How does traditional knowledge persist in communities where biomedical healthcare is increasingly accessible? This question challenges assumptions that modernization inevitably displaces indigenous practices. This study examines traditional knowledge of Alpinia elegans C. (Presl) K. Schum, locally known as  tagbak, in Infanta, Quezon, Philippines, to understand the social mechanisms through which ethnomedicinal knowledge maintains legitimacy and utility. Through sixteen months of ethnographic fieldwork with traditional healers, farmers, and community members, combined with phytochemical analysis, the research reveals that traditional knowledge operates not merely as medical information but as embedded social practice serving multiple community functions simultaneously. The plant addresses hyperuricemia (93% of informants), musculoskeletal disorders (60%), and various other conditions, while also functioning in agricultural pest management, nutrition, and ritual practice. Phytochemical screening confirmed the presence of bioactive compounds (flavonoids, saponins, sterols, glycosides, tannins) that support traditional therapeutic claims. The study demonstrates that traditional knowledge persists through cognitive and cultural embeddedness mechanisms—structured decision-making frameworks and trust networks—highlighting its relevance for shaping healthcare policies and conservation efforts. These findings contribute to understanding how communities maintain indigenous knowledge systems in contemporary contexts and have implications for integrative healthcare policy and biocultural conservation.