This essay examines historical and contemporary connections between Buddhist and medical traditions through a study of the Accomplishing Medicine (sman sgrub) practice and the Yuthok Heart Essence (G.yu thog snying thig) anthology. Accomplishing Medicine is an esoteric Buddhist yogic and contemplative exercise focused on several levels of “alchemical” transformation. The article will trace the acquisition of this practice from India by Tibetan medical figures and its assimilation into medical practice. It will propose that this alchemical practice forms the central nexus of connection between Tibetan medicine and the Buddhist Nyingma tradition, and that this little-studied link is not a marginal feature of Tibetan medicine but rather one that has had a significant shaping factor on each tradition throughout history.