This review explores recent advances in the biotechnology of Lamprocapnos spectabilis (L.) Fukuhara (commonly known as bleeding heart), a valuable ornamental-medicinal perennial. The article covers in vitro morphogenesis, cryopreservation techniques, and methods for inducing variability. The establishment of in vitro cultures utilized Murashige and Skoog medium enriched with various auxins, cytokinins, gold nanoparticles, and plant extracts, under both fluorescent and wide-spectrum LED lighting. Axillary bud activation and indirect somatic embryogenesis were more efficient, particularly in the presence of kinetin and picloram, respectively, compared to adventitious shoot regeneration. Significant cultivar differences were observed, with ‘Valentine’ being the easiest and ‘White Gold’ the most challenging to culture in vitro. To mitigate stress caused by classical growth regulators, alternative substances such as nanoparticles and natural extracts were used. Gold nanoparticles enhanced shoot proliferation and plantlet quality, while coconut and rice extracts improved survival rates during acclimatization. Enhanced metabolite production was achieved using exogenous auxins and gold nanoparticles. Guaiacol peroxidase was identified as a sensitive oxidative stress marker, with glutathione reductase being the most stable under stress. Cryogenic techniques incorporating explant encapsulation, i.e. encapsulation-vitrification, showed high effectiveness and genetic stability of plants, with nanomaterials boosting effectiveness. Coconut extract also enhanced post-thaw shoot proliferation, while sesame extract served as a natural retardant for slow-growth cultures. Mutagenic effectiveness ranked as microwaves < nanoparticles < X-rays. Comprehensive genetic variability insights were provided by integrating multiple SPAR marker systems. This review underscores the promising biotechnological advancements for L. spectabilis, emphasizing the potential of in vitro techniques, innovative cryopreservation methods, and the application of nanoparticles and plant extracts to enhance micropropagation, genetic variability, and metabolite production, thereby contributing to the conservation and commercial sustainability of this valuable ornamental-medicinal perennial.