Objective Forest healing, as an interdisciplinary practice, has become an important strategy to address the escalating global burden of health crises caused by urbanization, including chronic stress, cardiovascular disease, and mental health disorders. Against the backdrop of China’s “Healthy China 2030" initiative, forest-based health practices are increasingly recognized as a cost-effective non pharmacological intervention that can improve human health and reduce healthcare costs. However, the industrialization of forest healing is still constrained by fragmented theoretical frameworks, inconsistent empirical evidence, and a lack of policy consistency with international best practices. This research synthesizes international and domestic research to: 1) Identify the key factors shaping forest healing effects, 2) elucidate underlying physiological and psychological mechanisms, and 3) assess the current status and future directions of forest healing industrialization.

Methods This research systematically retrieves 5,173 papers from the Web of Science (WoS) and China National Knowledge Infrastructure (CNKI) databases spaning the period from 1990 to 2023. Based on strict inclusion and exclusion criteria, namely clear research content, integrated research methods combining on-site experiments and questionnaire interviews, measurable health indicators, and clear intervention measures, a total of 46 papers are selected and analyzed in detail. The research adopts a narrative review method to synthesize and summarize research results, with a focus on the synergistic effects of forest environment, recreational activities, and forest management practices. Analysis includes both quantitative and qualitative data, emphasizing the identification of key mechanisms and existing gaps in existing research to guide future research priorities. In addition, case studies are conducted on Japan and Germany to extract best practices in certification systems, related industries, and medical integration.

Results Forest healing takes place through the interaction of three core elements. (1) Environmental factors: The healing effects of forests are moderated through three environmental dimensions: biological dimension (biodiversity, tree age, canopy density, etc.), physical dimension (microclimate, light intensity, negative air ions, etc.) and landscape dimension (aesthetic value, seasonal variation, etc.). For example, Compared with young forests, mature broad-leaved forests have better health improvement effects. High biodiversity levels are associated with improved mental health indicators. (2) Recreational activities: Activities are categorized as static activities (meditation, watching, etc.), low-intensity activities (walking, yoga, etc.), and moderate to vigorous activities (cycling, jogging, etc.). Walking in the forest may reduce the level of salivary cortisol, while enhancing the activity of natural killer (NK) cell. (3) Forest management: Scientific forest management, including sustainable resource allocation and certification systems, is essential to maintain healing effects. The health outcomes are as follows: (1) Physiological benefits: Significant improvements are observed in five systems: Cardiovascular system (decreased blood pressure), endocrine system (decreased serum cortisol), immune system (increased NK cell activity), respiratory system (improved respiratory function), and nervous system (increased parasympathetic activity). (2) Psychological benefits: Forest therapy reduces stress, depression and anxiety while improving mood, concentration and cognitive function. Forest bathing has produced sustained psychological benefits, including relieving stress, restoring attention, improving mood, enhancing sleep quality and cognitive function, while also reducing levels of anxiety and depression, among others. (3) Spiritual benefits: Forests have a moderating effect on internal mental state. In the forest experience, people may feel a sense of awe towards nature, deeper calmness, and inner harmony, which helps to adjust their mental state. (4) Social benefits: Forest welfare includes providing ecological products, ecosystem services, and environmental education, while promoting social interaction, enhancing social cohesion and connections, and helping to achieve social empowerment and reduce social crime rates and violent incidents. This research also highlights successful industrialization models from countries such as Japan and Germany, which have incorporated forest healing into national welfare programs. These models emphasize healthcare, tourism, and education, and are supported by strong policy frameworks and certification standards. In contrast, China’s forest healing industry is still in its infancy and has tremendous potential for growth through policy support, scientific research, and innovative product development.

Conclusion This research integrates the closed-loop system of “environmental foundation −experience transformation − institutional guarantee”, emphasizing the synergistic effect of forest environment, recreational activities, and forest management in promoting industrialization. The main gaps include insufficient dose − response models, individual heterogeneity (such as gender and specific stress recovery patterns), and clinical validation of therapeutic products. To promote the development of this field, the research proposes the following suggestions. 1) Accurate quantification of forest design: Establish interdisciplinary collaboration, quantify environmental exposure thresholds, prioritize dose − response modeling, and optimize forest configuration design for specific diseases such as hypertension and depression. 2) Policy − industry collaboration: Develop a “government − industry − academia − research” collaboration system to align forest theraph with national health policies, including insurance coverage and medical referrals. 3) Technological innovation: Utilizing digital technology tools such as VR-based forest therapy and AI-driven health monitoring to improve the popularity and economic feasibility of the forest health industry. By addressing these challenges, forest therapy can evolve from a niche health practice into a scalable, evidence-based public health intervention that serves as the cornerstone of a global health strategy aimed at coordinating human well-being and ecosystem resilience, thus contributing to global sustainable development and the United Nations Sustainable Development Goals.