Indiscriminate extraction of Picrorhiza kurrooa is a serious threat to the population of this Himalayan medicinal plant. Over 90% of the market demand for this species is met from the wild. We conducted a study on the patterns and processes of kutki extraction in a part of the Dhauladhar range, Western Himalaya, in the state of Himachal Pradesh (India). Semistructured interviews and participant observations with the medicinal plant collectors (n = 85) were used to assess current trends of medicinal plant extraction. It was revealed that the collectors camp at altitudes > 3500 m and collect medicinal plants over a period of 5 months. Individually they collect 5.2 ± 0.37 kg (fresh weight) of kutki/day. To get 1 kg dry weight of the plant, as many as 300–400 individual plants are uprooted. Further, the initial processing of the material is done in the wild; ca. 1 MT of fuelwood, comprising sensitive tree line species, is burnt to dry the same amount of collected material. This is a threat not only to the survival of the plant itself, but also to that of the sensitive tree line species. The study reveals that the extraction of kutki is unselective and unmanaged, which may be a threat for its regeneration and survival. We recommend spatiotemporal regulation of kutki extraction so as to ensure its conservation. The integrated approach of taking into confidence the local people in the present study has helped in generating a reliable picture of the patterns and processes of kutki extraction. The same may be replicated in other mountain areas for other heavily extracted species.