Herbal medicine has experienced a renaissance both for health reasons and as part of a bioeconomy for regions rich in biodiversity and traditional knowledge. Medicinal plant value chains can promote local development and sustainable livelihoods that are critical for forest frontiers in need of inclusive economic alternatives. This sector can become an example of restorative bioeconomy, which not only maintains but enhances nature's contributions to people – notably to historically marginalized actors such as Indigenous peoples. However, a reality check is due. Using the Amazon as an emblematic case study, this article examines Brazil's context and policy framework on herbal medicine promotion. It draws from a literature review as well as 23 key-informant interviews and field visits to 10 local herbal medicine value chain initiatives. Our findings expose a closing window of opportunity, as while deforestation and forest degradation advances, Brazil's herbal medicine promotion has fallen short of its potentials for development and inclusiveness. Insufficient attention to traditional knowledge or to research on Brazil's native biodiversity, regulatory stringency without converse support to integrate marginalized actors, and ambivalent social acceptability of herbal medicine have been key barriers to advancing the sector. We conclude that herbal medicine offers a clear case of restorative bioeconomy with double potential to address historical inequalities both on healthcare access and socioeconomic inclusiveness, but delivering on that requires much more participatory research, attention to local capacity enhancement, and a better understanding of herbal medicine promotion in multicultural social settings.