In 1949, when many of China’s citizens were running from the newly-victorious Communists, Dr Li Zhisui returned to his homeland. He had been making good money as a ship’s doctor with the Australian Oriental Company, and he could have stayed there or joined his wife in Hong Kong. But since Australia only admitted white people to citizenship, and in Hong Kong he could have become only the ‘disenfranchised subject of a foreign king’, he decided to take part in the reconstruction of his own country: this, he writes, was more important to him than making money. Besides, he wanted to become a neurosurgeon, and non-whites were barred from the top medical posts in both Australia and Hong Kong. Dr Li had a letter from Fu Lianzhang, deputy director of public health, which promised him a suitable job in China: five years later he became personal physician to Chairman Mao Zedong. He didn’t want the honour.

Dr Li’s great-grandfather had attended the young Tongzhi emperor, son of the infamous Dowager Empress Cixi. The Emperor liked to go out into Beijing at night and sample the brothels. When he fell ill with syphilis, the Dowager Empress refused to accept the elder Li’s diagnosis and insisted that her son be treated for smallpox. He died, and the physician was disgraced. He warned his descendants never to accept a job at the Imperial court.

There were more immediate reasons for Dr Li’s unease. His father had been a high-ranking official of the defeated Guomindang Government, and his father-in-law had been a wealthy landlord and was now officially declared an ‘enemy of the people’. He himself had been marginally involved in a Guomindang organisation, the National Renaissance Society. The job was not for him, he thought, but for the son of a worker or peasant. If he took it on, he would be watched all the time. The slightest mistake might cause him to be declared a ‘class enemy’. But his protests were useless. He had no choice.

In any case, Mao had long been Dr Li’s hero. ‘Mao’s eyes,’ he writes of their first meeting, ‘seemed full of wisdom and he exuded good feeling ... I felt that I was in the presence of a great man.’ His fears about his dubious background were dealt with: ‘You were only 15 years old in 1935, when you joined the National Renaissance Society – just a kid,’ Mao told him. ‘You didn’t know anything then.’ Dr Li was grateful, and felt safe at last.

Mao liked to be looked after by grateful people. His barber, ‘Big Beard Wang’, had confessed during a rectification campaign in 1942 that he was plotting to murder him, but Mao found out that the barber had been kept awake till he said what his interrogators wanted, and so he saved him. When, early in his career, Li heard this story, the implications were lost on him. The Chairman, he thought, needed people he could trust. It was only later that he realised why he and Wang could be trusted. Mao had them on a knife-edge, and he could destroy them any time he wanted.

‘I have paid for this book with my life,’ says Li Zhisui. He had returned to China prepared to endure hardship, hoping that he could learn to be proud of himself and of his country. He got only hardship: his family life was wrecked by Mao’s demands, his hopes for a new China were dashed and he never became a neurosurgeon. He was forced to remain silent when the innocent were attacked, even, at times, to take part in their destruction. He lived in fear. The book’s photographs show his distress: in all of them he wears the same helpless, unhappy smile. ‘Survival in China,’ he writes, ‘then and now, depends on constantly betraying one’s conscience.’

Li was an educated man who believed in conscience (for which, he reports, Mao often mocked him). He was heir to a tradition of Confucian benevolence: his ancestors were famous for their generosity to the poor. When he refers to Mao as the ‘emperor’, as he does repeatedly, it is the ancient Chinese concept of the Mandate of Heaven that he has in mind. It was a concept formulated by the Zhou Dynasty to explain their victory over the Yin, but it developed into a Chinese version of the contrat social. The emperor was the supreme priest, whose function was to link Heaven with Earth to form the vital cosmic triad of Heaven, Earth and Humanity. Confucius and Mencius expanded the concept to include a whole web of correct relationships between individuals and within the state. If the emperor was to maintain the Mandate, he must not behave as if his privileges were unlimited. Benevolence and morality were the qualities necessary to link Heaven and Earth, but there also had to be a sensible respect for natural rhythms: ‘If you do not interfere with the busy seasons in the fields,’ said Mencius, ‘then there will be more grain than the people can eat ... if hatchets and axes are permitted in the forests on the hills only in the proper seasons, then there will be more timber than they can use.’ The duty of a monarch was to create conditions under which his people could feed themselves, house themselves and live contented family lives. He must rule in such a way that the people welcomed his decrees. If he failed to cultivate the moral qualities that differentiated the human heart from those of wild beasts, the people would behave like wild beasts and it would be his fault. ‘For a cruel man to be in a high position,’ Mencius said, ‘is for him to disseminate his wickedness among the people.’ In such cases, it was legitimate to overthrow the emperor.

Zhou, last emperor of the Shang Dynasty, was a waster and womaniser. When his officials complained about his orgies he had them roasted alive inside hollow bronze pillars while he made love to his favourite concubine, turned on, apparently, by the screams. At last he was deposed and killed. When Mencius was asked if this meant that regicide was permissible, he replied that Zhou had made himself an outcast by mutilating benevolence and crippling rightness. ‘I have heard of the punishment of the outcast Zhou,’ he said, ‘but I have not heard of any regicide.’

Few governments lived up to the Mencian model of benevolent autocracy, and one dynasty after another lost the Mandate of Heaven for reasons that were all too plain to their subjects. Nevertheless, the ideal persisted. It is hard to eradicate tradition in China. When Dr Li first heard Mao speak in Tiananmen Square in 1949, he wept for joy: ‘I was so proud of China, so full of hope, so happy that the exploitation and suffering, the aggression from foreigners, would be gone for ever.’ Li never says it outright, but it is easy to read the traditional text between the lines. In 1949, it looked as if Mao had stepped into that space between Heaven and Earth. Li says he thought of Mao as ‘our tallest mountain’. He saw China as one huge family and believed it needed a head. He would serve the Chinese people by serving Mao.

He was not alone: Mao-veneration was always a feature of the People’s Republic. It reached its zenith during the Cultural Revolution. Li tells the story of a mango that Mao sent to a Beijing factory at that time. The fruit was displayed on an altar for the workers to venerate. When it began to rot, it was boiled in water which was then distributed to the ecstatic workers. A waxen mango was set on the altar instead, and the workers were delighted to worship this substitute. Right from the start, Mao (who was known simply as ‘Chairman’) was deferred to, flattered, spoilt. He lived surrounded by guards and attendants in the Imperial gardens of Zhongnanhai, and he lived as he pleased, without discipline, eating when he wanted to, sleeping when he wanted to, irritated when the demands of state occasions forced him to get up in the morning. Mao never washed, or cleaned his teeth (they were always covered in thick green plaque), nor did he like to wear smart clothes.

This slovenliness, filthiness indeed, was supposed to prove the simplicity of his lifestyle. But Mao’s life was only as simple as he liked it to be. He travelled by bullet-proof limousine, or in his own luxury train. Whenever he was on the move, the entire line would be cleared, and train schedules disrupted throughout the country. When Mao flew, all Chinese air traffic was grounded. Nobody ever dared to argue with him. Li describes the tragicomic scenes which occurred every time Mao decided to go swimming in various dangerous, polluted, schistosomiasis-infested locations. The captain of Mao’s guard. Han Qingyu, ruined his career by telling the Chairman that it wasn’t safe to swim in the Yangtse. Of course Mao did swim in the Yangtse, and his retinue had to go in with him. Han Qingyu got covered in human excrement from a submerged manure pit. Had it happened to Mao, heads might have rolled. But it was only Han, and everyone had a good laugh.

Everywhere Mao went, he took his own hard wooden bed. It was enormous, and one side was about four inches higher than the other. Li was told that this was to prevent Mao falling out, but later he realised it had more to do with Mao’s sex life than his safety. Just like the emperors. Li reports, Mao had scores of concubines – nurses, dancers, travel attendants. He no longer slept with his wife, Jiang Qing; and when he was 67 he began to use Daoist sexual practices – which meant that he had to refrain from ejaculating so that his sexual energy, jing, would remain within his body and be converted into the vital energy, chi. The young women – they had to be young – also had to adopt special positions. Li doesn’t go into details, but Daoist tantric practice involves a good deal of athleticism, and the built-up bed must have made things easier. Ideally, these exercises would have helped an immortal embryo to form within Mao which would emerge from the crown of his head at his death, and live for ever. More realistically, the exercises were supposed to prolong his life. Li would have it that Daoism was no more than an excuse for Mao to continue womanising, but this is probably unfair. The evidence of Li’s own writing is that Mao never needed an excuse. In any case, he was diligent in his exercises. His partners – usually naive, uneducated young women who thought it was an honour to service the Chairman, even to catch his sexually transmitted diseases – also did their bit, preparing themselves by studying the text that Mao worked from, and asking poor Li for help when they didn’t understand the archaic writing.

Mao’s luxurious living – even his womanising – surprised Doctor Li, but didn’t greatly trouble him at the beginning. This seems strange, since Li was full of Communist enthusiasm when he first came to Mao, but it makes sense in the context of traditional Chinese thought. ‘In antiquity’, said Mencius, ‘T’ai Wang was fond of women, and loved his concubines ... At that time, there were neither girls pining for a husband nor men without a wife. You may be fond of women, but so long as you share this fondness with the people, how can it interfere with your becoming a true king?’

As long as he was improving the lives of the Chinese people Mao’s behaviour was acceptable to Li. Once the doctor realised that the people were being exploited, his attitude changed. Mao, who cared little for his own family, presided over an era when no one was allowed to marry without the agreement of their party organisation, and husbands and wives were often sent to work at opposite ends of China. This happened to Li and his wife; even when they were both living in Beijing, they weren’t allowed to see much of each other. Mao never shared his fondness of women with the people.

He also neglected his duties for his sex-life. There was a special room in the Great Hall of the People where he would withdraw from meetings to ‘rest’ with his women. He did this while the country was in crisis: during the Great Leap Forward, while the people were starving, and during the Cultural Revolution, when Mao’s cruelty, faithfully replicated by the masses, led to the deaths of thousands of ‘rightists’. Li’s Mao, like the ‘outcast Zhou’, enjoyed his pleasures while ruining the lives of the people. He liked to draw on the classic texts; and his heroes, according to Li, were the emperors traditionally regarded as China’s cruellest. He admired Zhou, for instance, because he had expanded China’s territory. His other heroes were Qin Shihuangdi, who drove the Chinese out to build the Great Wall, burned the classics and executed Confucian scholars (he was also interested in immortality), and Sui Yangdi who conscripted thousands to build the Grand Canal (and then made young maidens draw his pleasure boat up it so that he could watch their bottoms waggle). In Li’s portrait Mao was a true follower of these emperors.

The Communist hierarchy took over the Confucian/Mencian idea that the leader is responsible for the actions of those below him. But instead of pursuing virtue, Mao’s high officials, like their feudal predecessors, distorted the doctrine, exercising such control over their underlings that these men and women were terrified of taking any decisions for themselves. During purges, officials were toppled because of errors made by their subordinates, but Mao was never made to suffer for China’s misfortunes. After the Great Leap Forward, he did make a self-criticism of sorts; ‘For all errors directly or indirectly attributable to the central authority, I am responsible.’ But then he immediately added: ‘Many others also have a share in the responsibility.’ Whereupon Vice-Chairman Lin Biao replied: ‘The thoughts of the Chairman are always correct. If we encounter any problem, any difficulty, it is because we have not followed the instructions of the Chairman closely enough.’ Mao was delighted with this speech. ‘Lin Biao’s words are always so clear and direct. They are simply superb! Why can’t the other party leaders be so perceptive?’

Dr Li’s book is subtitled ‘The Inside Story of the Man Who Made Modern China’. The fly-leaf announces that the book is ‘unprecedentedly intimate’. But it isn’t quite that. Li was too frightened, too shocked, too disappointed to empathise with his patient and what he gives us is principally an account of his symptoms. Certainly, Li tells us what he observed from his position alongside Mao, who, he says, was a fearful, isolated man, severely stressed – ‘neurasthenic’. ‘Neurasthenia’ was prevalent among all the members of the Communist hierarchy. Mao’s subordinates were stressed by the constant purges but the Chairman’s trouble (and the cause of the purges) was ‘his continuing fear that other ranking leaders were not loyal to him and that there were few within the Party whom he could genuinely trust.’ As a result, he suffered a range of psychosomatic illnesses: insomnia, depression, dizziness, itchiness and, sometimes, impotence. He had panic attacks. He consumed enormous quantities of sleeping tablets. His tolerance for barbiturates was such that he took up to ten times the normal dose. When Li prescribed chloral hydrate to make him sleep, Mao became addicted to it because it stimulated his appetite and brought on euphoria.

Mao had his food regularly tasted for poison, but that didn’t calm his fears. He suspected poison in the water of the swimming-pool that had been specially installed for him when he visited Sichuan; when he fell ill in Nanchang, he thought it was because his guesthouse was poisoned. Being deliberately ignorant about medicine, which he affected to despise (though when he was really ill he always shouted for Li), he was unable to place these fears in any rational context. His trust in Li was far from unconditional, and he made Li explain the detail of every medical treatment to him, but then didn’t understand the explanations, nor act on them. If he was given antibiotics, he stopped taking them as soon as he felt better. When advised not to squeeze a pimple on his chest, he squeezed it anyway, turning it into an abscess that almost killed him.

The book opens with the grisly story of Mao’s embalming. Li was horrified when the Politburo decided that the Chairman’s body was to be permanently preserved, because he wasn’t at all sure that it could be done. He’d seen Lenin’s body falling apart in Red Square, his nose and ears replaced by wax, and knew that the Soviet Union had far more expertise in this field than China. One of the medical team’s two experts in body preservation spent an hour in the library and discovered that the body had to be injected with between 12 and 16 litres of formaldehyde. The team used 22 to be on the safe side. The chemical blew Mao up: his ears stuck out from his head at right angles, his face was bloated and his neck got to be as wide as his head. The team had to massage the fluid down into the body, where the distortion could be hidden by clothes. He became a thinly-disguised monster, which is how he appears in Li’s book.

Only once does Li allow us a glimpse of humanity in his master. In 1961, Mao was visited by his second wife, He Zizhen, who, Li writes, had been diagnosed schizophrenic, though he fails to mention that she fell ill after the Long March. She had left two children with peasants and they were never found again; she had been badly wounded just before she gave birth to her fourth child, and had been carried for almost six thousand miles on a stretcher. Li says that Mao was ‘as gentle and kind’ with He Zizhen ‘as I had ever seen him’. She was disoriented and incoherent and the visit didn’t last long. Afterwards Mao sat silently, smoking cigarette after cigarette. Li had never seen him show such sorrow.