<p>Medicinal plant-derived extracellular vesicles (MPDEVs) are nanoscale vesicles secreted by medicinal plant cells. They are enriched in diverse functional components and function as natural mediators that facilitate intercellular communication and regulate multiple physiological processes. Owing to their unique biological activities and delivery capabilities, these vesicles have emerged as a frontier research hotspot. Recent studies have demonstrated that MPDEVs exhibit excellent biocompatibility and cross-species delivery potential and can be engineered to encapsulate small-molecule compounds for use as drug delivery vectors. Remarkably, MPDEVs also display notable intrinsic therapeutic effects and can be directly applied as natural therapeutic agents in various disease models. Furthermore, MPDEVs can be co-administered with conventional therapeutic drugs to strengthen their efficacy and improve bioavailability. This article systematically summarizes the biogenesis, composition, and functional properties of MPDEVs and emphasizes their broad application potential, characterized by a triple identity as intelligent carriers, natural therapeutic agents, and synergistic treatment systems. Nonetheless, the translation of MPDEVs from laboratory research to clinical application is impeded by several critical challenges, including source heterogeneity, the absence of specific biomarkers for efficient purification and identification, and a lack of standardized quality control procedures. Accordingly, this paper also highlights these core limitations and outlines future development directions aimed at facilitating clinical translation and industrial deployment. The objective is to provide a comprehensive reference and theoretical framework to support overcoming these constraints and to contribute to the advancement of MPDEVs into reliable and scalable biomedical tools.</p> Graphical Abstract <p></p>