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Early records, including Sumerian clay tablets, document the use of medicinal plants. Hippocrates promoted observation-based therapy, while Dioscorides’ De Materia Medica remained an influential reference for centuries. Later, Arabic scholars preserved and expanded pharmacological knowledge and advanced extraction methods. Apothecaries, guilds, and national pharmacopeias helped formalize compounding and drug quality. Chemical isolation and structural discoveries then supported a shift from extracting natural substances toward synthesizing and designing medicines. Milestones such as morphine isolation, aspirin production, Salvarsan, penicillin, and the development of steroids and other drug classes illustrate the expanding scope of the field. Structure–activity relationships and QSAR further enabled more systematic approaches to modifying molecules for therapeutic purposes.