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Galen’s response to epicurean mechanism is based on qualitative alteration, which he holds responsible for higher-order natural phenomena, especially vital ones. A parallel is regularly drawn with the contemporary notion of emergence; but depending on the interpretations, Galen would have foreseen, adopted or rejected such a position. In this paper, we focus the analysis on the main witness in the case (De elementis, 3, 7-24). Galen defends here the idea that the existence of “something generically different” (τι κατὰ γένος ἕτερον), such as sensibility, supposes at least alterability at the elementary level; but in what sense? To understand this, we further investigate the relations between sensation and alteration in other passages of the corpus. We then argue that the leap between the levels of reality is more epistemic than ontological, and that it confers all the more relevance to the suggestion of a galenic emergentism.