Tibetan medicine or Sowa Rigpa was largely ignored in classic publications on “Asian medical systems.” This article contends that one important reason for this oversight was that Tibetan medicine had not yet managed to establish itself as a recognizable medical system at that time. This has changed only recently with ongoing political and economic processes through which Tibetan medicine in exile has been transformed, since the 1990s, from a regional health tradition into a globally recognizable and clearly defined and delimited medical system. After some reflection on the notion of medical systems, this article focuses on the events and interests that led to the establishment of the Central Council of Tibetan Medicine in early 2004, which can be regarded as the official establishment of Sowa Rigpa as a medical system. The discussion then moves on to the consequences of this development for Tibetan medicine in exile at large, and for its most powerful institution, the Men-Tsee-Khang, in particular. The outcome of wider exile Tibetan political aspirations, Sowa Rigpa's “embodiment” as a medical system also has direct medical and pharmaceutical dimensions, manifesting most importantly in efforts to regulate and standardize its syllabi, clinical practice, and pharmaceutical production. The article gives in-depth insights into some of the most important recent developments in Tibetan medicine in exile, its economic and political organization, and the role of its main institutions.