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General characteristics

• Literary use of myths
• Folk literature
• Vernacular fiction
• Classical literature
• Vernacular literature
• Poetry and prose nonfiction
• Prose fiction
• 19th-century translations of Western literature
• 19th-century native prose and poetry
• May Fourth period
• The war years: 1937–49
• After the Cultural Revolution
• Literature in Taiwan after 1949

Chinese literature

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• World History Encyclopedia - Chinese Literature
• Association for Asian Studies - Chinese Literature: An Introduction
• Columbia University - Asia for Educators - Introduction to Chinese Literature
• Chinese literature - Children's Encyclopedia (Ages 8-11)
• Chinese literature - Student Encyclopedia (Ages 11 and up)
• Table Of Contents

Chinese literature , the body of works written in Chinese, including lyric poetry , historical and didactic writing, drama , and various forms of fiction .

Chinese literature is one of the major literary heritages of the world, with an uninterrupted history of more than 3,000 years, dating back at least to the 14th century bce . Its medium, the Chinese language , has retained its unmistakable identity in both its spoken and written aspects in spite of generally gradual changes in pronunciation, the existence of regional and local dialects , and several stages in the structural representation of the written graphs, or “characters.” Even the partial or total conquests of China for considerable periods by non-Han Chinese ethnic groups from outside the Great Wall failed to disrupt this continuity , for the conquerors were forced to adopt the written Chinese language as their official medium of communication because they had none of their own. Since the Chinese graphs were inherently nonphonetic, they were at best unsatisfactory tools for the transcription of a non-Chinese language, and attempts at creating a new alphabetic-phonetic written language for empire building proved unsuccessful on three separate occasions. The result was that after a period of alien domination, the conquerors were culturally assimilated (except the Mongols, who retreated en masse to their original homeland after the collapse of the Yuan [or Mongol] dynasty in 1368). Thus, there was no disruption in China’s literary development.

Through cultural contacts, Chinese literature has profoundly influenced the literary traditions of other Asian countries, particularly Korea, Japan, and Vietnam. Not only was the Chinese script adopted for the written language in these countries, but some writers adopted the Chinese language as their chief literary medium, at least before the 20th century.

The graphic nature of the written aspect of the Chinese language has produced a number of noteworthy effects upon Chinese literature and its diffusion: (1) Chinese literature, especially poetry , is recorded in handwriting or in print and purports to make an aesthetic appeal to the reader that is visual as well as aural. (2) This visual appeal of the graphs has in fact given rise to the elevated status of calligraphy in China, where it has been regarded for at least the last 16 centuries as a fine art comparable to painting. Scrolls of calligraphic renderings of poems and prose selections have continued to be hung alongside paintings in the homes of the common people as well as the elite, converting these literary gems into something to be enjoyed in everyday living. (3) On the negative side, such a writing system has been an impediment to education and the spread of literacy , thus reducing the number of readers of literature, for even a rudimentary level of reading and writing requires knowledge of more than 1,000 graphs, together with their pronunciation. (4) On the other hand, the Chinese written language, even with its obvious disadvantages, has been a potent factor in perpetuating the cultural unity of the growing millions of the Chinese people, including assimilated groups in far-flung peripheral areas. Different in function from recording words in an alphabetic–phonetic language, the graphs are not primarily indicators of sounds and can therefore be pronounced in variant ways to accommodate geographical diversities in speech and historical phonological changes without damage to the meaning of the written page. As a result, the major dialects in China never developed into separate written languages as did the Romance languages , and, although the reader of a Confucian Classic in southern China might not understand the everyday speech of someone from the far north, Chinese literature has continued to be the common asset of the whole Han Chinese people. By the same token, the graphs of China could be utilized by speakers of other languages as their literary mediums.

The pronunciation of the Chinese graphs has also influenced the development of Chinese literature. The fact that each graph had a monophonic pronunciation in a given context created a large number of homonyms, which led to misunderstanding and confusion when spoken or read aloud without the aid of the graphs. One corrective was the introduction of tones or pitches in pronunciation. As a result, metre in Chinese prosody is not concerned with the combination of syllabic stresses, as in English, but with those of syllabic tones, which produce a different but equally pleasing cadence . This tonal feature of the Chinese language has brought about an intimate relationship between poetry and music in China. All major types of Chinese poetry were originally sung to the accompaniment of music. Even after the musical scores were lost, the poems were, as they still are, more often chanted—in order to approximate singing—than merely read.

Chinese poetry, besides depending on end rhyme and tonal metre for its cadence, is characterized by its compactness and brevity . There are no epics of either folk or literary variety and hardly any narrative or descriptive poems that are long by the standards of world literature. Stressing the lyrical , as has often been pointed out, the Chinese poet refrains from being exhaustive, marking instead the heights of his ecstasies and inspiration or the depths of sorrow and sympathy. Generally, pronouns and conjunctions are omitted, and one or two words often allude to highly complex thoughts or situations. This explains why many poems have been differently interpreted by learned commentators and competent translators.

The line of demarcation between prose and poetry is much less distinctly drawn in Chinese literature than in other national literatures. This is clearly reflected in three genres . The fu , for example, is on the borderline between poetry and prose, containing elements of both. It uses rhyme and metre and not infrequently also antithetic structure, but, despite occasional flights into the realm of the poetic, it retains the features of prose without being necessarily prosaic. This accounts for the variety of labels given to the fu in English by writers on Chinese literature—poetic prose, rhyme prose, prose poem , rhapsody, and prose poetry.

Another genre belonging to this category is pianwen (“parallel prose”), characterized by antithetic construction and balanced tonal patterns without the use of rhyme; the term is suggestive of “a team of paired horses,” as is implied in the Chinese word pian. Despite the polyphonic effect thus produced, which approximates that of poetry, it has often been made the vehicle of proselike exposition and argumentation. Another genre , a peculiar mutation in this borderland, is the baguwen (“eight-legged essay”). Now generally regarded as unworthy of classification as literature, for centuries (from 1487 to 1901) it dominated the field of Chinese writing as the principal yardstick in grading candidates in the official civil-service examinations. It exploited antithetical construction and contrasting tonal patterns to the limit by requiring pairs of columns consisting of long paragraphs, one responding to the other, word for word, phrase for phrase, sentence for sentence.

Chinese prose writing has been diverted into two streams, separated at least for the last 1,000 years by a gap much wider than the one between folk songs and so-called literary poems. Classical, or literary, prose ( guwen , or wenyan ) aims at the standards and styles set by ancient writers and their distinguished followers of subsequent ages, with the Confucian Classics and the early philosophers as supreme models. While the styles may vary with individual writers, the language is always far removed from their spoken tongues. Sanctioned by official requirement for the competitive examinations and dignified by traditional respect for the cultural accomplishments of past ages, this medium became the linguistic tool of practically all Chinese prose writers. Vernacular prose ( baihua ), in contrast, consists of writings in the living tongue, the everyday language of the authors. Traditionally considered inferior, the medium was piously avoided for creative writing until it was adopted by novelists and playwrights from the 13th century on.

Origins: c. 1400–221 bce

The oldest specimens of Chinese writing extant are inscriptions on bones and tortoise shells dating back to the last three centuries of the Shang dynasty (18th–12th centuries bce ) and recording divinations performed at the royal capital. These inscriptions, like those engraved on ceremonial bronze vessels toward the end of the Shang period, are usually brief and factual and cannot be considered literature. Nonetheless, they are significant in that their sizable vocabulary (about 3,400 characters, of which nearly 2,000 have been reliably deciphered) has proved to be the direct ancestor of the modern Chinese script. Moreover, the syntactical structure of the language bears a striking resemblance to later usages. From the frequent occurrences in the bone inscriptions of such characters as “dance” and “music,” “drum” and “chimes” (of stone), “words” and “southern” (airs), it can safely be inferred that, by the Shang dynasty, songs were sung to the accompaniment of dance and music, but these songs are now lost.

Chinese Literature

Chinese Literature is among the most imaginative and interesting in the world. The precision of the language results in perfectly realized images whether in poetry or prose and, as with all great literature, the themes are timeless. The Chinese valued literature highly and even had a god of literature named Wen Chang , also known as Wendi, Wen Ti.

Wen Chang kept track of all the writers in China and what they produced to reward to punish them according to how well or poorly they had used their talents. This god was thought to have once been a man named Zhang Ya, a brilliant writer who drowned himself after a disappointment and was deified. He presided not only over written works and writers but over Chinese script itself.

Ancient Chinese script evolved from the practice of divination during the Shang Dynasty (1600-1046 BCE). The pictographs made on oracle bones by diviners became the script known as Jiaguwen (c. 1600-1000 BCE) which developed into Dazhuan (c. 1000-700 BCE), Xiaozhuan (700 BCE to present), and Lishu (the so-called "Clerky Script", c. 500 BCE). From these also developed Kaishu, Xingshu, and Caoshu, cursive scripts which writers later used in prose, poetry, and other kinds of artistic works.

Exactly when writing was first used in China is not known since most writing would have been done on perishable materials like wood, bamboo, or silk . Scholar Patricia Buckley Ebrey writes, "In China, as elsewhere, writing, once adopted has profound effects on social and cultural processes (26)." The bureaucracy of China came to rely on written records but eventually writing was used for self-expression to create some of the greatest literature in the world. Paper was invented in c. 105 BCE during the Han Dynasty (202 BCE to 220 CE), and the process of woodblock printing developed during the Tang Dynasty (618-907 CE), and by that time China had already developed an impressive body of literary works.

Early Stories

The earliest written works in China are ghost stories and myths. Ebrey writes how early Han literature is "rich in references to spirits, portents, myths, the strange and powerful, the death -defying and the dazzling (71)". The Chinese were especially concerned with ghosts because the appearance of someone who had died meant that the living had somehow failed them, usually by improper honor in burial , and the dead would haunt the living until the wrong was righted. If the dead could not find their family, they would find anyone nearby.

One famous story is about five brothers who are visited by the ghost of a little girl. They cannot get rid of the ghost until they finally seal her in a hollow log, cap both ends, and throw it into the river. The ghost thanks them for giving her a proper burial and sails away. In another story, the ghost of a mother whose grave was defiled returns to tell her son and ask him to avenge her dishonor. The son does not question the vision for a moment and reports the event to the authorities, who apprehend the criminals and execute them. Ghost stories served to emphasize important cultural values such as the proper treatment of the dead and honoring one's fellow citizens.

A story which exemplifies this is a famous tale concerning a man named Commandant Yang . Yang had lived selfishly and caused great harm to many people without much thought. When he died and went to the afterlife he found himself in front of a tribunal. He was asked by the king of the underworld how he managed to have so many sins built up on his soul. Yang maintained his innocence and said he had done nothing wrong.

The king of the underworld commanded that scrolls be brought in and read. As Yang stood in judgment, a clerk read the date and time of his sins, who was affected by his actions, and how many died because of his decisions. Yang was condemned, and a giant hand appeared and crushed him into a bloody pulp.

In another tale, a man named Coffin Head Li is a bully who preys on cats and dogs. One day he is visited by two men dressed in dark purple robes. They tell him he has been condemned in the afterlife for his abuse of animals. Coffin Head Li refuses to believe them and asks who put them up to this joke. They tell him that they are ghosts, sent from the afterlife, and then produce an official document in which the souls of 460 cats and dogs have registered complaints against him for their abuse and death. Coffin Head Li is condemned and taken away. The abuse of living things, whether people or animals, was considered a grave sin against the community, and ghost stories about immoral acts by people such as Commandant Yang and Coffin Head Li served as cautionary tales of what happened to people who behaved badly.

Ghost stories were accompanied by myths about the Kunlun Mountains where the gods and great men of the past lived. These myths also expressed cultural values and impressed their lessons on audiences. One early myth concerns the demi-god Gun who tried to stop the great flood during the Xia Dynasty (c. 2070-1600 BCE). Gun fails and either kills himself or is exiled and the emperor appoints his son Yu to complete the job.

Yu understands that his father failed because he tried to do too much by himself without asking others for help, refused to respect the forces of nature, and had overestimated his own abilities. Yu learned from his father's mistakes and invited everyone to help him control the flood. By encouraging his neighbors' participation, and respecting their abilities and the power of nature, he succeeded and became known as Yu the Great who founded the Xia Dynasty and established the order of rule.

During the Han Dynasty, a very popular myth was the Queen Mother of the West. Ebrey writes:

Her paradise was portrayed as a land of marvels where trees of deathlessness grew and rivers of immortality flowed. Mythical birds and beasts were her constant companions, including the three-legged crow, the dancing toad, the nine-tailed fox, and the elixir-producing rabbit. (71)

The myth became so popular it grew into a cult, which forced the Han administration to commission shrines to the Queen Mother of the West and to acknowledge her worship as a legitimate faith. The popularity of the myth came from its promise of eternal life if one accepted the Queen Mother of the West into their hearts. Followers wore talismans representing her on strings around their necks and carried texts of the story. Ebrey writes, "This movement was the first recorded messianic, millenarian movement in Chinese history. It coincided with prophecies foretelling the end of the dynasty (73)."

In this time of uncertainty, the people latched onto a myth that upheld important values of the past; in this case, that value was permanence. The Han Dynasty might fall but, through faith in the Queen Mother of the West, the individual could continue to live eternally. The texts concerning her, which appear to have been very popular and widely circulated, were mainly hand-written in the Han Dynasty and afterwards. During the Tang Dynasty, though, a process became popular which would make written texts even more accessible to people and help preserve the cultural heritage of the country.

Woodblock Printing & Books

The Chinese produced poetry, literature, drama, histories, personal essays, and every other kind of writing imaginable all of which was done by hand and then copied. The creation of woodblock printing, which became widespread during the Tang Dynasty under the second emperor Taizong (r. 626-649 CE), made books more available to people. Before the invention of woodblock printing, any text had to be copied by hand; this process took a long time, and the copies were very expensive. Woodblock printing was a kind of printing press whereby a text could be copied quickly and easily by carving the characters in relief on wooden blocks which were then inked and pressed to paper.

This method allowed writers to reach a wider audience than they had previously. Even though the technology of woodblock printing had been known since the Qin Dynasty , it had not been used to any great extent. During the Tang Dynasty, poets like the great Wang Wei (l. c. 701-761 CE) were read and appreciated by people who would have never heard of his work before. Scholar Harold M. Tanner writes, "Wang Wei was not only a poet but also an accomplished painter. Some said that his paintings entered his poetry and his poems were suffused with the images of his paintings (189)." Most poets were also painters and Wang Wei's contemporaries created their own masterpieces equal to or greater than his.

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In the past, poets like Wang Wei were only read by the elite who could afford the books but, after woodblock printing became more commonplace, anyone with a little disposable income could buy a book. Those who did not have the money could find books at the library. This practice led to a dramatic increase in literacy in China and authors, essayists, historians, scientists, medical professionals, poets, philosophers, and every other kind of writer found they could reach wider and wider audiences with their work.

Literary Works

Chinese literary works are too numerous to list here, spanning some 2,000 years, but among the most influential are those of the Tang Dynasty. The greatest poet of the Tang Dynasty is Li Po (also known as Li Bai, l. 701-762 CE) whose work was so popular in his time that it was considered one of the Three Wonders of the World (along with Pei Min's ability with a sword and Zhang Xu's beautiful calligraphy). Thanks to the woodblock printing process, his work was widely distributed throughout China and over 1,000 of his poems have survived to the present day.

His close friend, Du Fu (also known as Tu Fu, l. 712-770 CE), was equally popular, and the two are regarded as the most important poets of the Tang Dynasty followed by Bai Juyi (also known as Bo Juyi, l. 772-846 CE). Bai Juyi's poem " Song of Everlasting Sorrow ", is a romanticized version of the tragic love affair of emperor Xuanzong (r. 712-756 CE) and Lady Yang. It became so popular that it entered the public school curriculum and students had to memorize it in part or in full to pass exams. This poem is still required reading in Chinese schools in the present day.

Older works of philosophers such as Confucius , Mo Ti , Mencius , Lao-Tzu , Teng Shih , and others from the Hundred Schools of Thought were also widely available from the Tang Dynasty onward. The most important of these philosophical writings, as far as Chinese culture is concerned, are the texts known as The Five Classics and The Four Books ( The I-Ching, The Classics of Poetry, The Classics of Rites, The Classics of History, The Spring and Autumn Annals, The Analects of Confucius, The Works of Mencius, The Doctrine of the Mean, and The Great Book of Learning) . Although these works are not 'literature' in an artistic sense, they were central to Chinese education and remain just as important in China today as they were in the past.

These nine works provided a cultural standard that people were expected to meet if they wanted to work for the government, and ensured a candidate was literate and qualified as one of the elite. On an aesthetic level, though, they were considered personally enriching and were read for self-improvement and simple enjoyment. The philosophers and poets of China created many important artistic works, which are still admired today and which contributed to and complemented the works of literary prose which were also produced.

The greatest prose master of the Tang was Han Yu (l. 768-824 CE), considered 'the Shakespeare of China', whose style influenced every writer who came after him. Han Yu is known as an essayist who advocated Confucian values and so is also regarded highly as a philosophical writer. Shen Kuo (l. 1031-1095 CE) was a polymath of the Sung Dynasty (960-1234 CE), whose writings on scientific subjects were extremely influential. Between the 14th and 18th centuries CE, literary fiction reached its heights through the Four Great Classic Novels of China: Romance of the Three Kingdoms by Luo Guanzhong (l. 1280-1360 CE), Water Margin by Shi Nai'an (l. 1296-1372 CE), Journey to the West by Wu Cheng'en (l. 1500-1582 CE), and Dream of Red Mansions by Cao Xueqin (1715-1764 CE). Of these four, Dream of Red Mansions is considered the greatest literary masterpiece in Chinese writing because of its style, theme, and scope. It was published in 1791 CE and has remained a best-seller in China ever since.

These works were read throughout China and those who could not read themselves would hear them read. Chinese script was adopted by Japan , Korea , and Vietnam, and became the basis for Khitan Script (Mongolia), Jurchen Script (of the Manchus), and the Yi Script of the indigenous people of Yunnan Province which differs from traditional Chinese script. Chinese literary works, along with The Five Classics and The Five Books, became the basis for the development of all these scripts and so Chinese thought significantly impacted these cultures. Books like Dream of Red Mansions or Romance of the Three Kingdoms became as popular in other cultures as they were in China and influenced themes of those cultures' literary works.

Scholar Harold M. Tanner writes how, through Chinese literature, especially poetry, we are invited into the world of the writer and experience life directly as "we read their descriptions of home and family, landscapes, palaces, and war , and as they speak out on behalf of the poor and the oppressed (187)". Ancient Chinese literary works are just as moving and impressive today as when they were written because, like any great literature, they tell us what we need to know about ourselves and the world we live in. Through their work, the great Chinese masters wrote about their personal experiences in life and, in doing so, gave expression to the whole human experience.

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Bibliography

• Ancient Scripts: Chinese Script by Lawrence Lo Accessed 1 Dec 2016.
• Ebrey, P. B. The Cambridge Illustrated History of China. Cambridge University Press, 2010.
• Owen, S. The Great Age of Chinese Poetry. Quirin Press, 2013.
• Tanner, H.M. China: A History, From Neolithic Cultures through the Great Qing Empire. Hackett Publishing Company, Inc., 2010.
• Wintle, J. The Timeline History of China. Barnes & Noble Books, 2005.
• Yun X. Tales and Traditions. Cheng & Tsui Publishers, 2007.

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Mark, E. (2016, April 11). Chinese Literature . World History Encyclopedia . Retrieved from https://www.worldhistory.org/Chinese_Literature/

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Mark, Emily. " Chinese Literature ." World History Encyclopedia . Last modified April 11, 2016. https://www.worldhistory.org/Chinese_Literature/.

Mark, Emily. " Chinese Literature ." World History Encyclopedia . World History Encyclopedia, 11 Apr 2016. Web. 18 Jun 2024.

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Chinese Literature: A Very Short Introduction

Associate Professor of Chinese and Comparative Literature

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Chinese Literature: A Very Short Introduction tells the story of Chinese literature from antiquity to the present, focusing on the key role literary culture played in supporting social and political concerns. Embracing traditional Chinese understandings of literature as encompassing history and philosophy as well as poetry and poetics, storytelling, drama, and the novel, this VSI discusses the philosophical foundations of literary culture as well as literature's power to address historical trauma and cultivate moral and sensual passions. From ancient historical records through the modernization and globalization of Chinese literature, lively examples underscore the close relationship between ethics and aesthetics, as well as the diversity of Chinese thought.

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Introduction to Chinese Literature

China possesses one of the world's major literary traditions. Its texts have been preserved for over 3,000 years. Reverence for the past has influenced the preservation of these cultural sources, and may have influenced the invention of woodblock printing in the 9th century and moveable type printing in the 12th century. The practice of collecting and reproducing libraries has also played a major role in the transmission of literary tradition. Most important, China can boast an unbroken cultural tradition based on the Chinese script as a language — a written medium — independent of spoken dialectic difference. As literary language became increasingly removed from spoken language, it became less vital and literature took a natural turn toward imitation. Indeed, after the formative classical period that began with Confucius, the literary history of China becomes one of imitation-with-variations of different models. Literature also thus becomes more elitist, for an understanding or appreciation of a text may require familiarity with the models being alluded to.

The principal genre of Chinese literature is poetry ; early folk songs established the shi ( shih ) form that crystallized during the Han dynasty and dominated for the next 1,200 years. Beginning with the simple complaints and longings expressed in rhymed couplets of folk songs, this form gradually became more and more complex, or "regulated," until it took years of study to master its formal rules of composition.

The short story , which began to develop during the Tang dynasty, at first emphasized either historical events or supernatural happenings which could not be related in a formal historical work. The notion of fiction as connected to history persisted, yet more imaginative and rationally inexplicable, culminating in China's greatest novel, The Dream of the Red Chamber or The Story of the Stone , which is at once autobiographical and realistic, and at the same time imaginative and mystical.

Drama , one of China's least well-developed genres, had its origins also in popular entertainment. The high point of elite drama was during the Yuan dynasty, when intellectuals dispossessed by the Mongol invaders turned to the composition of drama both to productively employ their taste and erudition and also to covertly criticize the foreign government. During the following centuries, dramas tended to become longer, and the opera dominated. Spoken drama was not generally conspicuous until the 20th century.

By the beginning of the 20th century, the movement to modernize and westernize China's literature became very popular. The formal classical language, which by then survived only in written texts, was replaced by the vernacular spoken language as a literary medium. Experiments with free verse and sonnet forms, short autobiographical stories and interior monologues, spoken drama and radio or film scripts were influenced by western models rather than by classical Chinese tradition. However, the theme of China's plight dominated 20th-century Chinese literature, and for the past six decades the pendulum has frequently swung back and forth between western imitation and modernized styles versus Chinese foundation and conservative techniques. Whereas classical Chinese literature was often valued for its craft and erudition, post-1919 Chinese literature has been evaluated largely in terms of its social and political relevance.

Much Chinese literature of the 1920s and 1930s both exposed national social problems and also expressed writers' doubts about finding viable solutions to these problems.

In 1942 Mao Zedong, in his "Talks at Yenan on Literature and Art," emphasized to his fellow communist revolutionaries that the goal of literature was neither to reflect the dark side of society nor to express the author's own private feelings or artistic inspirations. Instead, he said, literature and art should inspire the masses by presenting positive examples of heroism and socialist idealism. It should also be written in the public voice and style of the workers, peasants, and soldiers, not of the elite intellectuals.

During the Cultural Revolution period (1966-76), Mao's principle that literature and art should serve the people and promote socialism was most rigidly adhered to. The fiction of Hao Ran (Hao Jan) constitutes an excellent example of this tendency.

Literature After 1976

With the death of Mao Zedong in 1976 came the official end of the Cultural Revolution period, and with it increased freedom for writers. During the subsequent decade, Chinese fiction tended to fall into the following five (necessarily overlapping) categories:

1. Literature of the Wounded

The initial impulse of writers was to begin, tentatively at first, to express the profound suffering of the previous decades. Chen Roxi's stories in The Execution of Mayor Yin and Other Stories offer an example of very well-crafted fiction which reveals the physical, psychological and spiritual pain the Chinese people endured under Mao. But finally, Chen Roxi must be considered a foreigner, though she is Chinese and she lived in China during the Cultural Revolution era.

Within China, the "literature of the wounded" movement began in the summer of 1977 when Lu Xinhua, a 23-year-old student at Fudan University, presented a story entitled "The Wounded" as a big-character poster on the walls of the campus. The story was soon published, and it inspired hundreds of others. Another one which became equally famous was Liu Xinwu's "Class Counselor," published in November 1977. In Liu's story, the young girl fails to achieve a reconciliation with her mother, whom she had been forced to denounce during the Cultural Revolution. An open-minded class advisor recognizes that there is still hope for the generation of youth who suffered at the hands of the Gang of Four. For several years, story after story poured out the guilt, regret, and pain over lost lives and ruined careers, betrayal of friends and family members, and the need to seek restitution. Within the "wounded" tradition, though not literature per se, a number of Chinese have written accounts of this tragic period for Western audiences.

2. Humanistic Literature

A related literary trend which began in the late 1970s and early 1980s was fiction which treated the problems of recreating the whole person after the constricting movements of the Cultural Revolution. A large number of women writers predominate in this category.

Since personal feelings were supposed to be subordinate to political action during the Cultural Revolution, writers who reacted in the opposite direction after the death of Mao used the rally cry, "Love Must Not Be Forgotten" — the title of one of Zhang Jie's short stories advocating marriage based only on love and private desire.

3. Social Criticism

Finally allowed once again to treat in fiction the darker side of Chinese society, many writers composed works which addressed post-Cultural Revolution social problems: alienated youth, the loneliness of the elderly and the divorced, the housing shortage, government corruption, dissatisfaction with the system of job assignments, etc. In a bold social indictment, Bai Hua in his screenplay, "Unrequited Love," has the protagonist's daughter ask the fundamental question: "Dad, you love our country. Through bitter frustration you go on loving her . . . But, Dad, does this country love you?" This script first appeared in 1979, and by 1980 it was banned.

4. Seeking Roots

Some writers, especially those who live outside the main cities, have turned to local themes and subject matter in their recent fiction. For example, Lu Wenfu describes the customs of the Suzhou region and Gao Xiaosheng depicts agricultural life in his native Hunan province. These people are seeking a meaning in life separate from political movements and urban upward mobility.

5. Reportage

Some writers feel that the most important contribution they can make is to record the facts of Chinese life in a way that illuminates both the problems and strengths of the Chinese people. The most famous journalist who exposes corruption in his sophisticated reporting style is Liu Binyan, whose "People or Monsters?" was acclaimed for its unflinching honesty in confronting deeply rooted government corruption.

In a different tone, Chinese Profiles, compiled by Zhang Xinxin and Sang Ye, presents interviews with 100 Chinese citizens who tell about their lives in a way similar to people interviewed by Studs Terkel. Their stories are poignant and surprising as individual accounts. They illuminate the rich social fabric of China and indirectly point out major social and political issues implicit in the individual accounts.

Acknowledgment: The consultant for this unit was Dr. Marsha Wagner, Columbia University.

Let your curiosity lead the way:

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Modern and Contemporary Chinese Literature

Global studies 342.

Chinese American Literature

Jan 03, 2020

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Chinese American Literature. First period (from the end of the 19th century to 1960s).

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First period (from the end of the 19th century to 1960s) • 19th century Chinese American literature has only recently come to be studied, as much of it was written in Chinese. These Chinese-language writings of Chinese Americans immigrants have only recently been made available • 19th century Chinese American writers were primarily workers and students. • These early Chinese American authors produced autobiographies as well as novels and poems, mostly in Cantonese. • Island : Poetry and History of Chinese Immigrants on Angel Island《埃伦诗集 1910-1940》

Yan Phou Lee（李恩富）When I was Boy in China 《我在中国的童年时代》1887 Yung Wing (容闳)the first Chinese student to graduate from an American University (Yale, in 1854), whose autobiography, My Life in China and America《我在中国和美国的生活》, was published in 1909.

Sui Sin Far (Edith Eaton)(水仙花) • Mrs.Spring Fragrance《春香太太》1912 • Pardee Lowe (刘裔昌) Father and Glorious Descendant 《虎父虎子》1943 • Jade Snow Wong(黄玉雪) Fifth Chinese Daughter《华女阿五》1945

Chin Yang Lee (黎锦杨)Flower Drum Song《花鼓歌》 • Virginia Lee (李金兰) The House That Tai Ming Built《太明所建之屋》 • Betty Lee Sung (宋李瑞芳) Mountain of Gold《金山》

Louis Chu（雷庭招）Eat a Bowl of Tea《吃碗茶》1961

Second period (1960s-1980s) • ABC- American Born Chinses • Civil Right Movements

Kai-yu Hsu（许芥昱） & Helen Palubinskas(海伦·帕卢宾斯克斯) • Asian-American Authors《美国亚裔作家选》 • Frank Chin（赵建秀）, Jeffrey Paul（陈耀光）, Shawn Hsu Wong（徐忠雄） • Aiiieeee! An Anthology of Asian-American Writers《哎呀！美国亚裔作家文集》

Maxine Hong Kingston汤亭亭 • The Woman Warrior《女勇士》 • China Men《中国佬》 • Tripmaster Monkey: His Fake Book《孙行者》

Third period (1989-) • Amy Tan (谭恩美) • The Joy Luck Club《喜福会》1989 • Kitchen God’s Wife《灶神之妻》1991 • A Hundred Secret Senses《通灵女孩》1995 • The Bonesetter’s Daughter《接骨师之女》2001 • Saving Fish from Drowning《拯救溺水鱼》2005

Gish Jen (任碧莲)Mona’s Promised Land《莫娜的希望之乡》1996 • David Henry Hwang（黄哲伦） • M. Butterfly《蝴蝶君》1988 • Fae Myenne Ng伍慧明 Bone《骨》1993

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Classical Chinese Literature - Doctor of Philosophy (Ph.D.) in Chinese

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• Published: 14 June 2024

NeuroBehcet’s-related intracranial hypertension without cerebral venous thrombosis: case report and review of literature

• Jinesh Mukesh Shah 1 ,
• Warren Fong 2 &
• Deidre Anne De Silva 1  

BMC Neurology volume  24 , Article number:  203 ( 2024 ) Cite this article

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We present a rare case of NeuroBehcet’s-related intracranial hypertension without cerebral venous thrombosis (NBrIHwCVT), occurring as the first presentation of NeuroBehcet’s. In addition, we describe the novel use of subcutaneous tocilizumab for this indication. This is followed by a review of the literature on this topic.

The patient was a 28-year-old lady of Southern Chinese origin with a known history of Behcet’s disease with oral ulcers and ocular findings for which she was on mycophenolate mofetil and adalimumab. She presented with a headache and bilateral disc swelling associated with an intracranial pressure (ICP) of > 40cmH20. There were no structural lesions or cerebral venous thrombosis (CVT) on imaging. Initial lumbar puncture had raised leucocytes and protein. We discuss diagnostic challenges given persistently elevated ICP despite subsequent non-inflammatory cerebrospinal fluid (CSF) profiles and non-response to acetazolamide. She eventually showed a response to immunosuppressant therapy in the form of pulsed methylprednisolone, cyclophosphamide and subsequently subcutaneous tocilizumab, supporting the diagnosis of NBrIHwCVT. Complete normalization of ICP remains challenging. Her disease course was severe, unusual for her ethnicity.

Literature review

We identified 34 patients (including ours) from 14 publications. We found that the majority of NBrIHwCVT patients were young (average age of 34 years), with a slight female preponderance. Of the 17 cases in the literature with available data on CSF profile, none had raised leucocytes whilst one patient had elevated protein. Patients were generally treated with steroids and occasionally azathioprine, in line with the suspected autoimmune pathophysiology. Of 22 patients with data on outcome, six (27%) were noted to have recurrence of symptoms generally occurring a few months later.

As demonstrated by this case, NBrIHwCVT can present with BD with raised ICP even if there is no prior history of NB, central Asian ethnicity, cerebral venous thrombosis or features of inflammation on the CSF. We demonstrated how novel use of Tocilizumab may have a role in the management of NBrIHwCVT. Based on our literature review, patients were more likely to be young, female, display a non-inflammatory CSF picture, be treated with steroids and harbour a possibility of recurrence.

Peer Review reports

A 28-year-old lady of Southern Chinese origin with a history of Behcet’s disease (BD) presented with a new onset of headache. For five years prior, she experienced symptoms of recurrent oral ulcers and ocular findings (panuveitis with cystoid macular oedema). She had been first treated with steroids for four years before they were stopped 11 months prior to presentation in view of bilateral posterior subcapsular cataracts, hypertension and weight gain (weight of 94.5 kg (BMI 37.4) around the time steroids were stopped compared to her baseline of about 70 kg, Table  1 ). She had been on methotrexate for two and half years before a change to mycophenolate mofetil (MMF) two months prior to presentation. She was also on adalimumab for the last two years. However, her ocular disease (inflammation and oedema) was not well-controlled, suggesting inadequate immunosuppression. Other than calcium and Vitamin D, there was no supplemental medication use including traditional medications.

Two weeks prior to current presentation, she had developed gradual onset of holocranial headache, of pressing character, moderate to severe intensity, without postural variation lasting one week which then resolved. There was no nausea or vomiting, new visual disturbances, or other focal neurological deficits. Systemic review was unremarkable for symptoms of infection, sleep apnoea, urinary or bowel disturbances, new arthralgias, orogenital ulcers or recent vaccination. There was no recent weight gain, with her weight actually having dropped 6 kg (BMI now 34.9) over the last nine months (Table  1 ). At a routine review, asymmetrical disc swelling was detected (optical coherence tomography retinal nerve fibre layer (OCT RNFL) disc thickness 331 μm and 194 μm on right and left respectively) (normal is 102 ± 7 μm) [ 1 ]. Humphrey’s visual field testing showed an enlarged blind spot bilaterally with normal confrontational testing. There was a right eye grade 1 relative afferent pupillary defect. Neurological examination was unremarkable with regards to cranial nerves, tone, reflexes, power, sensation, and cerebellar function. Contrasted MRI of the brain, orbit and venogram was normal. There were no radiological features of IIH such as flattened optic discs, tortuous optic nerves, enlarged Meckel’s caves, empty sella or acquired tonsillar ectopia. There were also no orbital or intracranial lesion, enhancement, hydrocephalus, or venous thrombosis. Lumbar puncture (LP) showed an opening pressure > 40 cmH20, 151 leucocytes (mainly lymphocytic) without erythrocytes, glucose 2.7 mmol/L (capillary glucose was 7.4mmol/L) and protein was slightly raised at 0.56 g/L. Cerebrospinal fluid (CSF) screen for bacteria, viruses, tuberculosis, fungi, cryptococci was negative. CSF flow cytometry showed large B cells. CSF cytology did not show malignancy. Serum biochemistry, erythrocyte sedimentation rate, inflammatory markers, angiotensin converting enzyme levels were normal.

The impression was that of a lymphocytic meningitis with severely raised intracranial pressure (ICP), on background of BD. Given uncertain etiology and potential morbidity, the treatment approach was broad. She was covered with antimicrobials until the infective screen returned negative. As an inflammatory, possibly autoimmune process related to her BD could not be ruled out, her immunosuppressive treatment was consolidated with initiation of prednisolone 60 mg OM whilst adalimumab and MMF were held off. Idiopathic intracranial hypertension (IIH) was considered as a differential given significantly elevated pressures and the patient’s body habitus; and she was empirically treated with oral acetazolamide. She was initiated on a dose of 250 mg thrice daily, with plans to up-titrate to IIH treatment dosing of 500 mg twice a day, and even higher if indicated.

A targeted second LP was repeated six days later in view of large B cells in previous CSF flow cytometry. It showed an opening pressure of 36.5 cm H20 and resolution of raised protein (0.29 G/L). The cell count was not rechecked. Flow cytometry did not show clonal proliferation.

After an initial improvement in disc swelling, the prednisolone was downtitrated (refer to Table  2 ). The acetazolamide had to be stopped due to metabolic acidosis. An LP was once again repeated which confirmed there was no clonal proliferation. Opening pressure was 36.5 cm H20, however there were no elevated CSF leucocytes or protein.

The differential diagnosis at this point included an autoimmune cause possibly NeuroBehcet’s (NB)-related inflammatory process and IIH. The diagnosis of IIH was mainly supported by her obese habitus. However, compared to nine months prior to her presentation when her BMI was at its peak and her steroids had been also stopped, at the time point when she eventually presented her BMI had dropped 2.5 points and had been on an overall downward trend. This downward weight trend was not supportive of a new development of IIH). Furthermore, the headache was not prominently associated with the raised ICP, lymphocytic meningitis is inconsistent with IIH, and imaging was not supportive of IIH. Nonetheless she had persistent disc swelling (OCT RFNL 177 and 163 μm) and raised ICP. Given the lack of alternatives, she was re-trialed on acetazolamide at a low dose, which was subsequently increased. She was restarted on adalimumab and MMF which were then uptitrated, whilst prednisolone was weaned off.

Ten months after her initial presentation, she complained of daily headaches, occurring in association with bilateral mildly limited abduction, orogenital ulcers and left eye uveitis, again suggesting inadequate control of the underlying BD. A LP was performed showing an opening pressure was 41 cmH20 but CSF was otherwise bland (protein was 0.33G/L and 2 white cells).

The decision was made to treat her as NeuroBehcet’s-related intracranial hypertension without cerebral venous thrombosis (NBrIHwCVT) given her background of BD, initial lymphocytic meningitis, and lack of response to acetazolamide rather than IIH. Therefore, she was pulsed with steroids, followed by cyclophosphamide whilst non-steroid immunosuppressants were stopped. About a month after the prior LP, she showed an early response to high dose steroids and intravenous cyclophosphamide, with pressure decreasing to 34.5 cmH20. Headache, vision and OCTs (158/142) continued to improve as she was completing her cyclophosphamide with down-titrating prednisolone. However, she still had bilateral active ocular Behcet’s after 6 cycles of cyclophosphamide. After consideration, a novel treatment approach was initiated with weekly subcutaneous Tocilizumab. After a month of tocilizumab, the opening pressure had further declined to 30 cmH20, demonstrating apparent significant response to immunosuppressive therapy, further confirming the diagnosis of NBrIHwCVT. This was associated with gradually decreasing disc swelling OCTRFNL values over the next few months. The ocular BD also showed some improvement with regards to her retrolental inflammation and peripheral vasculitis. After seven months of tocilizumab, the ICP remained similar (31.5 cm H20). The maintenance of ICP at about 30–31 cm H20 even seven months later, and a decrease in OCT RFNL thickness points to efficacy of Tocilizumab in the absence of cyclophosphamide action. However, further attempts to bring down her ICP remains challenging despite trial of multiple immunosuppressant agents. Acetazolamide was also continued however, its effect on the ICP was likely limited given ICP remained unchanged at three times a day dosing.

Review of the literature

NB is an uncommon manifestation of BD affecting < 10% of patients with the disease [ 2 ]. It is generally divided by the presence or absence of parenchymal involvement. Raised ICP in NB generally occurs in association with cerebral venous thrombosis, occurrence without thrombosis is rare [ 3 ], as evidenced by limited case reports.

We searched for publications on PubMed and Google Scholar with various combinations of ‘Behcet’, ‘NeuroBehcet’s’, ‘intracranial hypertension’, ‘raised intracranial pressure’ and ‘without cerebral venous thrombosis’. Publications not in English were excluded. Paediatric patients and patients who subsequently developed CVT were excluded. Cases were also excluded if there was uncertainty on adequacy of imaging to exclude CVT as well as no documentation of performed LPs. We identified 14 publications, with 34 patients including ours. Information on demographics, imaging modality, exclusion of parenchymal lesions, CSF pressure, exclusion of CSF inflammation, treatment given and/or outcome was tabulated (Table  3 ). The majority, barring seven patients, had incomplete data. Of note, there was a recent review of reports from 18 patients inclusive of paediatric cases.

Our literature review revealed that the majority of NBrIHwCVT patients were young (third to fourth decade of life, with an average age of 34 years), with a slight female preponderance (12 of 20 patients with available data), in keeping with our patient’s demographics. Interestingly, our review found that in patients for whom we have details of presentation all the patients had presented with NBrIHwCVT as first presentation of NB. We found that of the 17 cases in the literature (not including ours) with available data on CSF profile, none had raised leucocytes whilst one patient had elevated protein; this non-inflammatory CSF profile was similar to our case. A non-inflammatory CSF however, would be contrary to the expected findings for NBrIHwCVT which is thought to be immune-mediated. This may make diagnosis challenging. Our case also highlighted an interesting point, where after the first lumbar puncture, subsequent LPs have all been bland with, however, persistently raised CSF pressures, suggesting that CSF findings may depend on the timing of the LP. The diagnosis of NBrIHwCVT would need to be made assimilating both CSF profile as well as other clinical features, underscoring the challenging diagnostic process.

Patients were generally treated with steroids and occasionally azathioprine, in line with the suspected autoimmune pathophysiology. The use of Tocilizumab, an IL-6 recombinant humanized anti–IL-6 receptor monoclonal antibody was not reported in any of the cases in the literature review. None of the patients were treated with anticoagulation.

Only 22 patients had data on outcome, of which six (27%) were noted to have recurrence of symptoms generally occurring a few months later based on the limited data available. However, there is insufficient data to draw definite conclusions on typical disease course of NBrIHwCVT. Our patient’s disease course would be considered quite refractory and severe, failing to respond to multiple immunosuppressive agents and was unlike the course of BD and NB previously reported in Southern Chinese [ 4 ].

As demonstrated by this case, intracranial hypertension secondary to NeuroBehcet’s can present with BD with raised ICP even if there is no prior history of NB, central Asian ethnicity or cerebral venous thrombosis. We demonstrated how novel use of Tocilizumab may have a role in the management of NBrIHwCVT.

The pathophysiology of BD involves alteration of cellular immunity and cytokines, the latter which includes IL-6 [ 5 ] which plays an essential role in BD [ 6 ] whilst the pathophysiology of NB remains unknown [ 6 ]. IL-6 is a multifunctional cytokine involved in immune regulation, hematopoiesis, inflammation, and neural development, and it has a major role in the brain’s response to injury [ 6 ]. Liu et al. described that the pro-inflammatory cytokines produced by infiltrating T lymphocytes and monocytes, such as IL-6, might result in neuronal apoptosis [ 6 ]. The pathophysiology of NBrIHwCVT is not well understood. It has been suggested that there may be an immune-mediated impairment of CSF re-absorption across arachnoid villi and this explanation is supported by the good clinical response to immunosuppression. Another possibility might be inflammation of the venous sinus wall [ 7 ].

For BD-related neurologic disease including manifestation such as meningitis and myelitis and not specifically NBrIHwCVT, Tocilizumab has been described to be an effective alternative to conventional treatment options e.g. anti-TNF agents [ 8 , 9 ]. Recognized treatment options for parenchymal NB include steroids, azathioprine, anti-TNF-α agents and cyclophosphamide whilst anti-IL6 agents have limited clinical evidence [ 10 ]. With regards to treatment options for non-parenchymal BD, we can consider the example of, i.e. BD-related cerebral venous sinus thrombosis. This condition is treated with steroids and anticoagulation acutely whilst azathioprine, cyclophosphamide, cyclosporin and anti-TNF-α agents can be considered in relapsing cases [ 10 ]. Lastly, patients with BD with arterial disease as an example of vascular involvement are typically treated with steroids and cyclophosphamide, with small studies reporting improvement with tocilizumab [ 11 ]. As such, Tocilizumab may have a potential role in treating raised ICP secondary to NB, increasing treatment options for clinicians in future and it would make our case an important contribution to the literature.

Data availability

No datasets were generated or analysed during the current study.

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https:// www.uptodate.com/contents/treatment-of-behcet-syndrome?search=behcet%20pathophysiology &topicRef=8223&source=related_link#H67007445

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Department of Neurology, National Neuroscience Institute, Singapore General Hospital Campus, Singapore, Singapore

Jinesh Mukesh Shah & Deidre Anne De Silva

Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore

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JS helped to write the manuscript.WF helped in review of the manuscript.DADS helped to structure and review the manuscript.All authors reviewed the manuscript.

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Correspondence to Jinesh Mukesh Shah .

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Shah, J.M., Fong, W. & De Silva, D.A. NeuroBehcet’s-related intracranial hypertension without cerebral venous thrombosis: case report and review of literature. BMC Neurol 24 , 203 (2024). https://doi.org/10.1186/s12883-024-03708-x

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Received : 16 February 2024

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Published : 14 June 2024

DOI : https://doi.org/10.1186/s12883-024-03708-x

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• Behcet’s disease
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• Cerebral venous thrombosis
• Idiopathic intracranial hypertension
• Tocilizumab

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