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This paper describes the findings of ethnobotanical research conducted in Tibetan community of agro-pastoralists in Dolpo, northwest Nepal. We assessed vernacular classification and plant nomenclature system with a particular focus on medicinal plants. We aimed to encompass the interpretation of semantic categories, as well as observing directly how people relate to plants in all material and symbolic aspects of their life. The methodology used consisted of village-level group meetings, indoor semistructured interviews, in situ open interviews and resource mapping. The results showed that a substantial body of knowledge concerning ethno-medical practices and ethno-systematics remain intact in the study area. The Dolpo agro-pastoralists and particularly local amchi (specialists trained in the Tibetan medical system) name and classify the plant world based on morphological, ecological and organoleptic criteria producing a system of hierarchical classification. The richness and complexity of the botanical nomenclature reflect their profound knowledge obtained both from Tibetan materia medica and through direct field experience about the use and management of plant resources. The knowledge of amchi, in particular, is highly linked to the context of social interaction and practices. The study reveals that the use of knowledge and perception of local resource users is valuable for developing management guidelines for medicinal plants in our case and for overall conservation approaches.