Grounded in Greek medical theory and strengthened by diverse pharmacological influences, ?ibb arrived in its South Asian environment from the Middle East around the time the Delhi Sultans established their rule, in the thirteenth century. Those diverse pharmacological influences are the crux of the paper I propose to present. How does the practice of a tradition change when it moves to an entirely new environment, and, more importantly, how can we track such changes and developments. I study Naj?b al-D?n al-Samarqand?’s (d. 1222) al-Asb?b wa al-?Al?m?t and its extensive South Asian commentary tradition to better understand the development of ?ibb in India. To do this, I focus on the paratextual clues offered by the manuscripts. In the case of this paper, I use marginalia pertaining specifically to the treatments recommended by the texts and their authors, and I focus particularly on those marginal notations that suggest a move away from materia medica with more Middle Eastern roots to medical substances that are more Indian in origin. Whereas pharmacological notations suggesting Middle Eastern ingredients tend to quote their treatment regimens from major medical scholars such as Ibn S?n? or al-R?z?, these Indian-specific marginalia do not cite their sources and are more local in ingredient composition. These observations allow me to make conclusions about the changes ?ibb underwent as it settled in South Asia and what that meant for ?ibb? practice, purely from a textual standpoint.