Toward knowing: Engaging Chinese medical worlds

Goldstamp Huang: Do you believe in fate?

In the course of anthropological field research in southern China, we met Dr Goldstamp Huang, ⁵ a senior practitioner in a Yao nationality medicine hospital. Having been introduced by Yang Jian, our research associate, who was interning with Dr Huang, we followed him one morning as he began his rounds in the inpatient ward of this 40-bed hospital. He went first to see a 50-year-old patient diagnosed with lymphoma. He told us she had been through six rounds of chemotherapy over the past six years. Her current main complaint was a terrible ulcer near her left popliteal lymph node. Dr Huang examined the open sore closely, then he left. Yang Jian told us that he was going downstairs to prepare a very special herbal plaster. She had already said that Dr Huang had been trying to find a certain special herb for this patient for a long time. He had asked almost every herb collector in town, even eventually riding on a motorcycle with one of them so they could go together deep into the mountains, where he himself dug up the precious root.

Very curious, Lili went with Dr Huang to see this special drug. He went into his clinic and took out a large tuber that looked rather like a bamboo shoot. Yang Jian told us later it is the tuber of qiye yizhihua 七叶一枝花, ‘seven leaves per flowering stem.’ We were impressed – this is a famously rare herbal drug. After peeling the tuber, Dr Huang told Lili that no metal should be in contact with the tuber as it was prepared, so he put down the knife and picked up a big rock. ‘Step back a bit further,’ he warned her, ‘the herb is poisonous.’ Then he put on gloves and safety glasses, and started to carefully smash and grind the tuber with the big rock. He was trying to make the paste as fine as he could, so it took quite a while.

‘Will this freshly-made paste, put into a plaster, work for the patient?’ Lili asked him. He first explained that the ulcer looked like what is called in Yao medicine a ‘grievous toxic sore’ (da du chuang 大毒疮), and the ‘seven leaf stem’ paste was known to be a specific treatment for this kind of ulcer. He also noted that he had already tried many different therapies on the patient, to see which might work better. Then he smiled, and asked Lili: ‘Do you believe in fate (ni xiangxin mingyun ma 你相信命运吗)?’ Sometimes the method that works on one patient will not work on other patients. You have to believe in fate, ride the waves of personal destiny (mingyun 命运).

Local knowledges

Dr Huang, it would seem, knew what he did not know. Yet he was not surprised that a couple of metropolitan anthropologists sought him out, trying to discern just what he did know. In what follows we want to re-explore some of the complex and uncertain terrain we two authors have covered, usually together, in our recent research on minority nationality medical knowledge and practice. New systems of traditional medicine are now emerging, with varying amounts of official support, in south and southwestern China. As we have worked, we have increasingly thought of these emergent medicines not as ethnic, or nationality, or folk, or vernacular, or indigenous, but as local knowledges. ⁶ There are readily understandable ways to speak of local knowledge in Chinese; no one was surprised, for example, to hear us announce that we had come to Dr Huang’s Great Yao Mountains in search of bendi zhishi (本地知识), or local knowledge. They might have presumed that we had come from a world of knowing that was translocal or universal (e.g., the natural sciences), or that we were seeking to translate local knowledge into nationally-recognized information, and add it in purified form to the databases of the Chinese medicine pharmacopeia. At times we had occasion to explain to our interlocutors in the rural south that we tended to think of all knowledge as constrained by its knowers’ local perspectives, practices, and aims. ⁷ Speakers of Chinese seem to have an intuitive understanding that all knowing is partial and informed by a point of view. (Are they keeping zhizhi wei zhizhi in mind?) Science and Technology Studies, moreover, showed us long ago that scientific facts depend on rigorous constraints and controls of variables locally put in place in particular laboratories. As China anthropologists of medical knowledge, moreover, and as speakers of a non-totalizing Chinese vernacular, we had long done research that relativized truth and refused most universalizing styles of thought.

So let’s think again about Dr Huang and his several ways of knowing. He is a widely respected expert in the herbal medicine practiced by Yao nationality doctors in the Great Yao Mountains of northern Guangxi. He is one of the founders of a modern hospital of Yao medicine, he supervises junior residents and interns, and sufferers come from far and wide to receive his treatments. As is evident in the episode described here, he knew the natural medical resources of his home region better than almost any of his colleagues, and he was known for the many years of clinical experience that informed his therapeutic strategies. ⁸ He knew the unnamed and trackless places in the great forests near the hospital where ‘seven leaf stem’ might be found growing. He knew his lymphoma patient’s sad history. He knew what the visible characteristics of her skin ulcer could tell him about the state of a disease process. He knew how this kind of ‘grievous toxic sore’ had been understood and managed by Yao practitioners in the past. He knew how to protect himself, his patient, and bystanders from the toxic fumes of the pounded root. And he worked hard to put his skills and understanding into service as good medicine, or healing. ⁹

But he did not know what would happen in the future. Lili’s question, ‘Will this plaster help?’, asked for a prognosis or a prediction and implied that there might be a knowable cause and effect chain linking natural drug, bodily lesion, and the progress of the lymphoma. But to answer such a question Dr Huang had to turn interrogative himself, and invoke not knowledge but belief: ‘Do you believe in fate?’ Even if for him and Lili (and Judith too, and possibly you, dear reader) ‘fate’ is a perfectly real force in our lives, we know that we cannot know our fate. There is nothing definitive or reliable or unalterable about personal fate or destiny, which is why it should not be thought of as knowledge about the future. ¹⁰

The word he used for fate or destiny was mingyun, which literally means the (particular) flow of a (particular) life and death. ¹¹ Though it is usually humans who have a ming, in this instance in which Dr Huang was putting several agents into close relationship with each other – the forest plant, the mashed root fibers, the gauze-wrapped plaster, and his own hard labor and devoted time – the fated particularity seems to be the relationship among these players, and their convergence upon a clinical problem. A therapeutic grouping has been conscientiously gathered. Perhaps as it nears the patient’s body it will join with her particular destiny and help to redirect the flow of her life so far.

But mingyun cannot be known definitively even by skilled diviners (and it’s possible that Dr Huang was such a diviner in his spare time). If anything, the practical divide between what can and cannot be known reminds us how many mundane practices of knowing are referred to in the paragraphs above. Dr Huang’s knowledge of what has worked medically in the past is here found alongside his craft knowledge of how to control toxins. His experienced diagnostic and therapeutic judgment is noted along with his authoritative reputation: he is ‘known for’ his expertise. Expertise like Dr Huang’s, relating to the forest and its natural agents (both toxic and healing), is far from universal among the residents of villages and towns near his Yao medicine hospital, so locally he is a rather unique expert knower. And even health policy-makers in Beijing hesitate to dismiss his medical expertise as mere belief, superstition, or folklore. Committed as the modern world may be to knowing translocal information, when faced with a knowing practice that heals in place, both its particular zhizhi (知之) and buzhi (不知) must be respected.

Knowledge: Is that a thing?

Treating these words for knowing and not-knowing as redolent terms, both ancient and modern, we hope in the remainder of this discussion to other knowledge as a problem. This effort to alienate a commonsense epistemology hardly makes us original among scholars who have studied Asian medical systems. ¹² Various writers, faced with what seemed to be very different worlds and embodiments in Chinese medicine, yoga, Qigong, Ayurveda and so forth, found themselves speaking of ‘styles of knowing,’ emphasizing tacit, embodied, and ‘ecological’ assumptions (see, e.g., Hsu, 1999). Some found refuge in a concept of ‘theory’ that allowed non-structural entities to have a functional life (Porkert, 1974), and others translated Chinese medical realities into a materialist commonsense that was nevertheless full of surprises (Sivin, 1987). Judith Farquhar’s (1994) ethnographic study of ‘knowing practice’ aimed to demonstrate the unity of knowledge and action in Chinese medicine. But the study included few descriptions that could clarify the ‘action’ side of this dynamic unity.

The relativism achieved by comparative research tended to multiply bodies of knowledge, but anthropology persisted in treating non-Western knowing practices as opinions, beliefs, or world-views, things that mostly take the form of cognition and systems of representation. We did not escape a certain idealism in the term knowledge itself. More recently, however, anthropology has recuperated a pointedly materialist or ontological way of thinking about our pluralistic universe (Blaser, 2010; de la Cadena, 2015; Kohn, 2013; Pedersen, 2011; Stevenson, 2014; Viveiros de Castro, 2004). As we began our fieldwork on nationality medicines in 2010, we found much inspiration in all manner of newly plural and concrete ‘worldings’ (Zhan, 2009). But as we worked, and stimulated by questions like those posed by the present volume, we came to ask – eventually, after some more engagement with healers in China’s southern mountains – why we still care to investigate the genesis and practice of ‘knowledge’ at all? As a thing, knowledge became permanently elusive.

Doing ethnographic fieldwork, we found ourselves in that frictional field of medicine where expertise is not just (or even centrally) derived from a body of knowledge. Rather, it is a politics, an ethics, practices (lots of manipulations), ideologies, and (more than one) ontology (Law & Lin, 2017; Mol, 2002). Expertise also, as Confucius said, and as Dr Huang showed us, includes knowing how to cope with not knowing. We do not follow the (arguably half-ironic) example of the Analects and attempt to definitively state ‘the way to know,’ or zhizhi (etc.). But we still want to more sympathetically and better grasp how people go about knowing and acting in actual worlds. We hope the Chinese material, both pre-modern and recent, that we briefly introduce in the remainder of this chapter will help to address this desire, even if it just leaves us riding the waves of fate with Dr Goldstamp Huang.

So, before we seek in the Confucian tradition a terminology more suitable to the herbalist expertise we have been exploring, let’s consider the puzzles presented by a Lisu nationality healer working from his farmhouse above the eastern shore of Yunnan Province’s Erhai Lake.

Lasting Loyalty Su: Thinking it up

Lasting Loyalty Su was 40 when we met him in his comfortable but isolated farmhouse. Both his father and grandfather had practiced in the same widely dispersed village as herbalists, but he himself took up medicine and herbal treatments only after his father died at the age of 67, six or seven years before we met him. His father didn’t really teach him, though it was he, the ninth of 11 siblings, who had stayed in the house to care for his parents. As his father was dying, the old man expressed a wish for Su to practice healing. To mark this agreement, Su said, he constructed a wall-hanging storage system for herbal drugs. It was sewn of pink silk, and had two long rows of pockets, each pocket labeled.

We asked Dr Su how he had learned his techniques and formulas. He said that he ‘thought up’ (xiangchulai 想出来) all his methods and medicines. Sometimes the solutions to stubborn therapeutic puzzles would come to him through dreams – his deceased grandfather or father would visit in a dream and tell him what drugs were good for what complaints. We felt he was speaking not only as a person who was able to ‘learn from the yin side’ (yinchuan 阴传, his term) through encounters with seniors who had passed away, but as a canny observer of his social and natural environment, over the years his father had been practicing and since.

Dr Su was reluctant to share with us many details of his clinical practice. It was important to him that only he, among all his siblings, had been designated as a kind of disciple after death by his father. He had a fated ability (yuanfen 缘分) that his siblings did not. (Recall Goldstamp Huang’s turn to fate, mentioned above.) Asked to explain what he meant by yuanfen, he argued that healing skills cannot be passed on and taken up by just anybody. He really began to ‘think up’ medicine when the first patients came to him after his father died. His father had asked him to do something for them, so he began re-gathering his father’s abilities, ¹³ going out into the forest and up into the mountains to find herbs. Sometimes he observed what sorts of plants were eaten by wild animals to improve their health, and sometimes he gathered plants to use experimentally in addressing symptoms for which there was no usual cure.

Lasting Loyalty Su showed us his pharmacy. Our research team companions from the Academy of Chinese Medicine in Kunming were quite fascinated by this system of pink silk pockets. They took a lot of pictures, opened pouches to inspect the dried herbal contents, and noted the puzzling labels on the pockets. These labels at first seemed extremely simple: ‘women’s formula one’ (and two, and three, up to seven), ‘cooling drugs,’ or ‘summer wildflowers.’ These medicines were a challenge to the scientific team partly because they were not identified by their proper names (i.e., those acknowledged by a universal botany) – Dr Su said he doesn’t know the names of most of the things he collects, dries, makes into powders, and uses with patients; and there was not even one plant drug in each pocket but more often carefully crafted mixtures. Only someone who had a personal relationship with these particular plants could even read the labels, much less know how to use them safely and responsibly.

We suspect that our friends from a provincial research agency concluded that they had encountered here a particularly devious way for a mountain healer to maintain ‘secret knowledge’ away from the scientific eyes of the state. ¹⁴ But his labels were hiding in the full light of our camera lenses and notebooks. Our colleagues expressed a kind of grudging respect for Dr Su’s complex expertise, and they probably began to think about how they could later collect and study his mixtures in the interest of developing and testing new drug compounds.

Dr Su told us he has an average of seven to eight patients a week. Every summer he hosts a three-day fête for the Medicine King: a small shrine to medical sage Sun Simiao sits above the family stove, near a more central shrine to the God of Heaven and Earth and set well above a much smaller family shrine with a few jars for burning incense to female ancestors. Many current and former patients bring offerings of food and a little money to the Medicine King fête to support their devotions. These satisfied patients treat the whole network of agents centering on Dr Su’s own person as a source of healing efficacy. Do they think of him as a repository of knowledge? Perhaps, but we think they are more likely to see him as a conduit of healing powers over which he, as an individual expert, only has partial control.

For us this visit was an event that hit a cultural wall. How could we anthropologists comprehend the ghostly interlocutors, the mysteriously named herbal drugs, the stubborn chronic disorders brought by sufferers, the animals in the high forests, the devoted network of patients and supporters who visit Dr Su and the Medicine King Sun Simiao? We are tempted to see the medical work of grandfather and father Su, Lasting Loyalty Su, and the Medicine King as working on a continuum of forms of agency and service to the local people, bringing a healing tradition into the present, renewed. We know that nonhuman actors like Sun Simiao are built up in social practice over many years of the exchange of favors and gifts. So are actors like Lasting Loyalty Su, the herbalist, constructed as healers, with (at least) the continuing help of his forebears, the creatures of the forest, grateful patients, and the efficacious presence of the gods. But it is precisely because of this laborious process that we anthropologists – caught up in other networks, participating in other constructions – cannot know how in the world he knows what he puts into play as a healer.

Philosophy, cited

We have noted that medical anthropology, along with studies of Chinese medicine, has a rather long history of relativizing and localizing knowledge. But we anthropologists have not clearly delineated the place that knowing practices – sometimes known as expertise – occupy in the various social worlds that engage us. But the constant re-citation in contemporary Chinese medical practice of classical Chinese philosophy has impressed on us the importance of attending to something like knowledge. ¹⁵ (After all, even Confucius in his teaching constantly returned to whatever it was he meant by zhi 知.) In other words, if knowledge is what knowers do (just as ‘science’ is what scientists do, calling it science), then the living significations of this term ‘knowledge’ (but really zhi, of course) become an ethical, political, ecological, and very practical problem. Perhaps it bears repeating: In this reconsideration of a Confucian terminology, we are performing neither a philology nor an epistemology. We cite ‘Confucius’ not because we are in search of either origins or foundations of shared truths, but because many practitioners of Chinese medicine also find themselves citing Confucius and other early Chinese philosophers, as they try to explain what they are up to. We are trying to listen to those explanations.

The centrality of some process of knowing to the successful institution of an ethical sociality has long been asserted in Chinese philosophy. The ‘Great Learning’ (c. 3rd century bce) is one of the Confucian Four Books to which scholars and thinkers in China have returned many times, generating tons of commentary and influencing debates far beyond intellectual and ruling circles. The short original text is, in part, a beautifully structured string of dominoes, first set up and then knocked over in reverse order: ‘Of old, those who sought to emanate bright virtue in the world, first brought order to their kingdoms. Wishing to order their kingdom, they first regulated their families. Wishing to regulate their family, they first cultivated their persons . . .’ and so forth. Positioned squarely between this sort of advice (to accomplish A, do B) and a parallel series of predictions (if B is done, A will follow, if the family is regulated, then the kingdom will be ordered . . .), are two sentences that work as the crucial pivot of the text: Knowing (zhizhi 致知) comes from drawing near to things/As things are thus approached, knowledge is attained (zhizhi 知至). ¹⁶ (For readers who are not comparing the Chinese characters, we should point out that these two phrases pronounced ‘zhizhi’ are not the same as the zhizhi [knowing it] in our epigraph on the first page.)

This is the key U-turn in the Great Learning’s core text: once knowledge has been attained through a practice of drawing near to things, then the dominoes can fall in the proper order: ‘Their hearts being rectified, their persons were cultivated; their persons being cultivated, their families were regulated . . ., ’ right down to the achievement of ‘world peace’ (tianxia ping 天下平), which results from well-governed kingdoms, well-regulated families, and several more intimate self-cultivations. All of these great good things can be achieved, step by step, because a knowing comprehension can be reached through the action of drawing near to things. ¹⁷

The Great Learning thus positions a practice of knowing at the turning point between aspirations to the good and successful achievement of the good; but this is not really a surprise in our scientific age, is it? It is almost taken for granted in modern popular epistemology, if we accept the commonsense meanings of these English terms, that good action, progressive social construction, wise governance, integral selfhood, and maybe even world peace, require the true facts that a scientific practice of knowing can provide. Read in a certain way, then, ancient philosophy in a foreign language once again confirms what we modernists already know about how the (one) world naturally works.

But some commentators on the Great Learning have rendered this commonsense more problematic with their genealogical work on ‘the investigation of things’ in the history of Chinese philosophy and scholarship. ¹⁸ We have noted above that the term usually translated as ‘investigate’ (ge 格) is literally and contextually better rendered as ‘drawing near’ to things. And the ‘things’ in question in the original text, our sources point out, are not external objects dongxi (东西) perceived by subjects and referred to with words, or other mental tools. They are more like the constructed entities we associate with STS epistemology or the gathered things present-at-hand, posited by Heidegger (1971). Knowing (zhizhi 致知) slippery social things is thus perceived in the text as being more difficult, more of a process of self-cultivation and world-building, than empiricist versions of investigation and cognition would admit: one doesn’t come to terms with one’s own family, heart-mind, intentions, sincerity, and personhood (all matters of concern in the Great Learning) through ‘investigations’ that measure, dissect, sample, represent, depict, conceptualize, or materially test a solid material thing. The Great Learning proposes instead that we need to cross a few distances, draw near to changing and unreliable things, catching them in the act of becoming manifest.

The implications of this critical translation of ‘nearing’ and ‘things’ are, in our view, massive. For one thing, the action of drawing near to gathering things is not served by a remote observer stance. The nearing to things that we read of in the original Great Learning is a turn both toward the widest world and toward the deepest self, extending its attention across both inner and outer spaces. To adopt a Latourian language, the ‘things’ in question are both quasi-subjects and quasi-objects, so the knower ideally would not be even a step away from the things known.

Our herbalist friends are experts at drawing near to things. They make their way up into the mountain forests seeking medicines conceived not as inert objects but as living and changing partners in healing. Dr Huang invoked a fated relationship between the seven leaf stem and a patient’s illness; Dr Su insisted that only he among his many siblings had the fated ability to ‘think up’ herbal formulas by drawing near to things in the forest. Their knowing, then, is a rather strenuous practice.

Knowing the pattern, through-ing the way

This is not to say that some Chinese thinkers did not ask questions that were properly epistemological. ¹⁹ The very centrality of zhi knowing and wu things in the Great Learning seems to have demanded that later philosophers fill in a few (onto)logical blanks. Neo-Confucian thinkers Zhu Xi and the Cheng Brothers apparently asked themselves how, exactly, one gets from nearing things to fully attaining knowing. ²⁰ The answer had to be more cosmological than psychological or cognitive: these philosophers turned to the patterns of things, li 理.

Before we try to approach their argument, however, we must confess that it is with this li that our own way of tracing an itinerary for knowing practice is interrupted: How should we translate or rigorously use this term? The Anglophone experts in classical, neo-Confucian, and evidential scholarship in China pretty uniformly translate li as ‘principle.’ But we cannot get over the fact that a more literal gloss of the word (per many dictionaries) is texture or grain (as in wood, the sources always point out): that is to say, pattern, a configuration that is inseparable from the materiality of the stuff in which it appears. Li-pattern, moreover, unfolds in time, as a kind of variable continuity, like the currents of a stream. If li is the pattern displayed in natural processes like the growth and branching of trees, or like the regularly repeating eddies in flowing water, then it is something – a very real and material process – that can be known. ²¹

So, returning to Zhu Xi and his interlocutors, how did they fill in that troublesome gap between drawing near to things and actually comprehending them? Fan Hongye (1988) says that they interposed li. ‘Thoroughly [engage] the patterns’ (qiongli 穷理), they advised. ²² And following upon this intervention there were thinkers who clarified: We can only know anything because pattern is shared by knowing heart-minds and known things. ²³ As a corollary of this position, ‘things’ cannot really be thought of – in objectivist, modernist fashion – as objects that a subject knows about. Li is that form of natural reason that brings pattern to all processes of generation, not just human creativity. Only by coming to terms with li can the knowing that concerned Confucius be successful, or attained (Fan, 1988). ²⁴ In the phrase qiongli, li-pattern is the object of the verb ‘thoroughly [engage]’; but li can be a verb itself: li is a patterning of processes of generation. (And when we get our hair cut, the barber li’s the hair. In Chinese medicine, the acupuncture needle might li, or nudge into motion, blobs of stagnant qi, blood, and fluids.)

We love this idea of a patterned flow that incorporates and unifies knower and known in an active field of structured practice (even if it might not be what most of the neo-Confucians really meant). The term li-pattern proposes a world of becoming that can underpin the social, moral, and political concerns of the Great Learning. Thoroughly engaging li becomes the only way to imagine the efficacy of ‘drawing near to [social but not only] things’ as this nearing achieves something that could be called – what? – an attainment of knowingness? (Thanks to Marisol de la Cadena, in this volume, for her awkward-felicitous usage of ‘but not only.’)

This is not just a technical point that only Song and Ming dynasty historians of ideas need to grapple with. Wang Hui (1995) argues that lixue (理学) (might we translate this as patterning thought, following Foucault [1970] and Timothy Reiss [1982]?) was the chief rubric under which much ethical-metaphysical thought, covering about six centuries, should be considered. ²⁵ Partly due to the vast shadow cast over Chinese modernity by Ming period philosopher Wang Yangming (1472–1529) – who is sometimes presented as an East Asian rationalist who insisted on cognitive forms inherent to Mind – pre-modern lixue lent itself to a somewhat paradoxical translation into modern empiricism and science (kexue 科学). As anthropologists of medicine, we note that terms like physiology (shenglixue 生理学) and pathology (binglixue 病理学), pharmacology (yaolixue 药理学) and physics (wulixue 物理学) still incorporate that resonant old li-pattern that is so very non-empiricist (and not even rationalist). Is this patterning resonance heard among Chinese speakers? We have lots of casual evidence that it is.

We cannot move along the Confucian itineraries of knowing practice and matters of concern that fall under the rubric of zhi (知) without saying a bit more about Wang Yangming. This 16th century commentator on the Great Learning is famous among philosophers for his emphasis on the personal heart-mind, but he is more famous among the rest of us for his insistence on ‘the unity of knowing and acting’ (zhi xing he yi 知行合一). ²⁶ Perhaps this is because Mao Zedong in his still-influential philosophical essays of the 1930s rather eerily channeled the epistemological pragmatics of Wang Yangming into the 20th century (Mao, 1971). Looking back over the translations of knowing practice that have occurred over the centuries in China, Wang Yangming helps us see the activity of knowing (zhi 知 and xing 行 together) as both taken for granted in the authoritative texts and as ever historically situated. Under his influence, for example, we notice that the terms ‘nearing,’ ‘comprehending,’ and ‘attaining’ in the pivotal sentences of the Great Learning are all verbs.

The word that Wang Yangming used for ‘acting,’ moreover, which is echoed in so much modern Chinese writing including Mao, was xing (行), which means first of all to walk along, to travel. Wang insistently reminded his 15th and 16th century readers that a unified understanding of knowledge and action presented not just conceptual but ethical challenges. Recalling again the matters of (social) concern evoked in the Great Learning, he insisted that a humane way of going along together required not a disembodied representation of objects, but a personal and exemplary practice of knowing the good (zhi liangzhi 致良知). And on that road through a vastly extended and mostly unknowable world, it is presumed that transformations in the itinerant knower take place even as more and more that can be known unfolds before us and within us.

Anthropology and philosophy have, we feel, returned us to the empirical. Looking back on our many encounters with working herbalists, we now see that the two doctors we have introduced thus far are actually representative of a certain situation of knowing. They were not the only southern mountain healers who tried to tell us something important about ‘knowing it’ and ‘not knowing.’ Indeed, our interviewees were much more interested in pointing to areas of not knowing than they were in claiming any special access to true knowledge. We had trouble hearing them at times, we now think. How in the world, we kept asking, do active knowers know? And how can our recent interlocutors, experienced healers in China’s southern mountains, teach us about translating zhizhi (知之 or, for that matter, buzhi 不知) into an Anglophone and cosmopolitan term? We will address these questions with one more story. We hope that, through the ethnographic material we introduce in this article, readers can appreciate how some knowers we have known go about knowing, and how, like Goldstamp Huang and Lasting Loyalty Su, they live with also not-knowing, even as they are widely known for their efforts to know well how to ride the waves of an incalculable fate.

Virtuefont Li: All doing our best together

When we met him Virtuefont Li was a locally renowned doctor of Qiang medicine practicing in a new hospital built after the 2008 earthquake that had devastated Mao County. In our visit to his clinic, which he established to help a traumatized people, we encountered an anteroom full of patients who had come from all over the region to consult him. Local people in Mao County refer to Dr Li as a ‘divine healer’ (shenyi 神医), an appellation that refers mostly to the unusual effectiveness of his therapy.

Residents of a village near the county town all know, for example, how he brought a pancreatitis patient back from the brink of death with his effective treatments. We got the story of this dramatic cure from the patient herself, and she brought out all manner of documents and proofs to show us. She had been hospitalized in Chengdu for 70 days, some of that time in the ICU. This intensive and unsuccessful treatment completely depleted the family’s savings and had them borrowing from all their relatives and neighbors. When doctors in the big city admitted there was nothing more they could do to save this patient’s life, she was returned to the county hospital where hematemesis and hemorrhagic shock immediately developed. Everyone thought she was soon going to die. Her son showed us the firecrackers they had bought for the funeral, they had all been so despairing. But that evening a member of the patient's family had run into Dr Li on the street and asked him to try. Dr Li’s son recalled that the patient’s grown children had said, ‘We won’t blame you if you can’t save her. We have nothing more to lose now by trying Qiang medicine.’

Later, recalling this case, Dr Li said: ‘When I saw the patient, I could see her strong will to live. This is very important to me; also her family did not want to give up on her, her whole family was very close. Seeing all this, I gained confidence that we could all do our best together to take her life back.’ Dr Li and his disciple-son went to see the patient that night, and then instead of going home they went back to the clinic – where they were surrounded by the herbal medicines they gather and process themselves – to discuss how to compose the first formula. According to Li Junior, the first eight sets of a drug formula are the most crucial. After eight sets of drugs, this patient was indeed able to get out of bed and walk a bit. Usually one set of drugs lasts for a week, but for this special patient, they compounded only three to five days’ worth in each set, so they could adjust the prescription as the symptoms changed. When she was taking the third set, the symptoms worsened. Dr Li asked about her diet, and, discovering that she had eaten four fermented soybeans, ‘for the flavor,’ he changed the formula right away.

Throughout this patient’s illness, Dr Li and his son paid close attention to her condition, especially how her bodily state changed as the drugs did their work. This was a ‘dance of agency’ unfolding in time (Pickering, 1993), one in which the skilled, experienced, and ethical doctor intervenes alongside the powers of drugs, symptoms, food, and diverse human affections. Dr Li’s understanding of how to handle advanced pancreatitis (a term that meant almost nothing to him) was not something stored in his mind, ready to ‘apply’ in an outside world. Rather it was a constant coordination of powers and impulses in social time, working toward good ends with salient powers, only some of them ‘known.’

On knowing and not knowing

The three healers we have briefly introduced, Yao Dr Huang, Lisu Dr Su, and Qiang Dr Li, show us different but similar situations of knowing. Dr Huang knows how to safely and therapeutically mobilize some rare powers from the forests of the Great Yao Mountains, but he can only do it by putting his own time, effort, experience, and hopes for success into the plaster applied to the wound. Dr Su gathers a network of powers that pre-existed his own medical practice, bringing nonhuman agents near and cultivating a relationship with the yin side, which is to say, the invisible, the un-nameable. And Dr Li works along the flow of pathological and therapeutic time, discerning and responding to the currents of change in a pancreas, a patient, a family and a supportive village. These embodied and emergent ways of knowing toward the good, rather than dominating illness with drugs, navigate between knowing and not-knowing, and in so doing participate in the currents or the grain of the world.

Our anthropological work of drawing near to nationality medicines in China’s southern mountains has challenged us to look for patterns in particular unities of knowing and acting rather than facts, information, concepts, representations – the standard stuff of knowledge. We have been helped to understand a Chinese philosophy of knowing practice by witnessing the workmanlike ways in which three healers (Goldstamp Huang, Lasting Loyalty Su, and Virtuefont Li) draw near to things and attain both understanding and efficacy, seeking to build an ethical world of reliable interlocutors (intentions, heart-minds, families, even nations) while riding the waves of what can be known. The 3rd century bce Great Learning still seems to describe a ‘thorough engagement with li-pattern’ as exemplified by these contemporary local medical men who, so passionately engaged, draw near to the myriad things that are local to them. If we were to circle back to reflect on and generalize their work, seeking deep insights about knowledge itself, this would be a betrayal, proof that we have not been paying attention. These lives teach us about knowing practice in their woody grain, in the changes of their flowing currents. To abstract from these stories would only foreclose what we can learn and delude us into forgetting how much we don’t know.

This is the way to know

As anthropologists, we are in the knowledge game, as are you, dear readers. In this article, however, and in our other writings on these subjects, we make no pretense of thoroughly comprehending either the medical expertise of the herbalists Yao, Lisu, or Qiang, ²⁷ or the consensus insights and translations gathered in the Confucian and neo-Confucian tradition of writing. The extreme partiality of our knowledge has been pointed out to us (usually irritably) both by disciplined China philologists and devoted ethnographers of rural places in China. But we take comfort in returning often to the program of research and self-cultivation, ethical social construction and peace in the world that we find condensed in the Great Learning. How do we read this program, knowing comes from drawing near to things, as things are thus approached, knowledge is attained? Now that we have rendered knowledge as a verb, insisting on the unity of knowing and acting; now that we have seen how experimental and interrogatory is the practice of some skilled healers; now that we have acknowledged how truly myriad are the things to be known; now, perhaps we can join mountain herbalists in efforts to more humbly draw nearer to more of the myriad things. Other worlds await us, asking us to attend to the powers and dilemmas in play in particular networks, the particular things that can be known under local conditions, and the stubborn areas of unknowability with which actors always must cope.