By 2100, the impacts of land use change on biodiversity at global scale are likely to be more significant than climate change and invasive species introductions. All these changes along with socio‐economic and cultural transformations shaped the indigenous systems to adjust the new circumstances. The interest of this study was to assess the relative effects of changes on climate and land use on dynamics of medicinal plants utilization and indigenous medicines. We used Remote Sensing data to assess land use change, Normalized Difference Vegetation Index (NDVI) and Leaf Area Index (LAI) to estimate the condition of the districts' forests and vegetation, and interviews and discussion with local people to evaluate the forces affecting the condition of medicinal plants and indigenous medicines in three districts of Farwestern Nepal. We found that the LAI and NDVI are insignificantly reduced in the last decade, and it could partly be due to the less influence of climate variables and more influence of vegetation and socio‐cultural variables. The reduction of LAI and NDVI and change in land use were more intense in high altitude area forests. However, the forests are valued as socio‐culturally integral as collection grounds for medicinal plants, as grazing lands for cattle and as sacred sites for ritual and cultural persistence.