Officials called it the 'hold room', a private space in the West Wing of the White House set aside for Xi Jinping to take lengthy rest breaks between meetings during last month's summit with Donald Trump. 

The demand for the room was highly unusual, according to US officials, and may hold the secret of a gathering mystery – that of the true state of the Chinese leader's health.

Trump claimed 73–year–old Xi looked 'strong, vibrant and fit', but – privately – officials were struck by his physical weakness.

China demanded a substantial amount of downtime be built into the schedule and were concerned about how long Xi would be required to stand and walk, according to The Wall Street Journal.

One of the main demands was the 'hold room', where only Xi's wife, Peng Liyuan, was allowed to join him. Not even his powerful chief of staff, Cai Qi, was granted entry.

China reportedly turned down an offer of a working lunch with Trump on the only full day of the summit, according to officials involved in planning.

Stairs seemed a particular challenge for Xi. Slowly and cautiously descending from his plane on arrival in Washington – and later climbing the steps of the National Archives – he appeared to be gripping tightly to his wife's hand in a manner that suggested support rather than affection.

Peng, a glamorous singer who gained fame as a soprano for the People's Liberation Army, was more famous than her husband when he first became leader. She has had a much higher profile than the spouses of earlier leaders.

But all the same, the scene in Washington was unusual, since wives have traditionally played a more decorative or ceremonial role – if they had a role at all – in recent Chinese diplomacy.

It could be that Xi was just tired. Perhaps he had jet lag. But Chinese media were taking no chances, editing out any images that might suggest frailty.

State television reports skipped the aircraft steps and instead showed carefully edited video of Xi waving at the cabin door before cutting to the formalities on the tarmac below.

Unsubstantiated rumours about Xi's health were spreading even before the Trump meeting.

At a summit of emerging nations held in New Delhi earlier in September he withdrew at the last minute from a gala dinner hosted by Narendra Modi, the Indian Prime Minister. He reportedly felt unwell, prompting lurid reports spread by overseas exiles that he had fallen seriously ill and been rushed home.

The claim was pushed by Xie Wanjun, one of the dissident founders of the outlawed China Democratic Party, who is now based in the US. Quoting 'witnesses', he claimed that on arrival back in Beijing, Xi was carried off his plane and rushed to hospital by helicopter for emergency treatment.

A series of unexplained absences have also fuelled speculation.

In May last year he disappeared from public view for two weeks and analysts noted a marked reduction in the usual prolific references in state media to 'Xi Jinping Thought'. 

He vanished again at the end of May this year, for ten days this time, and a monthly Politburo meeting appeared to have been scrapped – which is highly unusual.

Caution is required, since the Chinese Communist Party (CCP) is an opaque and paranoid organisation. During my time in Beijing, a diplomat advised me: 'Anybody who claims to understand the party is misinformed.'

It is a system where rumours take on a life of their own and official denials are widely regarded as confirmations of truth.

The CCP even banned all mention of Winnie–the–Pooh from social media after Chinese internet users deployed the rotund bear to mock Xi's physique.

Xi is a lifelong smoker, overweight, unfit and fond of drink, according to Dennis Wilder, a former senior China analyst at the Central Intelligence Agency who is now a scholar at Georgetown University. 

He told The Wall Street Journal about a conversation with Qin Gang, China's former foreign minister, during which Qin said that Xi 'loved to drink'. A favourite tipple was Moutai, a powerful grain liquor popular with China's leaders.

'They would drink themselves silly,' according to Wilder.

Desmond Shum, an exiled but still well–connected Chinese businessman, who had close ties to the family of former Chinese premier Wen Jiabao, says China's leaders go to extraordinary lengths to hide any ill health while travelling internationally.

'We were told they travelled with their own toilets and that even their s**t was packed up and taken away, lest their DNA or clues about their health would be leaked,' he wrote on X.

Similar reports have emerged about Xi's fellow dictator and 'good friend' Vladimir Putin.

Officials travelling with the Russian president on international visits reportedly collect his excrement in special bags, which are kept in a dedicated briefcase.

The Xi rumours matter because he has turned himself into China's most powerful leader since Mao Zedong, ruthlessly removing opponents and abolishing time limits on his rule – effectively making himself leader for life.

A purge at the top of the military has removed 36 generals and lieutenants (with another 65 missing or potentially purged) since 2022, according to an analysis by the Center for Strategic and International Studies.

They included earlier this summer Zhang Youxia, who was second in command of the military under Xi, and who was accused of disloyalty, corruption and other serious disciplinary breaches.

There is no obvious successor to Xi and he has avoided anointing one, fearing that person might become a threat.

It is fair to assume that he has made a lot of enemies, which increases the likelihood of a possibly violent power struggle to take over from him.

This is precisely what Deng Xiaoping sought to avoid.

It was Deng – who led China after a power struggle following the death of Mao – who introduced

a ten–year time–limit on leaders' tenure in office and a more collective form of leadership to ensure a smoother transition between premiers, safeguards now swept away by Xi.

For all his country's modernity – not least its cutting–edge technology and economic achievements – Xi has taken its politics back to the days of dynastic China. He has surrounded himself with sycophants, and loyalty to Xi is now the single most important requirement of those in positions of power.

His health is a closely guarded state secret, amplifying the speculation each time there are signs that he is flagging.

'In a system where so much power is monopolised by one man, the physical condition of that man is no longer merely a personal matter – it becomes a matter of consequence for the entire country,' according to Shum.

His book, Red Roulette: An Insider's Story Of Wealth, Power, Corruption And Vengeance In Today's China, lifts the lid on the country's systemic corruption. 

And the impact of Xi's health could be far worse than Shum suggests, since it could ripple well beyond China's borders as rivals manoeuvre for position, each attempting to sound stronger and more jingoistic on issues ranging from Taiwan to global competition with the US.

What China does or doesn't do is now far more consequential for the world than it was in Mao's day, and the prospect of Beijing consumed by a struggle for power will alarm Western leaders. China was isolated under Mao. Now it is responsible for a third of the world's manufacturing output. Fallout from either political paralysis or violent upheaval would shake the world economy.

Xi became party leader in 2012 after a power struggle with a popular provincial party boss and amid coup rumours involving the then head of state security. Judging by his military purges, Xi still worries about the loyalty of the army – the world's largest.

The threat of violence – even civil war – haunts a party with a turbulent history and which no longer has a mechanism for orderly transferring power. Taiwan might become collateral damage, as an ailing Xi seeks to fulfil his pledge to grab the island – or hardline rivals embrace the jingoistic slogans of 're–unification'.

The rapid deterioration of Mao's physical and mental health towards the end of his life showed the lengths the CCP will go to maintain the secrecy surrounding the health of its leaders.

His descent into decrepitude was subject to a massive cover–up. Even the CIA was fooled. A secret report in 1975 concluded: 'There is no evidence the chairman is especially troubled by health problems.'

A year after that report, Mao suffered his third heart attack and died four days later.

He also had Parkinson's disease and, according to a memoir by his personal doctor, spent his final years in a state of clinical paranoia. His death unleashed a vicious power struggle before Deng emerged as paramount leader.

The case of Soviet leader Leonid Brezhnev, who ruled the USSR from 1964 until his death in 1982, provides another uncomfortable warning about the impact of secrecy, lies and paranoia about a leader's health.

In his final years he could barely function. During a 1979 summit in Vienna with US President Jimmy Carter, he struggled to pay attention and his speech was slurred. He picked his way through a banquet using only a small spoon, while his spokesman insisted he was in 'excellent health'.

Brezhnev's decline was accompanied by economic stagnation as the Soviet Union ran out of ideas. The hopeless state of the country seemed to match that of its geriatric leader.

It did generate one boom though – in jokes that eroded the legitimacy of the party and the gerontocracy that ran it, turning it into a laughing stock. 'Did you go to the latest funeral?' asked one joke. 'Yes, I've got a season ticket,' came the reply.

Another asked the difference between a crocodile and the party's central committee.

'A crocodile has 40 teeth and four legs,' came the reply, 'while the central committee has four teeth and 40 legs.'

Xi Jinping is not Leonid Brezhnev – at least not yet.

And in the days of social media, it is far more difficult to hide the physical ailments of leaders. The old jokes have been replaced by internet memes.

And as hard as the CCP tries to control the internet, the trials of Winnie–the–Pooh will inevitably slip through the cracks.

There is often a fine line between tyranny and absurdity. No more so than when the party is seeking to cover up or deny the blindingly obvious at the behest of an all–powerful leader, which can quickly eat away at its legitimacy.

It seems no coincidence that days after Xi returned from the Washington summit, as speculation grew about possible illness, state media pictured him chairing what was described as a 'national meeting on health' – not his, but the nation's.

'Xi calls for decisive progress in Healthy China advancement,' trumpeted the Xinhua state news agency, in an almost cartoonish attempt to give Xi as much authority as it could muster on the issue of healthy living.

In the looking–glass world of the CCP, that is perhaps as clear a sign as you will find that all is not well.

- Ian Williams is author of Vampire State: The Rise And Fall Of The Chinese Economy.