Situated 14,000 feet above sea level, the vast Tibetan plateau has been inhabited by humans for at least 21,000 years. Adapted to extreme altitude and cold, early nomadic pastoralists hunted, herded, traded, and developed routes linking Tibet with other parts of the world. Their early religion was animistic. Mountains, rivers, and sky phenomena were regarded as living entities, angered deities could cause disease, and healing was inseparable from ritual and religion. Shamans were supposed to mediate between humans and the invisible world through chanting, sacrifices, and ritual negotiation. They believed the body was governed by elemental forces—wind, fire, water, and earth. In health, there was a proper relation between these forces, but illness signified imbalance.

Early shaman healers based their diagnosis on astrology and divination. Their practice consisted of observation, studying their patients’ pulses, prescribing specific diets and lifestyles, and using certain minerals and animal substances. Herbal medicine, in part, promoted culture, education, and spiritual teaching. Saffron, cloves, and green and black cardamoms were frequently prescribed.

One of the earliest Tibetan civilizations was Zhangzhung (c. 500 BCE – c. 600 CE). This was not a single state but a network of politico-cultural entities, centered in western Tibet near the border with Nepal, but eventually extending to Kashmir and Central Asia. It seems to have been a stratified society with rulers, priests, artisans, and workers. Its origins have been linked to the development of Bon, an earlier religion from which they incorporated many aspects. For many centuries, Zhangzhung was a powerful western rival to emerging central Tibetan polities, its rulers controlling important trade routes to India, Central Asia, and China.

Eventually, Zhangzhung was replaced by the Yarlung Dynasty, whose king, Songtsen Gampo (618–649), unified the region and established the Tibetan Empire. By the eighth–ninth centuries, it was one of Asia’s great empires, extending far beyond the Tibetan Plateau, from the Pamirs and Central Asia in the west to parts of China (Yunnan), even to Bengal. The second Yarlung Tibetan king, Trisong Detsen (755–797), married Buddhist princesses from China and Nepal and, under their influence, introduced Buddhism to Tibet. In 791, Buddhism became the official state religion, and Indian scholars were invited to teach and study. The king founded Tibet’s first monastery, ordained the first seven Tibetan monks, and adopted the Indian tradition (Mahayana) over the Chinese Buddhist tradition. Tibet transitioned into a society centered on monastic institutions, temporarily interrupted by the assassination of a Buddhist king in 842. In the 10th century, Buddhism was reinstated, promoted by feudal lords, leading to Tibetanization and the development of distinct Buddhist schools. Great monastic universities became centers of learning, philosophy, medicine, and art. Tibetan scholarship, astrology, and religious practices flourished and deeply integrated spiritual and scientific traditions. 

In medicine, Buddhist practices merged with local and earlier ones, forming a unique medical system, the Sowa Rigpa. This was primarily based on the writings of Y.Y. Gonpo (1126–1202), a Tibetan doctor who wrote the Four Medical Tantras. This four-book treatise on traditional Tibetan medicine is regarded as the principal founder of Tibetan medicine, a fusion of Buddhist and earlier religious formulations. Under this system, monasteries often functioned as centers of healthcare and learning. Monks were trained in prayer and ritual alongside diagnosis via pulse observation and urine analysis. They also addressed public health concerns, epidemics, war injuries, and childbirth, especially in isolated areas.  Childbirth practices emphasized warming, massage, and herbal support, while trauma medicine included bone-setting techniques. Buddhism was integrated with its predecessors and came to view illness as an imbalance of the three fundamental principles (wind, bile, and phlegm) that govern physical and spiritual well-being.

During the Mongol invasion in the 13th century, Tibet became a tributary of their empire for about a century. It became independent during the Chinese Ming Dynasty (1368–1644). In 1642, the Great Fifth Dalai Lama created the Ganden government with a unique monastic/secular coordinated administration. This government demilitarized Tibet and officially formed it into a spiritual theocratic nation that, for the next 30 years, was economically self-sufficient, promoting culture, education, spiritual teaching, and, above all, Buddhist education. In 1904, the British briefly invaded Tibet to impose a trade agreement and prevent it from coming under Russian domination.

Political upheavals in the 20th century threatened the institutional continuity and survival of Tibetan medicine. The People’s Republic of China invaded the Tibetan Eastern regions and, in 1950, marched into the Tibetan capital of Lhasa and annexed the entire country. An uprising against Chinese rule in 1959 resulted in the killing of some 1.2 million Tibetans. The Dalai Lama established a government-in-exile in India, and an exodus of Tibetan refugees created a diaspora of some 150,000 in India, Europe, and the United States. The Chinese have settled more than 8 million people in Tibet and pursued rapid assimilation, modernization, and infrastructure development, especially military installations. They suppressed many aspects of Buddhist culture, destroying monasteries and other Buddhist religious sites. Yet Tibetan medicine has survived to some extent, not only in Tibet and the Himalayan regions but also internationally. As it contributes to universal conversations about holistic health care, it has retained earlier Zhangzhung and Bon foundations beneath its Buddhist facade.