The effects of herbivorous insects on a plant population are not always well tolerated. This is especially true if the herbivorous actions are directed toward rare plant species. Salvia ceratophylloides Ard. is a rare endemism of southern Italy. Observations of the plants in situ revealed that many of them were under severe stress and did not produce seeds. Therefore, to find out which factors affect the reproductive activity as a whole, an observational study was carried out. We found bottom-up and top-down effects on plant health and reproduction associated with herbivorous action. Squamapion elongatum (Coleoptera, Curculionoidea, Apionidae), in all monitored sites, infested plants non-uniformly but was able to threaten the health condition, flowering, and seed production of sage by digging tunnels into the sage branches (bottom-up action), and then secondarily by seed feeder Systole salvia Zerova (Hymenoptera, Eurytomidae) predating sage seeds (top-down action). Mainly, chalcid parasitoid wasps such as Trichomalus spp. (Hymenoptera, Pteromalidae), as well as Eupelmus vesicularis and E. muellneri (Hymenoptera, Eupelmidae), limited the herbivorous S. elongatum population and the seed herbivore S. salviae emerged with its parasitoid Ormyrus diffinis (Hymenoptera, Ormyridae). Overall, this study showed how ecological interactions among herbivores, their host, and their natural enemies act on this sage species in all sites investigated. Among the herbivores, mainly S. elongatum affected this rare sage species, which should be taken into consideration, especially in the formulation of biological control solutions and for improving operating practice aimed at reproducing the species. This study provides the molecular characterization of the herbivorous species involved, in order to support future projects to evaluate the intra- and interspecific genetic variability of insects, their evolutionary relationships, and phylogeny studies.