This comprehensive review focuses on Eleutherococcus senticosus (ES), examining the phytochemical composition, traditional medicinal roles, ecological traits, and pharmacological effects. Native to Northeast Asia, ES is used in traditional Chinese, Korean, and Japanese medicine. The rhizomes and bark are utilized medicinally and valued for their adaptogenic properties that enhance stress resistance, boost mental and physical endurance, and exhibit immunostimulatory effects that strengthen the immune system. Its pharmacological potential stems from a variety of bioactive compounds, including eleutherosides, lignans, saponins, flavonoids, and polysaccharides, which contribute to health benefits such as neuroprotective, antidiabetic, anticancer, and antioxidative activities. Neuroprotective properties may aid in the management of neurodegenerative conditions, such as Alzheimer’s and Parkinson’s disease, while antidiabetic effects support glucose regulation and insulin sensitivity. With increasing demands and conservation concerns, sustainable cultivation practices are essential, as ES is endangered in some areas. Plant biotechnology techniques offer solutions to enhance secondary metabolite yields while ensuring genetic stability and minimizing environmental impacts. ES is a promising natural resource for various industries because of its extensive benefits. Still, its conservation and sustainable production are critical and require ongoing research and innovative cultivation strategies.