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Physician Patient Dissertation

The therapeutic tug of war: The Imperial physician -patient relationship in the era of Empress Dowager Cixi (1874--1908)

Che-chia Chang, University of Pennsylvania


This thesis constructs the medical history of the Qing Imperial family when Empress Dowager Cixi was the matriarch. Its underlying question is how the patient and the physician reacted to each other in the therapeutic process. The discussions concentrate on the differences of views between the physician and the patient; their communications; the factors influencing their decision-making; and the correlation between the physicians' social background and their behavior. In this regard this dissertation concludes that the physician-patient relationship rather than technical knowledge played the central role in the therapies. The relationship even affected how much the physician could crystallize his medical opinions. In the studied cases, the physicians' social background, bureaucratic or unofficial, significantly characterized the pattern of the imperial physician-patient interactions. When they first worked together in 1880, the divergence of the physicians' attributes caused tumults which gave Cixi a disastrous experience. However, she learned the lesson and applied it to her later decisions regarding medicare, which help to handle some political issues. By studying Cixi's family medical history as a long-run case, I am able to present that the therapeutic process was not only interactive but also dynamic.^ Other than the palace medical archives, I use physicians' private writings, witnesses' records as the primary sources, supplemented with the contemporary newspapers, jottings, medical manuals, and various historical works for explaining the technical and social circumstance. Through cross-reading these materials, I discovered that a portion of the medical archives were severely edited in an effort to distort the sequence of medical events. For those which were not, the imperial physicians often withheld information from their reports. I illustrate how a physician could construct his reports to be truthful but with subtext for the well-informed reader to interpret. As well the physicians' private writings had problems of reliability in different ways. These discoveries expose the imperfection of the trend in China to learn master physicians' experience by reading their published case histories. Finally I discuss the problems of the notion of experience, and suggest that by considering physician-patient relationship scholars can contribute to a richer Chinese medical history. ^

Subject Area

History, Asia, Australia and Oceania|History of Science

Recommended Citation

Chang, Che-chia, "The therapeutic tug of war: The Imperial physician -patient relationship in the era of Empress Dowager Cixi (1874--1908)" (1998). Dissertations available from ProQuest. AAI9833746.


Since July 16, 2004


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