<p>Understory cultivation pattern of medicinal plants is a kind of planting mode which makes full use of land resources, light, and heat resources. This planting mode is under the forest on the basis of fully understanding the growth environment of medicinal plants and using the principle of the symbiosis of forest medicine. The understory planting mode plays a positive role in the protection and sustainable utilization of forest resources, plants diversity, and ecological environment. Therefore, this planting mode has become a popular choice for the development of forest industry. This review mainly focus on the research progress in understory planting mode of medicinal plants, including the advantages of understory planting, the influence of understory planting on forest ecosystem, and the factors affecting the understory cultivation of medicinal plants. And it also proposes the possibility of optimizing the cultivation conditions of planting patterns of medicinal plants under forests through integrated analysis of metabolomics and transcriptomics. This review provides guidance and suggestions for related research on the sustainable development of understory planting medicinal plants and the rational utilization of forest land resources.</p>