Tibetan culture and livelihoods depend on native plants for medicine, food, grazing, wood, as well as cash from market sales. The Medicine Mountains (part of the Hengduan Mountains) of the eastern Himalayas, with tremendous plant diversity derived from steep gradients of both elevation and precipitation, have traditionally been an important source of Tibetan medicinal plants. We examine climate change in this area and vegetation patterns influenced by biogeography, precipitation and elevation (NMS and CCA ordinations of GLORIA plots). The Alpine environment has the highest plant diversity and most useful plants and is the most susceptible to climate change with impacts on traditional Tibetan culture and livelihoods—particularly Tibetan medicine and herding.