<p>Traditional medicine holds considerable potential and has a long history of conventional treatment, with insects serving as important therapeutic resources across cultures. In the North East Region (NER) of India, edible insects are widely employed by indigenous communities to treat fever, jaundice, hypertension, pain, and infections. Despite their ethnomedicinal importance, evidence-based studies are limited. This review compiles the edible medicinal insect species of NER and critically evaluates available pharmacological evidence in a global context. A two-tiered literature search was conducted across PubMed, Web of Science, Scopus, and Google Scholar. Tier A retrieved ethnomedicinal documentation using keywords such as “edible insects,” “ethnomedicine,” “therapeutics,” and “Northeast India,” while Tier B targeted pharmacological validation with “pharmacological significance” and species-specific terms. Eligible studies included medicinal uses, therapeutic compounds, or experimental validation; ecological or nutritional reports were excluded. We identified 40 insect species used by traditional healers with reported benefits against metabolic, infectious, and inflammatory disorders. Ethnographic knowledge is extensive, yet pharmacological validation remains limited, primarily confined to in vitro and in vivo, without sufficient clinical trials. Comparative appraisal with Africa, China, and Latin America highlights both convergent and distinct entomotherapeutic practices. This review highlights the novelty of NER entomotherapy as a promising yet underexplored source of bioactive compounds, while emphasizing the need for rigorous studies on toxicity, dosage, safety, and clinical efficacy to facilitate its translation into modern therapeutics.</p> Graphical abstract <p>A pictorial representation of insect derived bio-actives and their pharmacological significance</p> <p></p>