coup, which ousted a group of corrupt regents. His reign represented hope for the Qing Dynasty after the devastating Opium Wars and Taiping Rebellion had nearly toppled the imperial system.

Prince Gong, along with prominent officials like Wenxiang and Baojun, had implemented a series of reforms known as the Tongzhi Restoration. This movement sought to strengthen China through selective adoption of Western technology and military methods while preserving traditional Confucian values. The restoration achieved some success in suppressing major rebellions and initiating modernization projects, creating a brief period of optimism known as the “Tongzhi Zhongxing” .

The emperor’s coming of age in 1873 had been anticipated as a turning point when he would assume personal control of the government. Instead, his sudden illness now threatened to undo the progress made during the restoration and create a dangerous power vacuum.

The Cultural Significance of Imperial Illness

In traditional Chinese cosmology, the emperor’s health was intimately connected to the wellbeing of the entire empire. The Son of Heaven served as the crucial link between the human realm and the celestial order. His illness represented not just a medical crisis but a cosmological one that threatened the harmony between heaven and earth.

The specific nature of the emperor’s illness carried additional symbolic weight. Smallpox had historically been a disease that demonstrated the Mandate of Heaven—emperors who survived were seen as particularly favored by heaven, while those who succumbed were thought to have lost celestial favor. The Shunzhi Emperor’s death from smallpox in 1661 had created a similar succession crisis that was only resolved through the remarkable reign of his son, the Kangxi Emperor.

Medical treatment of the emperor followed strict protocols that blended practical medicine with cosmological considerations. The shift between warming and cooling treatments reflected the physician’s attempt to balance the emperor’s yin and yang energies according to traditional Chinese medical principles. The involvement of multiple physicians and the hesitation about treatment strategies revealed the limitations of imperial medicine when faced with serious illness.

Political Implications of the Succession Crisis

The absence of an heir created an unprecedented constitutional crisis in the Qing imperial system. Since its establishment, the dynasty had always passed directly from father to son. The Tongzhi Emperor’s childlessness threatened this continuity and raised fundamental questions about the selection process for a new emperor.

Prince Gong’s concerns about Empress Dowager Cixi’s ambitions proved prescient. As the emperor’s condition worsened, factions within the court began positioning themselves for the coming power struggle. The empress dowager, as the emperor’s mother, would play a crucial role in selecting the successor, but Prince Gong and other senior statesmen would also expect to influence this decision.

The uncertainty extended beyond the imperial palace throughout the bureaucracy. Officials who had built their careers around the Tongzhi Restoration wondered whether a new emperor would continue these policies or reverse them. Foreign diplomats watched anxiously, concerned about how a succession crisis might affect their treaty rights and commercial interests in China.

The Medical Response in Historical Perspective

The medical treatment of the Tongzhi Emperor illustrates the state of imperial medicine in late Qing China. The Imperial Hospital represented the pinnacle of traditional Chinese medical practice, drawing on centuries of accumulated knowledge and experience. However, it operated within a conservative system that valued seniority and tradition over innovation.

The physicians faced an nearly impossible situation: the stigma associated with failing to cure an emperor could destroy careers and even endanger lives. Li Dezuan’s cautious approach—consulting colleagues while maintaining primary responsibility—reflected this professional reality. His shift from warming to cooling treatments followed established medical principles but also demonstrated the limited arsenal available to even the most skilled physicians of the era.

Notably absent from the medical discussions was any consideration of Western medicine, despite its growing presence in China through missionary hospitals. This exclusion reflected both cultural pride and practical considerations—introducing foreign treatments would have been politically controversial and might have been interpreted as an admission that traditional Chinese medicine had failed.

Legacy of the Crisis

The Tongzhi Emperor would die on January 12, 1875, at just nineteen years of age. His death resolved the immediate medical crisis but intensified the political one. In a controversial move, Empress Dowager Cixi arranged for the succession of her three-year-old nephew, who became the Guangxu Emperor. This selection bypassed the generation that should have succeeded the Tongzhi Emperor, ensuring that Cixi could continue as regent.

The succession decision had profound consequences for China’s future. Prince Gong’s influence diminished as Cixi consolidated power, ending the reform momentum of the Tongzhi Restoration. The Guangxu Emperor would later attempt his own reforms during the Hundred Days’ Reform of 1898, but Cixi would suppress these efforts, further delaying China’s modernization.

The medical crisis also exposed weaknesses in the imperial system’s ability to handle succession issues, a problem that would recur in 1908 when the Guangxu Emperor died without an heir just one day before Cixi herself passed away. This later succession crisis would contribute to the downfall of the Qing Dynasty in 1912.

Modern Relevance and Historical Reflection

The events surrounding the Tongzhi Emperor’s final illness offer insights into the complex interplay between medicine, politics, and culture in late imperial China. They demonstrate how personal health crises of monarchs could become national political crises in hereditary systems of government.

From a medical historical perspective, the case illustrates both the sophistication and limitations of traditional Chinese medicine when confronted with infectious diseases. The physicians’ careful documentation of symptoms and treatments provides valuable historical information about medical practice at the highest levels of Qing society.

The succession crisis also highlights the vulnerability of political systems that depend too heavily on individual rulers. The Qing Dynasty’s inability to develop robust mechanisms for handling unexpected successions contributed to its eventual decline and collapse.

Today, the story of the Tongzhi Emperor’s final days serves as a reminder of how human mortality shapes history in unexpected ways. The anxiety felt by Prince Gong on that cold winter night would prove justified, as the emperor’s death indeed marked the end of one era and the beginning of another that would ultimately lead to the transformation of China’s political system.

The Tongzhi reign began with hope for renewal but ended in tragedy and uncertainty. Its legacy remains complex—a period of attempted reform that ultimately gave way to conservative retrenchment, a reminder that historical turning points often emerge from personal crises amplified through political structures. The emperor’s illness and the concerns it generated among his ministers reveal the human dimensions of historical processes that are often reduced to abstract forces and impersonal trends.