The Qinghai-Tibet Plateau (QTP) is characterized by extreme altitude, hypoxia, intense ultraviolet (UV) radiation, and complex geomorphology. Such extreme environments have fostered a distinctive spectrum of food and medicine homology resources (FMHR). These resources include medicinal and edible plants, animals, fungi, and traditional fermented dairy products, all of which are integrated into Tibetan daily life and ethnopharmacological systems. This review examines the ecological distribution, functional properties, and sustainable utilization of local species, specifically analyzing the impact of severe environmental stress and soil conditions on their adaptation and bioactive accumulation. The resources are then categorized along altitudinal gradients and major ecological zones to analyze their spatial distribution across alpine grasslands, agricultural valleys, and montane forests. By combining traditional Tibetan dietary wisdom and medical theories with modern pharmacological evidence, the review highlights reported biological activities, including antioxidant, antifatigue, immunomodulatory, and metabolic-regulatory activities. Currently, these plateau resources face severe threats from climate change, overexploitation, and inadequate standardization. Based on a comprehensive synthesis of the literature, this review identifies critical evidence gaps including the scarcity of clinical trials, incomplete quality standards, and limited quantitative data on industrial development. To address these challenges and gaps, future strategies focusing on germplasm conservation, scientific validation, industrial upgrading, and sustainable development are proposed. The overarching goal is to provide a systematic reference for the high-value utilization and ecological protection of FMHR on the QTP.