Tylophora indica (Burm. f.) Merr., a perennial climber from the Apocynaceae family, is a critically endangered medicinal plant renowned for its immense therapeutic value, particularly in traditional Ayurvedic medicine for treating respiratory ailments like asthma and bronchitis. Its pharmacological properties are primarily attributed to a unique class of bioactive compounds, the phenanthroindolizidine alkaloids, with tylophorine being the most significant. Rampant over-exploitation from wild habitats to meet commercial demand, coupled with its inherent constraints of low seed viability and poor germination rates, has pushed this species to the brink of extinction. This underscores an urgent need for a multifaceted conservation strategy. This review comprehensively explores the integrated approaches essential for the sustainable utilisation of T. indica. We discuss the critical role of in-situ conservation through habitat protection and the establishment of medicinal plant conservation areas. Furthermore, we emphasise the paramount importance of advanced ex-situ strategies, including biotechnological interventions like plant tissue culture for rapid clonal propagation, synthetic seed technology, and cell suspension cultures for continuous biomass and alkaloid production. Ultimately, a synergistic model that combines strict wild resource management with the adoption of modern cultivation and biotechnology techniques is proposed as the only viable pathway to ensure the long-term availability of this valuable genetic resource without compromising its natural populations.