Tibetan medicines are key material objects for medical treatment and have become part of a global trend of 'pharmaceuticalisation', playing increasingly important political and socio-economic roles in an 'alternative modernity'. As I argue in this paper, they also have become key 'sites of contestation' between different epistemic values and styles of practice related to efficacy and safety that are reproduced in and through specific formulation regimes. Based on my multisited ethnography of production, prescription, and use practices of Tibetan medicines in China and Europe, this paper conceptualises three distinct formulation regimes, offering a heuristic model for transnational comparison-a classical, an industrialised or reformulated, and a polyherbal regime. The first two are the major orientations while the polyherbal is a conjoint hybrid with either the classical or the industrialised formulation regime. Globalised national drug safety regulations legalise and confer legitimacy to industrialised Tibetan formulas that follow biomedically defined efficacy, safety, and disease categories, while classical formulas produced by private physicians or small-scale cottage pharmacies are increasingly marginalised as producing 'unsafe' and at times illegal medicines, and need to find new ways for adapting and circulating their formulas.;