Abstract: The depletion of wild medicinal resources in China has intensified the conflict with growing market demand. Leveraging the abundant forest resources in southern China, the efficient utilization of understory space for medicinal plant cultivation emerges as a critical solution to address supply-demand imbalances and achieve "forest-medicinal coexistence".At present, the four characteristic medicinal materials industries of Polygonatum cyrtonema, Paris polyphylla, Dendrobium officinale and Ganoderma lucidum have made some progress in breeding of improved varieties and cultivation technology. However, it still faces challenges such as insufficient supply of seedlings and limited promotion and application of high-efficiency cultivation techniques have constrained the healthy and orderly scaling of the industry. By focusing on these four characteristic medicinal species in southern China’s understory ecosystems, this study systematically reviews research advances in the evaluation of high-quality germplasm resources and key cultivation techniques. It further clarifies suitable growing conditions—such as soil properties, light availability, and water-fertilizer management—for each species under forest canopies, and establishes composite planting models including Castanea henryi–Polygonatum cyrtonema, Cunninghamia lanceolata–Paris polyphylla, Dimocarpus longan–Dendrobium officinale, and Vitis vinifera–Ganoderma lucidum. Based on these findings, future efforts should emphasize innovation in elite germplasm development and integrated cultivation techniques standards to provide theoretical support for the high-quality development of understory medicinal plant industries in southern China.