Himalayan Mayapple (Podophyllum hexandrum) is a perennial rhizomatous plant distributed in the alpine regions of Afghanistan, Bhutan, China, India, Nepal, and Pakistan. The species is overexploited for its rhizomes which are highly valued in cancer treatment and other medicinal purposes. The species reaches maturity after five to seven years of growth. Flowering and fruiting in the species are erratic and regeneration is poor. At most localities, the species is rare and has a low population density. Extensive harvesting is a serious concern for its survival. The species is also threatened due to habitat loss, deforestation, and climate change. Its subpopulations have decreased significantly and a decline of at least 50% of the population over the course of the last 21 years (three generations) is suspected as a result of excessive harvest. As demand for the species on medicinal markets remains high, these population declines are expected to continue into the foreseeable future at a comparable rate. In addition, the species is likely to be negatively impacted by climate change with habitat suitability models suggesting that substantial portions of the species' range may become unsuitable by 2050. The species is listed as Endangered under criteria A2bd+3cd+4cd. Additional studies on the rate of population decline, market trends, and interventions promoting sustainable cultivation of the species are urgently needed.

Himalayan Mayapple (Podophyllum hexandrum) is distributed in the Himalayan ranges from Afghanistan to Bhutan and Aranchal Pradesh, India at an altitude of 2,000 to 4,500 m asl (Airi et al. 1997, Chaurasia et al. 2012). The distribution of the species in India has been compiled in detail by Shah (2006).

A global estimate of the Himalayan Mayapple population is not available. Subpopulations tend to be small in size (40–700 plants per locality) and declining every year (Airi et al. 1997, Bhadula et al. 1996). The density of species in Uttarakhand, India ranged from 0.3–4.8 individuals/m² (Chandra et al. 2021). Airi et al. (1997) estimated its population from three catchments (Pindari, Sunderdhunga, and Kaphani) of Kumaun Himalaya involving 11 subpopulations and reported its density to vary from 0.50–8.23 individuals/m². The species exhibits poor density even in the protected areas of the Indian Himalayas. Kala (2005) reported its density to vary from 0.72, 0.98, and 2 individuals/m² in Kedarnath Wildlife Sanctuary, Valley of Flowers National Park, and Kibber Wildlife Sanctuary respectively. In the Nanda Devi biosphere, Western Himalaya, the density of the species ranged from 0.22–0.47 individuals/m² (Negi et al. 2018). Though density data for the species appear fragmentary, most reports on the population structure of Himalayan Mayapple have raised concern about population decline. 
The species was collected in large quantities from the wild since the British period in India, but precise documentation of its indiscriminate exploitation was documented for the first time by Shah and Kapoor (1978). A substantial portion of the export market in the 1980s was linked to European countries (Husain 1983). A 1997 Conservation and Management Plan (CAMP) workshop designated the species as Critically Endangered (Zoos’ Print 1998). Population declines have been noted in much of the species' range, particularly the western Himalayas (Chaudhari and Yamin Bibi 2021). Its subpopulations have decreased significantly since the late 1990s based on trade figures (Shah 2006) and a decline of at least 50% of the population is suspected over the the last 21 years (three generations). It is suspected that declines of a similar magnitude will occur over the course of the next 21 years as a result of the combined impacts of excessive harvest and climate change.

Himalayan Mayapple is an erect, succulent perennial herb, about 15–60 cm tall bearing alternate, long-stalked, often purple-spotted round leaves in groups of one to three. Flowers are large, cup-shaped, bisexual, actinomorphic, gamosepalous, and white or pink coloured. The fruit is a berry with numerous seeds. Reproductive shoots of the species have two, exceptionally three, leaves whereas vegetative shoots bear a single leaf (Airi et al. 1997). The species prefers to grow in shady and moist sub-alpine forest floors, forest openings/margins, and alpine slopes (Airi et al. 1997, Xiong et al. 2013). It is a slow-growing plant with poor seedling survival. The species requires five to seven years to reach an economically viable size (Singh et al. 2021). The longevity of the species is not well established. A generation length of five to seven years is considered reasonable for determining conservation status of the species. Additional research on the life history traits of the species is likely to result in increases to this figure.

The species is threatened due to destructive harvesting, high trade value, restricted distribution, low population density, poor natural regeneration, habitat fragmentation, low genetic diversity, and lack of cultivation protocols (Kala 2005, Maqbool 2011, Rana and Samant 2011, Banerjee et al. 2017, Nag et al. 2020). Excessive harvest has been identified as the primary threat to the species, particularly in the Western Himalayas (Chaurasia et al. 2012, Chaudhari and Bibi 2021). As demand continues to exceed available supply (Chaurasia et al. 2012), prices for the species are expected to remain high. There is currently no indication that existing prohibitions on collection of wild plants are adequate to address continuing population declines, and harvest levels are expected to remain at an unsustainably high level.

The impact of climate change on the species is not well understood, but it is likely to cause shifts in distribution or population declines. Given that temperatures during the coldest quarter of the year are the strongest predictor of Himalayan Mayapple presence (Banerjee et al. 2017), and that the winter temperatures have been rising more rapidly than average annual temperature increases (Telwala et al. 2013), the species may be especially sensitive to the impacts of climate change. In Nepal, modelling suggests that 74% of the species' habitat will become unsuitable for the species by 2050 (Shrestha et al. 2022).

Himalayan Mayapple was introduced as a part of Western medical traditions in 1787 and used as a medicinal source in the Pharmacological Department of the USA from 1820 (Bisht and Chauhan 2016). The roots and rhizomes of the species are valued in the traditional Indian and Chinese systems of medicine. Although the species contains several bioactive constituents, the primary pharmacologically important compound is podophyllotoxin which has anti-cancer activity (Paul et al. 2013). This compound is used in the synthesis of etoposide and teniposide that have been demonstrated as effective in the treatment of lung cancer, leukaemias, and other tumours (Woerdenbag et al. 1990). In folk medicine, it is used to cure ulcers, cuts, wounds, and skin diseases (Negi et al. 2011). 

Data on the trade of the species is species are fragmentary and appears non-reliable. Before the ban of its export from India in 1984, 8-15 metric tons of the rhizomes and roots were exported annually from India to the USA and European countries. About 37.3 tonnes of rhizomes of Himalayan Mayapple were uprooted from Himachal Pradesh, India between 1995 and 2000 (Chaurasia et al. 2012). Recent estimates from India show annual trade of about 10–50 metric tons (Goraya et al. 2017).

The species is widely sold and grown as an ornamental plant (mostly from artificially propagated sources).

India has banned the export of specimens of Himalayan Mayapple since April 1984. The export of species and its derivatives and extracts obtained from the wild is prohibited under Schedule 2-Appendix 2 of Export and Import Policy 1997–2002 (Bhardwaj et al. 2019). To check its illegal trade, the species has been listed in Appendix II of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES 2021). Propagation/cultivation protocols, control of illegal trade, and an integrated approach involving local communities in sustainable harvest are needed for its conservation.