The eighteenth century witnessed unprecedented expansion of the Qing realm, and this study examines how some of these changes were reflected onto imperial medicine at the center. Institutional history suggests that one aspect was the representation of people from different backgrounds in imperial medical posts. Dynamic changes in the structure and function of medical organizations point to the value of examining the breadth of medical knowledge and practices under the authority of the emperor during this time. Qing imperial medicine was pluralistic with respect to institutions, posts, medicines, languages, and medical conceptions. Multiplicity, as a principle and a practical solution, facilitated continuity, representation, as well as the integration of medical organizations with those of bureaucratic nature. Within such a context, having the ability to mobilize a range of medical practitioners could also serve to increase the power of the rulership. Imperial medicine in China was greatly restructured during the eighteenth century. The Imperial Pharmacy, which had been part of the Imperial Medical Bureau, gained relative independence before being integrated into the Imperial Household Department, where its functions expanded. During this time, the Imperial Medical Bureau became more distant from the Ministry of Rites with which it had been affiliated, and was increasingly overseen by the Imperial Household Department. Organizational plurality could be found beyond these examples. A class of specialty bonesetters at an institution that managed imperial horses reflected the overlapping spheres of human and equine medicine. The organization of medicine provided space for individual cultural and practical spheres while also allowing for interaction. The study of plurality in imperial medical institutions reveals a variety of human actors, as well as the role of mobility in the day-to-day functioning of medical affairs. Moreover, the multi-lingual context of the Qing points to the value of considering the various meanings of a particular term or name across a spectrum of languages. Multiplicity was also exhibited through the differing conceptions of the body in three imperially commissioned textual sources: a five-language dictionary, a Manchu manuscript on anatomy that was a “translation” of a Western treatise, and a text for establishing medical orthodoxy. The latter was widely distributed, and a part of it found a new life in Japan, thereby showing how imperial medicine existed far beyond the palace gates, including the social history of medicine within a wider East Asian context.