The aim of this paper is to trace developments in Traditional Medicine (TM) and legislation concerning conservation and use of biodiversity in Africa, with Tanzania as a case study. Based on field trips, interviews with different actors, site visits, and literature we explored the history, current status, re-establishment, and development of TM. A summary of laws and regulations concerning forests, access and benefit sharing is presented. During the last decade the Government of Tanzania put forth legislation to address national health needs, traditional knowledge, and the resource base for TM (e.g., practitioners, biodiversity). Our findings indicate that TM is the most common form of health care, and that the HIV pandemic has highlighted the need to work across health sectors. New legislation has facilitated this need. In Tanzania TM is experiencing a renaissance in being formally recognized, integrated into mainstream health care, formal establishment of practitioners, and gaining the interests of different sectors. More studies on bioactivity, safety, domestication, and sustainability of use of medicinal plants are needed. Development of TM can also, other than making a significant contribution to health care and livelihoods, provide income possibilities. It is however yet to be seen if the recent regulations can be made fully operational and implemented.