Xilinhot City is a significant pastoral city in China where groundwater serves as the primary water source for the cold and arid pastoral regions. The formation and evolution of material components in groundwater, as well as groundwater quality, are directly linked to the health of pastoral residents. This study is based on the physical and chemical test results of 22 groundwater samples collected from the Xilinhot River Basin in Inner Mongolia. Various statistical analyses, including Piper and Chadha diagrams, as well as hydrogeochemical simulation methods, were employed to assess the hydrogeochemical characteristics and material composition sources of groundwater, evaluate groundwater quality and non-carcinogenic risks, and comprehensively discuss the impact of macro- and microelements on human health. The findings indicate that igneous rocks containing minerals such as potassium feldspar, plagioclase, and pyroxene contribute Na⁺, Cl⁻, and K⁺ to the groundwater, while sedimentary rocks containing minerals like dolomite and calcite supply ions such as Ca²⁺, Mg²⁺, and HCO₃⁻. The groundwater quality is primarily classified as Class II–V, with F⁻ and NO₃⁻ exhibiting varying hazard quotients for children and adults in the study area, though they do not pose a non-carcinogenic risk. Additionally, the enrichment of hardness, Ca²⁺, Mg²⁺, Na⁺, SO₄²⁻, and other indicators in localized areas exceeds the recommended values for drinking water, potentially impacting the digestive and urinary systems of the human body. There is a risk of excessive fluoride in areas where F levels exceed 1 mg/L. Furthermore, the content of beneficial micronutrients such as selenium (Se), zinc (Zn), boron (B), and germanium (Ge) is relatively low. Based on the elemental abundance characteristics and a comparative analysis of the chemical properties of groundwater across five regions of China, this comparison facilitates a discussion on the definition of healthy groundwater, particularly in relation to safe consumption in cold and arid regions. This study aims to highlight the health issues associated with drinking groundwater in the cold and arid regions of Mongolia. The findings serve as a valuable reference for efforts aimed at reducing the incidence of endemic diseases and enhancing human lifespan.