When one peruses medical case histories from the Qing dynasty (1644-1911), one sees constant references to phlegm as both cause and consequence of disease. Phlegm, that is, figures as a central, indispensable concept in the Chinese imagination of the body and its pathologies. Curiously, however, when one goes back to the Huangdi neijing 黃 帝內經, the earliest and foundational classic of Chinese medicine, phlegm does not appear at all. In the earliest Chinese medical texts there is no notion that would resemble the concept of pathogenic phlegm.

By contrast, phlegm forms one of the basic building of Indic medical thinking. Thus, as the appearance of phlegm in Chinese medical thinking was coeval with the advent of Buddhist translations in China, some scholars have suggested that the development of the concept in China was influenced by ayurvedic notions of phlegm. Chinese medical scholars, however, have long explained the emergence of phlegm independently of Buddhist influences, as a system-internal development of the body fluid yin 飲.

In this paper, I take a fresh look at the possible Indic connections of phlegm in Chinese medicine. I argue that the earliest occurrences of phlegm in Chinese medicine developed independent of ayurvedic influences, from the Chinese notion of yin 飲. On the other hand, I review the translation terms for phlegm in early Chinese Buddhist translations. On the basis of these terms, I argue for Indic influences in the subsequent development the concept of phlegm during the first few hundred years after its appearance in Chinese medicine. Finally I ask how the phlegm of early Chinese medical text, and the phlegm of early Chinese Buddhist translations come to be associated with each other. To answer this question, I look at the context and the functions of the respective terms in both Ayurveda and Chinese medicine, and suggest that the nexus lies in the digestive and “metabolic” system transformation.