Northeastern India, being an integral part of the Himalaya and Indo-Burma biodiversity hotspot, is home to over 2000 medicinal plant species, representing nearly half of India’s medicinal flora. This rich biodiversity supports conservation, traditional health care, and sustainable livelihoods among indigenous communities, whose knowledge has been passed down for generations. However, this natural heritage is increasingly threatened by habitat loss, overexploitation, climate change, and anthropogenic pressures. This chapter provides an in-depth exploration of the diversity, traditional uses, and distribution of medicinal plants in the region. It addresses their conservation status, challenges to sustainable management, trade, and potential for bioprospection, highlighting the cultural and spiritual role of indigenous knowledge in health care. This chapter underscores the need for integrated approaches that align biodiversity conservation with economic development, advocating for community participation and equitable benefit-sharing. By fostering sustainable resource management and recognizing the intrinsic value of medicinal plants, Northeastern India can preserve its medicinal plant heritage while contributing to global healthcare innovations and sustainable livelihoods for future generations.