BackgroundModern therapeutic medicine is historically based on indigenous therapies and ethnopharmacological uses, which have become recognized tools in the search for new sources of pharmaceuticals. Globalization of herbal medicine along with uncontrolled exploitative practices and lack of concerted conservation efforts, have pushed many of Nepal's medicinal plants to the verge of extinction. Sustainable utilization and management of medicinal plants, based on traditional knowledge, is therefore necessary.MethodsAfter establishing verbal informed consent with participating communities, five field surveys, roughly 20 days in duration, were carried out. In all, 176 schedules were surveyed, and 52 participants were consulted through focus group discussions and informal meetings. Altogether, 24 key informants were surveyed to verify and validate the data. A total of 252 individuals, representing non-timber forest product (NTFP) collectors, cultivators, traders, traditional healers (Baidhya), community members, etc. participated in study. Medicinal plants were free-listed and their vernacular names and folk uses were collected, recorded, and applied to assess agreement among respondents about traditional medicines, markets and management.ResultsWithin the study area, medicinal herbs were the main ingredients of traditional therapies, and they were considered a main lifeline and frequently were the first choice. About 55% plants were ethnomedicinal, and about 37% of ethnomedicinal plants possessed the highest informant consensus value (0.86–1.00). Use of Cordyceps sinensis as an aphrodisiac, Berberis asiatica for eye problems, Bergenia ciliata for disintegration of calculi, Sapindus mukorossi for dandruff, and Zanthoxylum armatum for toothache were the most frequently mentioned. These species possess potential for pharmacology.ConclusionMedicinal plants are inseparable from local livelihoods because they have long been collected, consumed, and managed through local customs and knowledge. Management of traditional therapies is urged, because the therapies are empirically and knowledge based, often culturally inherited and important to pharmacology and local livelihoods. However, traditional therapies are currently being eroded due to changing lifestyles, perceptions, social transformations, and acculturation.