Toxic Remedies: On the Cultivation of Medicinal Plants and Urban Ecologies

Abstract

Growing concerns with air-pollution, contaminated drinking water, and deteriorated sewerage infrastructures contributed to an increasing environmental awareness in Vietnam during the past decade. At urban sites, such as herbal gardens in Hanoi, these ecological concerns converge with medicinal itineraries of East Asian herbal medications and the health of a rising middle-class. In these emerging chemosocial configurations, public health becomes an environmental issue, and the city holds out the promise of a resilient space of planetary health. To illustrate such lateral movements, this article focuses on the cultivation and transplantation of medicinal plants in central Hanoi. Thinking through the question of how people and herbs come to cultivate and be cultivated by one another, I argue, helps to understand the public health stakes of chemosocial infrastructures in a rapidly urbanizing Vietnam and, more generally, in urban transformations throughout Asia. At stake both in the transformation of plants into pharmaceutical products and in the modes of transplanting knowledges and methods from one world (or discipline) to another is the lateral mobility between East Asian medical practices and STS methodologies.

Keywords:

• Vietnam chemosocial infrastructures
• East Asian medicines
• urban gardening
• pharmaceutical pollution
• lateral ethnography

Lãn Ông street – also known as the “Herbal Street” – in Hanoi’s Old Quarter does not strike you as a particularly future-oriented neighborhood. Located conveniently within walking distance from the central market, north of Hoàn Kiếm Lake, it is a shopping quarter that specializes in selling and buying Chinese medicinal materials. A bitter-sweet aroma of herbal plants and the scenery of exotic animal products mark the area by setting the vending streets off from the surrounding blocks and the quiet residential alleys behind them. The vendors sell plant-based medicines either from big bags stacked at their storefronts and spilling over the pedestrian walk, or from medicine chests located deep inside the buildings in small private herbal clinics.

A former Chinatown populated by ethnic Chinese, the neighborhood had been called Fujian Street – after its settlers originally from Fujian Province – but later it was renamed after the famous 18th century Vietnamese herbalist, Hải Thượng Lãn Ông Lê Hữu Trác (1720–1791). That being said, the retailers and wholesalers operating their little shops in the street sell slightly more Chinese herbal commodities than local remedies.¹ Lãn Ông is part of a network of specialized craft streets that has developed through the centuries from the areas designated for artisans producing and selling similar goods. Urban transformation here has always been intertwined with a wide array of medical substances and the health of Hanoi’s multi-ethnic inhabitants.²

The last time I visited Lãn Ông in the spring of 2019 with my expert guide Ms. Đặng Châm,³ it was a sunny day and the streets were filled with boxes of herbal extracts as well as raw medicinal plants – leaves, stems, roots, seeds or barks – piled up on the pavement making it difficult to walk from one shop to the next. In some pharmacies, the owners were in the middle of processing raw plants or packaging the final products; in others, Chinese doctors were taking the pulse of their customers or they were just chit-chatting over a cup of tea. While I was trying to figure out some order in this chaotic medicinal cascade, Ms. Đặng kept reminding me of the low quality of these imported herbal products. She had studied Vietnamese medicine in Hanoi and ran a small herbalist practice at her home on the outskirts of the downtown. She was disappointed by the inefficacy of the remedies sold by these vendors and took every chance to voice her concern about the high levels of toxicity found in imported pharmaceutical products.

As we were exiting a small shop, she did not forget to mention, again, that several of the raw plants in the bags were probably not even registered by the public health authorities, but nevertheless made their ways to Vietnam outcompeting local brands. Then, she pointed at the smartly packaged herbal extracts lined up on a different shelf. “They advertise them as natural products, but in fact they are all full of chemicals,” she told me. And, indeed, that is exactly what the information label of each drug stated. The natural ingredients of these plant-derived products were listed on the boxes as chemically active organic compounds, such as methyl salicylate (C₈H₈O₃) in an anti-inflammatory mixture for pain relief.

Toxic or therapeutic – and everything in between – “chemicals” are part and parcel of the metabolic infrastructures that are at the focus of this article. From heavy metals, such as cadmium (Cd), mercury (Hg) and arsenic (As) in industrially polluted soils to the polychlorinated biphenyls (PCBs) and organochlorine pesticides often employed in the commercial cultivation of herbs, to a large variety of denatured alcohols and other chemicals widely used in the extraction process, medicinal plants in Hanoi are loaded with chemical elements or compounds that come into contact with an already chemically complex and diverse plant metabolism. As medical anthropologist Harris Solomon suggests, engaging with these “material forces that interlink bodies and their surrounding space” (Solomon 2016: 75) helps us to understand cities as assemblages of social and ecological, as well as scientific and technological processes. Transforming urban landscapes throughout Asia, and beyond, have been characterized by the expansion of chemosocial infrastructures into the daily life of people in cities (Choy 2011; UNEP 2013). From sewage systems to waterworks to plastics – infrastructures are now our bodies (see e.g. Jensen 2016; Lancione and Colin 2016; Pathak and Nichter 2019; Schwenkel 2015). Plant-based medicinal products, too, are important elements of such chemically embodied infrastructures, as I will discuss below. At these pharmaceutical crossroads, the health of the planet and our bodies become entangled in an experimental mode of cohabitating each other’s increasingly toxic worlds.

One does not have to be either a radical environmentalist or a health-conscious vegan, like Ms. Đặng, to pay close attention to the increasingly inextricable links between the health of our bodies and the planet. After recent decades of genetic hype and personalized medicine, it now seems obvious that human health is anything but an individual issue (see e.g. Fujimura 2018; Tutton 2014). Among other things, the growing interest in the gut as a microbial niche and emerging alliances around the new field of “planetary health” (Horton et al. 2014), offer constant reminders that our bodies are both interspecies crossroads and organic elements of chemosocial infrastructures.⁴ Urban sites, such as regenerated landfills and experimental gardens, are places where such medical and ecological itineraries converge. In these emerging material configurations, the health of cities becomes an environmental issue and vice versa.

In this article, I focus on the cultivation and transplantation of medicinal plants in central Hanoi. I argue that the mobility of herbs, a rather unusual suspect of urban transformation, is embedded in emergent chemosocial itineraries that, in turn, may serve as an entry point for exploring the technosocial entanglements of urban ecologies and human bodies. Thinking through the question of how people and medicinal plants come to cultivate and be cultivated by one another, I argue, helps to understand the public health stakes of climate change in a rapidly urbanizing Vietnam and, more generally, in urban transformations throughout Asia. How do medicinal plants become agents of chemosocial futures and urban metabolisms? How does the material flow of pharmaceuticals and other chemicals create new knowledge practices and, perhaps, more resilient forms of multi-species togetherness across different medical traditions? To tackle these questions, I draw upon the early phase of an unfolding ethnographic study that I have been conducting in short periods since 2017 in Hanoi and Lạng Sơn province – c.100 kilometers northeast of the capital – with environmental activists and entrepreneurs, medical practitioners of both Vietnamese and allopathic medicine and farmers of herbal plants.

But before I take up these matters, let me set the methodological stage by considering what it might mean to materialize East-Asian-medicine-as-a-method.⁵

1 Medicinal Itineraries

In a recent line of work informed by Actor-Network Theory (ANT), it has been proposed that traditional Chinese Medicine offers a possible conceptual stage for engaging with methodological issues in science and technology studies (STS), anthropology and medical history. Deep-rooted concepts of Chinese thought, and medicine have been mobilized in an attempt to rethink contemporary debates in these fields through an object of their pursuit, i.e. medical science. Anthropologist Mei Zhan (2014), for instance, has explored the notion of jingyan (roughly translated as “experience”) to unsettle relations between the empirical, the experiential and the conceptual as conditions for thinking, doing and being in the world in Euro-American epistemological traditions. Building on the comparative work of the French sinologist and philosopher François Jullien (1995), STS scholars Wen-yuan Lin and John Law used the concept of shi (“propensity”) to argue for a more fluid understanding of science capable of taking into consideration heterogenous materialities and techniques (Law and Lin 2017; Lin 2017). “The world and its propensities,” they wrote, “are not fixed, cannot be pinned down, [they] are contextual and therefore elusive to representation” (Law and Lin 2017: 221).

In contrast to more conventional historical and clinical studies that compare Western and Eastern medicines,⁶ these efforts illustrate both the challenges and potentials of what in the Introduction to this special issue has been called “lateral comparison.” Anthropologists have long been interested in mobilizing indigenous concepts in their theoretical and comparative work.⁷ More recently, a long-standing preoccupation with symmetry in science and technology studies has found fertile ground in these debates.⁸ Cultivating a sort of attentiveness to locate concepts and practices of, for example, Chinese medicine alongside other – and seemingly unrelated – methodological registers in Euro-American social and human sciences holds out the promise of a comparative perspective in which academic analysis and worldly practices transform each other (Gad and Jensen 2016).⁹

But what might be at stake in conducting such comparisons in the first place? On the one hand, as a result of these lateral strategies in anthropology and STS, it is increasingly clear that social scientific methods are bound up with ethnographic landscapes, such as postcolonial medicine or urban transformations (Chiang 2017; Farías and Blok 2016). On the other hand, there is a growing recognition that comparisons, from clinical trials to environmental conservation projects, often take material and infrastructural forms which themselves intervene in the transformation of urban landscapes (Choy 2011; Wahlberg 2008). These two important facets of lateral comparison can both be illustrated with reference to the present consideration of medicine in Asian urban contexts.

Urbanization from below has been depicted as an ethnographic context of East Asian medicine in a series of important works in the past decades. Margaret Lock’s classic monograph East Asian Medicine in Urban Japan (1980), for instance, draws on ethnographic research at cosmopolitan clinics and herbal pharmacies in Kyoto to explore the co-construction of medical knowledges and urban landscapes. Judith Farquhar and Qicheng Zhang’s Ten Thousand Things: Nurturing Life in Contemporary Beijing (2012) takes the reader on a journey through contemporary Beijing and makes the argument that self-health practices of yangsheng (“nurturing life”) are instrumental in urban transformations.

At the same time, as Zhan (2009) has shown so eloquently, the changing worlds of East Asian medicine are anything but geographically constrained. Her monograph, Other-Worldly: Making Chinese Medicine Through Transnational Frames (2009), is an ethnographic study of the “worlding” of Traditional Chinese Medicine (TCM). TCM is depicted here as a translocal phenomenon that performs cultural difference in scientific and commercial practices, as well as different urban landscapes. Most of Zhan’s fieldwork was conducted in clinical and research settings in Shanghai and San Francisco. Thus, the ethnography itself is embedded in a quasi-comparative urban framework. We learn that practitioners of TCM on both sides of the Pacific constantly contrast the modes and efficacy of their own healing methods and remedies with those of allopathic interventions. This comparison with biomedicine, Zhan tells us, is not only formative of clinical practice, but also integral to therapeutic success at these hospitals (Zhan 2009: 109). The emergent worlds of Chinese medicine are therefore always on the move, as “traveling comparisons”¹⁰ between East Asian and other affective urban landscapes, cosmopolitan lifestyles and healthcare infrastructures. Comparison here is an ethnographic method precisely to the extent that it is a series of scientific and/or diagnostic practices. They are shaping and transforming the worlds of urban medicine and healthcare that, in turn, become the objects of anthropological analysis.

A closer examination of the STS literature on herbal products in East Asia offers a vivid illustration of how these lateral topologies are brought about by complex material itineraries. Consider, for instance, the infrastructural politics of Tibetan pharmaceuticals explored by Saxer (2013). His Manufacturing Tibetan Medicine is an anthropological account of Sowa Rigpa – or Tibetan medicine – an assemblage of East Asian and Ayurvedic medical knowledges, indigenous healing traditions of the Himalayas, and, importantly, medicinal plants that circulate between geographic and epistemological spaces. As a consequence of China’s entry to the World Trade Organization in 2001, the industrial production and global trade of these herbal products, the scientific protocols that underpin international patent regulations, and the cross-border trade of raw materials have become agents that reshape Tibetan moral worlds. In what we might call “pharmaceutical itineraries,” authenticity transcends cultural, political, environmental and academic boundaries. They also challenge any simplistic or idealistic notion of “traditional medicine.”

In a related fashion, Wahlberg (2008, 2014) and Monnais (2019), among others, have shown the entanglements of mass produced standardized herbal extracts with revolutionary movements and processes of nation building in Vietnam. Rather than simply being colonized by biomedicine, Wahlberg explicates, herbal medicine has become a vital aspect of metropolitan life in contemporary Hanoi and Ho Chi Minh City “via an ethno-botanical taming of the countryside, a phytochemical effort to molecularly characterize and standardize herbal remedies into capsules or pills, and a pharmacological search for plausible mechanisms of action … that account for and standardize the workings of the ‘living laboratories’ that plants have been shown to be” (Wahlberg 2008: 55).

From this follows an important question that animates the rest of the present article. If, indeed, herbs – native to East Asian habitats and medical repertoires – are becoming pharmaceuticals – that are standardized to treat or prevent biomedically recognized disorders – where does this leave East-Asian-medicine-as-a-method? At stake both in the transformation of plants into synthetic pharmaceuticals and in the modes of transplanting knowledges and methods from one world (or discipline) to another is the fluidity of scales, which, as we know from de Laet and Mol (2000), is indeed also lateral: as much conceptual as material and affective.

2 When Chemosocial Infrastructures Leak

Ms. Đặng was probably more right than she realized when she told me that the herbal products imported from China and sold on Lãn Ông street were not free of chemicals. Considering the legacy of US chemical warfare – including herbicide spraying of forests and napalm bombing of villages in Central and Southern Vietnam – in the 1960s (Uesugi 2016), and the introduction of agricultural chemicals on a massive scale during the years of the Green Revolution, raw herbs free of synthetic chemicals are now in the realm of scarce resources in the country. But in relation to the urban orientation of this special issue, we might also want to ask: what might it even mean to be “chemical-free” in a metropolis like Hanoi?

Following two decades of war and a long period of socialist reconstruction, over the last two decades Vietnam has become one of Asia’s fastest growing economies, with all the environmental impact and developmental controversies that such rapid growth entails. Enjoying the benefits of China’s vicinity and even positioning itself as a low-cost alternative to its giant neighbor, the country is now a major manufacturing hub of cheap labor and pro-business policies for foreign investors.¹¹ In the Red River delta, arsenic contamination of drinking water, due to the increasing pressure on public water supplies and a direct consequence of the population boom, remains a serious public health challenge (Winkel et al. 2011). In recent years, growing concerns with air-pollution, on the one hand, and outdated infrastructures of wastewater management, on the other, contributed to increasing environmental awareness, which culminated in a series of local protest movements in Hanoi during the autumn of 2019.¹² Around that time, a mercury leak following a fire in a light-bulb manufacturer’s warehouse, and contaminated tap water after a brick factory in Hoa Binh Province had dumped used oil into an upper stream creek both alerted residents of the capital to the fundamental links between environmental pollution and public health in their daily lives.¹³

From food additives to plastics, from pharmaceuticals to cement materials, synthetic chemicals are vital – and often invisible – agents of city life and urban transformations. Even as they make our lives easier and more convenient, they also pollute urban (and, of course, other) environments on an unprecedented scale. Accordingly, some anthropologists and environmental historians have begun to pay close attention to the multiple ways in which chemosocial forms are built into the complex networks of industrial capitalism and more-than-human worlds (Murphy 2008; Shapiro and Kirksey 2017). Others have explored how chemical substances are woven into infrastructures of public health, with environmental consequences that include the reshaping of local biologies (Roberts 2017; Solomon 2016).

That these local biologies are permeable and changeable is thus not exclusively a historical or cultural consequence of medical pluralism (Leslie 1976), but also of chemosocial itineraries. For example, many synthetic compounds that are essential to urban life are non-biodegradable. The Lancet Commission on Planetary Health lists “toxic chemical exposure” as one of the major health consequences of environmental change. The report underlines that the growing number of people in urban areas living in poverty are the most susceptible to the toxic effects of chemicals through the high levels of bioconcentration in food chains and sewage systems (Whitmee et al. 2015: 1994). Cities are simultaneously the most chemically hazardous places and the largest contributors to chemical pollutants. Further complicating the issue, however, the same report also notes that “urban transition provides an unparalleled opportunity to improve population health and increase resilience to environmental change” (Whitmee et al. 2015: 1985).¹⁴

Adopting Nading’s (2016) notion of “leaky things”¹⁵ allows us to see that the default state of chemicals, including medical substances, is to be environmentally entangled. In the context of mosquito control in Nicaragua, insecticides and bleach disinfectants that were meant to prevent zoonotic diseases and control pathogens became agents that transform the landscapes – and the lives of people – into which they were released in the name of global health interventions. Hence, “chemical leakage,” in Nading’s reading, is not merely a technological failure, but rather a term for constitutively related material flows and actions:

My emphasis here is on the capacity of these substances to ‘leak’: to decompose into skin and water as well as to drift from spaces of biomedical control and bureaucratic surveillance to ones of situated social and political interaction. […] leakage calls attention not only to the dialectical production of human and nonhuman bodies and socio-political systems but also to the role played by nonliving things—houses, tools, protocols, standards, and, of course, chemicals themselves—in making and unmaking health. (Nading 2016: 142)

As this example so vividly illustrates, the enhancement of human health at times contributes to the ongoing contamination of urban and planetary environments – thereby introducing even more uncertainties.

Take pharmaceuticals, chemical substances they are, yet they never stand alone. They flow through bodies and environments, which they also compose in metabolic and ecological processes. A significant amount of our medications worldwide enters rivers or contaminate wells after being dumped in manufacturing plants or hospitals. Unlike agrochemicals, however, which are directly released into the environment by design, most pharmaceutical products move through, and are mediated by, the metabolism of the user before being flushed down in toilets and released into public wastewater systems. After consumption and excretion, these new metabolites (often containing between 30% and 90% of unaltered parent compounds) drained through urban sewage pipe networks and end up in the same rivers as the agrochemicals. In urban environments, in other words, drugs are leaky in an infrastructural, as well as in an ecological and metabolic, sense.¹⁶

Nor is the contamination of water the end of this pharmaceutical flow of matter. One important loop that makes this damage a truly planetary concern is called antimicrobial resistance (AMR). Antibiotic resistance (ABR) – a subset of AMR – in particular, “happens when bacteria change and become resistant to the antibiotics used to treat the infections they cause” (World Health Organization 2018). And since not only our health care systems, but life and death in contemporary societies are intrinsically linked to antibiotics, ABR has long been a concern of public health experts (Landecker 2016). The latest findings claim that soil biota, wastewater and air transmission make ABR an exemplary case of planetary health (Zhu et al. 2019). Yet others have argued that such environmental etiologies are also deeply embedded in poverty and uncertainty (Alvarez-Uria, Gandra, and Laxminarayan 2016; Collignon et al. 2018).

This brings me back to Hanoi, where leaking chemosocial infrastructures and the anxieties they conjure are both the side-effects of rapid urbanization and the context in which urban ecologies transform themselves.

3 The Propensity of Medicinal Plants

Uncertainty and antibiotics in the water are both part and parcel of life on Bãi Giữa, a small island in the Red River in central Hanoi, even if the latter is not quite a daily source of worry for its residents. As we shall see, it is, however, a concern for environmental scientists and social entrepreneurs of herbal medicines.

Under the famous Long Biên bridge, symbol of an innovative future in a colonial past, and not far from Xom Phao, a floating village of day laborers, lies Bãi Giữa Song Hong, or the Middle Warp, also known by the locals as Banana Island. On my walks through the island plotted with kitchen gardens and populated by some homeless people, drug users, a nudist community, and other outcasts of Hanoi society, I am often reminded of Anna Tsing’s evocative lines: “Ruins are now our gardens. Degraded (‘blasted’) landscapes produce our livelihoods. And even the most promising oasis of natural plenty requires massive interventions to be maintained” (2014: 87).

Rather than an oasis in the strict sense of the word, Bãi Giữa is a place where new forms of human-plant relations are in the making. A community project recently started to plant trees to help reduce the burden of air pollution in the city. They plan to turn the island into the “Green Lungs” of Hanoi.¹⁷ As for now, the plots of vegetable, corn and banana that stretch through the island are mostly cultivated by single farmers who rent the land from the city – although there is reportedly a small group of underclass families who manage to live there without paying at all. As an activist friend told me, “no one who has anything better to do would consider farming on such a polluted piece of land, anyway, so why bother too much collecting the rent…” Most of their produce ends up in tiny eateries in downtown, where customers rarely question the origin of the ingredients in their soup.

Mr. Phú, one of these agricultural entrepreneurs, is at the nexus of the following ethnographic account of pharmaceutical pollution and uncertainty. He leases a tiny patch of land of c. 1.5 ha from the municipality, but while most of his neighbors invest in farming products, he has decided to plant herbal medicines, which seem not only to be more profitable in the long run, but also better for the regeneration of soil productivity.¹⁸ “You know, there’s a boom of herbs in Vietnam these days and the government supports herbal medicines and generally traditional Vietnamese medicine,” he tells me. “New public lands are opened up for herbal gardens around the country on a daily basis. It is a thriving business, you see, and I’d be a fool not to try to take the opportunity.”

While cultivating herbs in his garden on Bãi Giữa, Mr. Phú studies herbal medicine at a school for Vietnamese medicine in the city center near Lãn Ông. He hopes to one day become a healer himself. One important difference between Chinese and Vietnamese medicine, is the latter’s more intense use of herbs. Rather than starting from abstract theories learnt from books – as Chinese doctors often do – Mr. Phú tells me, his knowledge derives partly from growing medicinal plants. His caring for his garden as part of aiming to become a doctor is exemplary of the “cultivation of sensibility to propensities,” which Law and Lin (2017: 221) propose as a Chinese-inflected alternative to “Western” epistemics. Ironically, however, the propensity of herbs, here, stands in opposition to Chinese medicine. The immanent comparison with traditional Chinese medicine lies in the becoming of a (Vietnamese) physician with herbs, underlying the ontological differences between the clinic and the garden. Based on his farming skills in general, the medicinal techniques he has learned in the school, and those he has learned from the physicians to whom he sells a part of the plants, he is developing his own distinctive way of transforming this low-quality and toxic urban land into a healthy garden and himself into a herbal doctor. On this contaminated land, however, that remains a dream, for the time being. Becoming a doctor will require a lot of money, yet he cannot secure a stable income except by selling his plants to pharmaceutical companies that transform them to standardized products.

Among many other techniques, Mr. Phú uses slash-and-burn methods to improve the soil. This often leads to disputes with his neighbors, most of whom are less concerned with the quality of their farm produce than with staying out of the authorities’ sight. One day, during a short walk on the ash-covered soil of his garden, he explained to me the multiple benefits of this method. It was not only that burning helped to release minerals and nutrients from the soil, and thereby increased the medicinal value of his herbs, but also, according to Mr. Phú, that the heat in the ground had an additional cleansing effect on the soil, which was continuously polluted by waste from the city and artificial chemicals flowing down the Red River from China.¹⁹ To which I naïvely responded that slash-and-burn cultivation is a significant emitter of greenhouse gases from a planetary perspective. Considering his neighbors’ unease, I further observed, burning the land was hardly the most discrete way of farming in the middle of the city. However, he reminded me once again that this garden, with all its communal and ecological compromises, was only a temporary solution. In the long run, he would be looking north of the capital for land with uncontaminated soil on higher altitudes, where he hoped to extend cultivation to more varieties useful for his future clinical practice.

The land of Banana Island is not very stable or productive, but it is good enough to enable the roots to develop to some depth into the warp soil, which consists of mineral-rich alluvial material – including antimicrobial agents discharged from pharmaceutical manufacturers and detected recently and independently by a Japanese and a Vietnamese group of environmental pharmacologists (Harada 2018; Thai et al. 2018). Mr. Phú, on the contrary, is more concerned about the antimicrobial effect of a plant he started to grow a couple of years ago from seedlings that were transplanted from the laboratory of a small pharmaceutical company to his garden. It is a dark green leafy shrub called đinh lăng (Polyscias fruticose; Ming aralia) but is also known among Vietnamese doctors as the “ginseng of the poor” (hồng đảng sâm). The roots of the plant are used to alleviate rheumatic pain, but it is also widely known across Vietnam for the antibacterial tonics that are prepared from its leaves. “Herbs can heal the land as much as they heal the bodies of patients,” Mr. Phú told me one day. And while the herbs grown in his garden were not yet ready to be used as raw materials for pharmaceutical extracts, Mr. Phú could easily sell them to the vendors on Lãn Ông street. Here, the plants that absorbed the antibiotic residue of pharmaceutical waste were much sought after for their antibiotic effect as “chemical-free” products, thereby bringing the chemical contamination of the river into a full urban-metabolic-circle of herbal efficacy.

The propensity of herbal medicines here follows the chemosocial flows and leakages of the city redrawing age-old distinctions between toxic and healing properties.

4 Transforming Urban Landscapes, Transplanting Medical Knowledges

As Plato’s discussion of the pharmakon makes clear, drugs hold the potentials to be either or both remedies and poisons.²⁰ They exert their capacities for action differentially across multiple ecologies of practice. In a cosmopolitical reading, Isabelle Stengers (2015) critiques Euro-centric views and purist genealogies of modern science when she notes:

What characterizes the pharmakon is at the same time both its efficacy and its absence of identity. Depending on dose and use, it can be both a poison and a remedy. The type of attention that their milieu can lend to user movements is a pharmakon. It is capable of both nourishing and poisoning them. (…) To think in pharmacological terms here is to pose the question, not of the identity of the sciences, but of the differences in milieu of these two practices, milieus that are not only external but that include the manner in which practitioners evaluate their relations with them. (Stengers 2015: 100-101)

Following from this, it can be argued that the efficacy of medicinal plants sold on Lãn Ông street does not inhere in sharply delineated and distinct traditions of Chinese, Vietnamese or any other medical knowledges, but is rather actualized by multiple forces and assemblages that constitute the urban common worlds of East Asian cities (see Bunnell and Goh 2018; Roy and Ong 2011). Pharmaceutical effects, Anita Hardon and Emilia Sanabria observe, emerge from chemosocial infrastructures that comprise herbicides, cosmetics, and many other “chemical agents that contaminate our environments and affect our health” (Hardon and Sanabria 2017: 125). In Tanzania, for example, plant-based medications are common elements of HIV treatment regimens as promoted by global health planners (Langwick 2018). These locally grown medicinal plants alleviate the toxicity of imported antiretrovirals – which, in turn, is critical to the biomedical capacities of the latter to suppress viral load. In northern Vietnam, these pharmaceutical effects are becoming part of an ecological loop of urban transformations.

In fact, an important source of support for his efforts to create a herbal garden on the polluted island of Bãi Giữa came from the same hilly regions of northern Vietnam where Mr. Phú was looking for his future farmland. VietHerb, a so-called “social enterprise,” was a group of young, enthusiastic ethnobotanical and ecological experts. They worked with local healers of ethnic minorities, such as the Red Dao or the Hmong, who live in the northern highlands and collect medicinal plants from the nearby forests. Activists at VietHerb aimed for no less than the protection of these traditional knowledges – concerning the use of herbal medicines – from extinction, and they promoted what they called a “green and chemical-free” lifestyle. This required a unique constellation of bringing plants and people together. Instead of focusing on herbal products in which plants have been refined and capsulated into pills with additional excipients, they saw their mission rather as one of transplanting plants and knowledges.

By extensively researching herbal remedies across Vietnam, they tried to collect what was left of the indigenous knowledge practices in mountainous areas. But rather than simply cataloging and conserving such knowledge – endeavors that had been central to many other social activists and scientific research – they were forming new alliances by transplanting various types of rare medicinal plants into home gardens to be used for harvesting. Some of these gardens are located in the villages of the healers deep in the mountains. Until recently, they have been collecting herbs from the forest, but the expansion of Chinese timber companies into this area endangered many of the species they have been using and collecting. Thus, cultivating them in small gardens was a skill they had to learn from agricultural engineers and pharmacognosy experts, like those at VietHerb.

As an extension of these activities in the forests, VietHerb started to support other types of gardens in urban areas where plants from the mountains were grown for the company’s healthcare and cosmetic products that are now sold in eco-friendly shops catering to middle-class lifestyles and health-conscious consumer niches – predominantly of Hanoi and Ho Chi Minh City. Mr. Phú’s garden on the island of Bãi Giữa was among these urban gardens sprouting up across the city in recent years (Kurfürst 2019). In its rather surprising capacity, it can be described as an experimental site that brought traditional medicines to bear on the rethinking of public health of the city.

About 100 kilometers northeast from Hanoi and Bãi Giữa, at their newly established center, next to the Hữu Liên forest in Lạng Sơn province, some members of VietHerb were at work on a pilot project, in which deforested areas and eroded soil were going to be detoxicated with the help of local healers. “The long-term plan,” said Mr. Đinh Thien, one of the founders of the enterprise, “is to extend the present center into a sort of retreat where people who are interested in the sustainable cultivation and use of these herbs can come together and exchange their ideas about plants and healing techniques.” As noted above, the raison d’étre of this new medical center was the transplantation of plants and knowledges between forests and urban spaces: between hill tribes – whose forests were threatened by Chinese pharmaceutical companies looking for wild medicinal herbs – and the rising urban middle class – whose desire for “natural herbal products” was immanent in the comparisons between Chinese (“chemical”) and Vietnamese (“natural”) remedies.

If we follow the shi-inflected methodology proposed by Law and Lin (2017), ironically, it is the Chinese pharmaceutical giants that seem to work against the propensity of medicinal plants. Their financial dependence on the exploitation of forests in northern Vietnam for cheap ingredients of herbal products, according to Thien, will have catastrophic consequences in the long run. In contrast, the efforts of ecological initiatives, such as VietHerb, to replant the remaining species to home gardens, may be thought of as an attempt to cultivate new sensibilities to these herbal propensities.

Transplanting medicinal plants from forests to gardens, and medical knowledges from the mountains to cities, similarly to what Zhan described as a series of translational movements between San Francisco and Shanghai, conjure “uneven visions, understandings, and practices of what makes up our worlds and our places in them” (Zhan 2009: 1), including the chemicals and their part in an ecologically sound urban transformation.

If there is a particularly Chinese (way of doing) medicine, it is articulated in its movement between worlds seemingly apart: Chinese and Vietnamese medicine, indigenous and scientific traditions, forests and cities, gardens and clinics. Such mobility,²¹ as I tried to argue above, is increasingly embedded in particular chemosocial itineraries, such as the mass manufacturing and trading of herbal extracts or the cleansing of urban soils. Detoxifying the contaminated land by plants that have been used by traditional healers in the mountains in a hope that they will provide the raw materials for sustainable healthcare products may sound utopian – and in a sense it is. And while the contamination of the soil has been a subject of ecological research and sanitary interventions (see e.g. Harada 2018; Winkel et al. 2011), most of the activists and doctors I talked to throughout my research had not framed this detoxification in terms of chemistry or other Western scientific disciplines. But it would be misleading to assume that Thien and his fellow founder Thanh were simply daydreamers. They did have a vision, but they were as pragmatic about their ecological agenda as Vietnamese doctors were about their plants. They knew a lot about the scale of the problem that toxic lands and rivers in Vietnamese cities presented for the future of local communities. They were also confident that investing in herbal products would pay off in the long run – both socially and environmentally. Some of the sustainable cosmetic products and dietary supplements VietHerb developed and launched in the past three years may be the first steps of a sound business model. And once these materials feed back into the toxic leakages of contaminated sewage systems and polluted waterways, there might be some hope for more resilient uses of both herbal and chemical medications, after all.

5 Gardening as a Lateral Method

I started this paper by asking how medicinal herbs may materialize our methodological toolkits when they become agents of chemosocial futures. As I argued, the constant flow of herbal remedies, pharmaceuticals and other chemicals between human bodies and urban infrastructures create new, laterally mobile knowledge practices and, perhaps, more resilient forms of multispecies togetherness across medical traditions. Let me bring this home, by linking it to the question of how people and medicinal plants come to cultivate and be cultivated by one another in urban herbal gardens like the one on Banana Island and elsewhere in northern Vietnam (see Kurfürst 2019: 211).

In general, the alignment of physical and ecological health has been a widely discussed subject in recent years from public health interventions – such as planetary- or eco-health – to the more tangible issues of zoonosis or airborne diseases (see e.g. Brown and Nading 2019; Watanabe and Watanabe 2019). What I tried to show in this brief ethnographic account is how such public health concerns emerge from human-plant entanglements of gardening medicinal plants. As some critiques of the green modernist version of environmental stewardship argue, the metaphor of gardening is a dangerous one. To these critical observers, the garden, on a planetary scale, is an unethical place because “once we shift to a gardener’s mindset, it gives us too much freedom to do whatever we want” (bioethicist Gregory Kaebnick, cit. Keim 2014). Rather than a metaphor, I prefer to think of herbal gardens as sites where embodied infrastructures and naturecultures for more resilient public health interventions are experimented with. As Natasha Myers has recently written:

Alongside farms, forests, and plantations, gardens are crucial sites for examining the more-than-human dimensions of social, political and economic life, offering profound insights into forms of governance, political economy and ecology, industry, labor and more. Gardens are sites where people explicitly stage and restage human relationships with nature. (Myers 2019: 125)

As an extension of this claim, I hold that the gardening of medicinal plants in urban settings can be seen as the lateral alignment of human well-being with affective ecologies of environmental health.

Perhaps we might think of herbal gardens as places where emerging knowledge practices across human bodies and urban landscapes are being transformed and transplanted (Strathern 2015). In a strictly pharmacological sense, herbal products – sold both on Lãn Ông street and in the burgeoning pharmacies of the city – are meant to transplant molecules from gardens, through laboratories, to bodies (and bodies only), but toxic rivers – behind Mr Phú’s garden, for instance – remind us that drugs are elements in chemosocial infrastructures that transform bodies and environments in their relatedness. On the other hand, as the activities of VietHerb illustrate, by transplanting herbal medications from forests to urban gardens some environmental activists hope to transform both sick bodies and contaminated soils in their multispecies entanglements. The gardening of herbs in urban gardens, thus, points to a lateral mobility between polluted rivers and healthy bodies, between the ecological challenges of deforestation and the health consequences of urban transformation as they are being aligned, contrasted and translated into one another.

The development of pharmaceutical products from herbs is a profound issue that allows us to ask questions about the inter-implication of plants, human bodies and the future of the planet. While we usually think of medicinal drugs as purely chemical compounds, the majority contain plants and/or herbs – either through direct processing in the case of plant-based medicines, or indirectly, when plants serve as models for synthetic drugs. In this regard, it is worth recalling that Mr Phú was selling a large portion – more than two-thirds of the total, in his own estimate – of his plants to relatively large manufacturers either as excipients or active pharmaceutical ingredients (APIs) of single drugs. The chemical reactions that are vital to the metabolic and reproductive health of plants have been crucial to Chinese and Vietnamese medicines, as well as to biomedical repertoires, albeit in different ways and for different ends.

More to the point, the fact that some of these plants are now cultivated in urban soils, processed into synthetic products for middle-class consumers, consumed by city dwellers, and excreted into municipal waterways, indicates that there is an infrastructural politics of chemical cohabitation specific to “an always transitory urban cosmos” (Farías and Blok 2016: 9). These herbal and chemical itineraries weave together indigenous medical practices threatened by deforestation, with leaking infrastructures of public health and chemical-free imageries of an emerging urban middle-class.

It is in this sense, that East-Asian-medicine-as-a-method “induces curiosity about ‘minor-to-minor forms of lateral connectivity’” (Chiang 2017 cit. in the introduction to this special issue), which deploy themselves in material itineraries, such as medicinal herbs. The alterity of Vietnamese and/or Chinese medical traditions, and scientific explanations depends on the scale – urban, embodied, planetary – of their deployment: the manufacturing of extracts that target chronic health problems; the transplantation of engendered species from forests into metropolitan gardens; or the cultivation of the same plants to clean polluted urban soils.²² In short, what François Jullien calls the “propensity” or “disposition” of things. “Within the disposition of things, the efficient cause that brings about the movement is not something external but is always totally immanent. The static order is also dynamic; the structure of reality is always in process” (Jullien 1995: 253). Herbs grow and become medicines; chemicals leak into rivers and are metabolized; soils become toxic and give rise to new remedies. In such material itineraries, the multiplicity of reality and the methods of knowing it are always in the making – forming and transforming the chemosocial infrastructures of urban worlds.

Medicinal plants may grow in the wild or are cultivated in laboratory settings, but mostly they are somewhere in between. In the garden, such relational encounters across differences are not only something essential for them to exist, but they are also what make them comparable. The activists, doctors and healers I worked with are all too well aware of these lateral encounters: they have to move herbal samples across cultural (Western, Chinese and Vietnamese medicine) and ecological (forests, gardens, ecosystems) differences, clinical sites, human bodies and laboratories in order to measure and improve their efficiency.

In such a lateral world, any easy grounding or context – such as “Chinese” or “Western” methods – is lost, and the multiplicity of knowledges fail to add up as a whole. In such a world, the relation between medical theories and gardening practices is not a methodological point of reference, but part and parcel of the ethnographic project. It is in this sense – a loop between ethnographic interventions and ontological worlds – that the laterality of our methods becomes a compelling issue.

Acknowledgments

First and foremost, I would like to sincerely thank friends and members at VietHerb and the residents of Bãi Giữa who have shared their professional and personal experiences with me. Without their generous hospitality this research would have been not only impossible, but greatly irrelevant. Earlier versions of the paper were presented at the University of Toronto, Osaka University, at the National Museum of Ethnology, Japan (Minpaku), as well as at the 2019 inter-congress of the International Union of Anthropological and Ethnological Sciences (IUAES) in Poznań, Poland. I am indebted to the participants of these events for their helpful suggestions and critical questions, including Naoki Naito, Atsufumi Kato, Mei Zhan, Michelle Murphy, Satsuka Shiho, Anders Blok and Moe Nakazora. Finally, many thanks to Casper Bruun Jensen for encouraging me to write this article and for his always keen and patient editing of my ever-changing revisions.

Additional information

Notes on contributors

Gergely Mohácsi

Gergely Mohácsi is an anthropologist based at Osaka University, Japan. His recent research has primarily focused on the ecological implications of public health interventions and drug development in Western Japan and Northern Vietnam. His scientific work has been published in English, Japanese, French and Hungarian.

Notes

¹ According to a survey conducted in 2004, the material origin of the products was either wild-harvested herbs (26%), cultivated crops (20%) or medicinal plants imported from China (54%) including commonly used remedies such as Angelica dahurica, Angelica sinensis, Achyranthes bidentata, Rehmania glutinosa, and the fungus Ganoderma lucidum (Nguyen and Nguyen 2008:51).

² As part of ongoing historical heritage projects in the Old Quarter, facades of the street have been restored by the district since 2013 amidst the ongoing resistance and distrust of local shop owners (Hanoi Times, 22 February 2019, “Hanoi and Toulouse work together on restoring Old Quarter” http://hanoitimes.vn/hanoi-and-toulouse-work-together-on-restoring-old-quarter-1859.html; last accessed on 1 February 2020).

³ All personal names in this article are pseudonyms to assure informants and friends the anonymity I promised them during my research.

⁴ Asthma, waterborne diseases and malaria are only among the more obvious illustrations of such entanglements of environmental and human health. As a major report of planetary health published by The Lancet reminds us, “major sources of chemical contamination and waste include pesticides from agricultural run-off; heavy metals associated with cement production; dioxins associated with electronics recycling; mercury and other heavy metals associated with mining and coal combustion; butyl tins, heavy metals, and asbestos released during ship breaking; mutagenic dyes, heavy metals, and other pollutants associated with textile production; toxic metals, solvents, polymers, and flame retardants used in electronics manufacturing; and drug or pharmaceutical pollution through excretion in urine and improper disposal” (Whitmee et al. 2015, 1982; emphasis added).

⁵ On “Asia as a method,” see the Introduction to this special issue.

⁶ For a rich historical study of ancient Chinese and Greek medicine with a comparative approach, see Kuriyama (1999); for a comparative discussion of the effectiveness of herbal and synthetic medications in Eastern and Western medicine, see Satō (2014).

⁷ Well-known examples include the potlatch, a feast practiced by indigenous peoples of North-America and made famous by Marcel Mauss’s essay The Gift ([1925] 1970); or latah, a state of possession originally observed in different parts of Southeast Asia and eventually made it into the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV (Winzeler 1995). For a more reflexive discussion on the anthropological uses of Amerindian perspectivism, see Viveiros de Castro (2004).

⁸ For sociologists of scientific knowledge (SSK) symmetry has been understood as a collapse of the long-standing distinction between true and false claims (Bloor 1976). Later, actor-network theory (ANT) proposed to extend this symmetry to human and non-human actants calling it “the principle of generalized symmetry” (Callon 1986: 200).

⁹ A more elaborate discussion of these issues with further examples from East Asia can be found in the special issue on “Traveling Comparisons: Ethnographic Reflections on Science and Technology” published in EASTS (Mohácsi and Morita 2013); for a general discussion of the subject, see Matei Candea’s recent work on the ethnographic method of comparison (Candea 2018).

¹⁰ See note 9 above.

¹¹ For a discussion on the political-economic context of technoscientific modernization on the peripheries of China, see Chiang (2017) and Jensen (in this volume).

¹² The ASEAN Post, 24 October 2019, “Hanoi’s pollution exposes growth risks.” https://theaseanpost.com/article/hanois-pollution-exposes-growth-risks (last accessed on 1 February 2020).

¹³ A recently edited volume, Food Anxiety in Globalizing Vietnam, provides excellent case studies to highlight these issues around food safety and economic transformation (Ehlert and Faltmann 2019).

¹⁴ See also the edited volume Health in Ecological Perspectives in the Anthropocene on environmental health issues with an East and South-East Asian focus (Watanabe and Watanabe 2019).

¹⁵ On leaking infrastructures, see also Eitel’s article in this special issue.

¹⁶ For quantitative studies of pharmaceutical contamination, see Fick et al. (2009) on antibiotics in India; Azuma 2013 on anti-influenza medications in Japan; Bean et al. (2014) on anti-depressants in the UK.

¹⁷ Việt Nam News, 25 November 2018, “Nostalgic Future: Turning Banana Island into Green Lungs of Hà Nội.” https://vietnamnews.vn/sunday/480370/nostalgic-future-turning-banana-island-into-green-lungs-of-ha-noi.html#YxjGD2sjlTcWrCqP.97 (last accessed on 1 February 2020).

¹⁸ According to his own estimate, Mr. Phú produces c. 600 kg of root, c. 200 kg of leaves and 50 kg of seeds in a year on this land (oral communication).

¹⁹ On arsenic contamination of the Red River in Hanoi, see Winkel et al. (2011); on the environmental effect of antibiotic residues in Vietnam, including the same river, see Harada (2018).

²⁰ The often cited and probably best known take on the issue is Jacques Derrida’s famous essay, “Plato’s Pharmacy” (Derrida [1972] 1981).

²¹ In a recent historical monograph on the early globalization of the Vietnamese pharmaceutical industry under French rule, Laurence Monnais has thoroughly discussed the colonial legacy of this mobility (Monnais 2019); see also Monnais, Thompson, and Wahlberg (2012) for comparative case studies on the same topic.

²² For a different take on the scaling potential of herbal medicines, see Mohácsi (2020).