Scholars of medical pluralism are interested in how healers position themselves and their healing practices within a therapeutic landscape, and how patients navigate an array of therapeutic traditions. Based on fieldwork in Lambaréné, Gabon, this article examines the discursive practices of tuberculosis patients and healers, finding that therapeutic traditions were kept separate. Examining a national programme that fosters traditional medicine, I show how the Gabonese government engages in practices of boundary making by reinforcing traditional healers’ position within the Gabonese therapeutic landscape. This research confirms popular paradigms of boundary making within the medical pluralism debate, wherein boundaries are produced and crossed to contrast, strengthen, purify, and divide the therapeutic landscape. Additionally, formal state-sponsored discursive practices refer to a merging of traditional medicine and biomedical medicine. This stands in contrast with patients’ and healers’ discursive practices, and their wariness of fluid or adaptive boundary-making processes. To explain this, I introduce the concept of ‘conventional boundary making’ and then analyse it in the context of tuberculosis and in relation to theories of state power, Gabonese therapeutic identity politics, and structural violence.