Most of the Nepalese population use various forms of traditional medicine (TM) as their primary form of health care. Biomedical health-care services are currently extremely limited and are largely situated in urban settings. Despite widespread reliance on TM in contemporary Nepal, we know relatively little about the roles and uses of traditional medicine and the sociocultural impacts of a diverse therapeutic landscape. Drawing on a series of in-depth interviews with eight Nepalese spiritual healers, this article explores the character of spiritual healing; processes of training and knowledge transfer and the interplay of biomedicine and spiritual healing. The results illustrate the importance of metaphysical referencing and the master–disciple tradition in securing the socio-medical authority of spiritual healers and the protection of ‘the art’ of healing. Furthermore, their accounts reflect the impact of recent biomedically driven development programmes on the contemporary practice of spiritual healing in Nepal. We use this data to argue for further research to examine interplay of different forms of TM and biomedicine in Nepal, and to illustrate the importance of such an understanding for health development projects in the region.