Instrumental data suggest changes in the intensity of the East Asian Monsoon system over the past century, possibly in response to anthropogenic climate change. To understand modern observations and explore past variations in East Asian summer monsoon (EASM) strength, we conducted grain size, geochemical, and pollen assemblage studies on a lacustrine sediment sequence from an earthquakedammed paleolake on the eastern Tibetan Plateau. The chronology, generated from eight optically stimulated luminescence and two pollen concentrate radiocarbon dates, indicates deposition of the lacustrine sequence between 600 and 1250 C.E. Fine grain sizes and low arboreal pollen percentages are associated with regional aridity (790-916, 1020-1080, 1125-1150 C.E.) and a weak EASM, whereas coarser grain sizes and higher arboreal pollen percentages are associated with increased precipitation and a stronger EASM (1090-1125, 1160-1230 C.E.). Although observed variations in our paleodata are predominantly driven by climate, the sequence is also influenced by regional tectonics, as evident from seismites, a *90-year hiatus (917-1004 C.E.) during a period of regional seismicity, and an abrupt increase in regional sedimentation rates. Human disturbance is also observed to increase during weak EASM intervals. On decadal to millennial scales, our paleodata are highly correlated with reconstructions of EASM strength from northeastern China and sea surface temperature reconstructions from the tropical Pacific Ocean, indicating that the Medieval Climate Anomaly was associated with a strong EASM and prolonged La Niña-like state. Our data also suggest decadal-scale EASM variability associated with solar intensity, but an inconsistent response suggests additional complexity in EASM forcing. The inverse relationship between modern EASM weakening with anthropogenic warming, and a strong EASM during the warm Medieval Climate Anomaly, suggests that the complexity of the decadal to centennial-scale EASM response may be related to changes in the mean state of the tropical Pacific Ocean.