Mountain farming systems rely on both empirical and academic knowledge. Their sustainability depends on how effectively diverse knowledge is used for solution-oriented decision making. For mountains, decisions must be conducive to rural farmers whose livelihoods depend on agriculture and related activities. Adopting transdisciplinary research approach, we define a composite Sustainability Space indicator that will help decision makers better understand the ingredients for sustainability, and formulate policy and management decisions to reinforce on-the-ground sustainability. Sustainability Space was derived through analysis of the positive and negative impact factors co-defined by community and disciplinary experts, and visualized through a radar diagram. We used Principal Component Analysis to understand relationships between factors. The results on Sustainability Spaces for eight cases of farming systems from the far-Eastern Himalayas indicated that the sustainability of farming systems is strengthened if decisions holistically cater to (i) geophysical pre-requisites, (ii) ecological foundations, (iii) integrated processes and practices, (iv) resources, knowledge, and value systems, (v) stakeholders’ development and economic aspirations, (vi) well-being of farming communities, and (vii) government support mechanisms. More equitable the attention to these seven components, the higher the sustainability of farming systems in this region could be.

Background: Balneotherapy, the therapeutic use of mineral and thermal waters, is an ancient practice with global significance. In Bhutan, the use of hot springs is deeply ingrained in culture and traditions as balneotherapy practices, enriched by extensive ethnopharmacological knowledge. Therefore, this study aims to document the socio-cultural and ethnopharmacological importance of Bhutanese hot springs, analyse their physicochemical characteristics, and correlate them with the perceived therapeutic benefits. Methods: The study focused on three hot springs in the Gasa and Punakha districts. Qualitative data collection on ethnopharmacological knowledge included informal conversations, semi-structured interviews, oral narrations, and focus group discussions. Thematic analysis was applied to interpret the data. Physicochemical properties of the thermal waters were analysed following standard laboratory protocols. Piper and Stiff plots were used to determine the water type and ion concentration, respectively. Moreover, Spearman’s correlation coefficient was used to assess the physicochemical relationships of the thermal water to the perceived health benefits. Results: The study found that people visit hot springs for spiritual connection, social bonding, and therapeutic benefits for musculoskeletal, dermatological, gastrointestinal, respiratory and cardiovascular conditions. The Piper diagram revealed that all hot springs exhibit a sodium-chloride (Na⁺–Cl⁻) hydro-chemical facies, suggesting a common geochemical origin. Stiff plot showed higher concentrations of ions in Gasa hot spring than other two sites. A moderate positive correlation was found between the concentrations of calcium, sodium, potassium, and magnesium, and the perceived health benefits for musculoskeletal and dermal conditions. Conclusion: This study highlights the cultural, spiritual, and therapeutic importance of hot springs in Bhutan. The ethnopharmacological benefits, particularly for musculoskeletal and dermal conditions, is found to be linked to the physicochemical composition of the thermal waters. However, it calls for more research in terms of physicochemical analysis of thermal waters and clinical trials to scientifically validate these practices so they can be institutionalized as complementary and alternative treatments.