Justicia spicigera Schltdl. (Acanthaceae), commonly known as “muicle,” is a medicinal plant used in Mexico to treat diabetes, anemia, gastrointestinal disorders, inflammation, and infections. Its phytochemical composition and the biological properties of its extracts and metabolites have attracted increasing scientific interest. This narrative review examines the available information on its botanical characteristics, traditional uses, phytochemical composition, and pharmacological activities. Studies have identified flavonoids, anthocyanins, phytosterols, carotenoids, and other secondary metabolites, as well as documented antioxidant, antidiabetic, antimicrobial, anti-inflammatory, neuropharmacological, and cytotoxic activities. Among the identified compounds, kaempferitrin stands out as one of the most extensively studied flavonoids in this species. However, the contribution of many of these metabolites to the observed effects remains poorly understood. Although some findings are consistent with its traditional uses, the evidence is derived primarily from in vitro studies and animal models, with insufficient clinical support. Overall, J. spicigera represents a source of bioactive compounds of pharmacological interest, although further studies are needed to elucidate their mechanisms of action and establish their therapeutic safety and efficacy.