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Guduchi (Tinospora cordifolia (Willd.) Hook.f. & Thomson) is one of the most widely used Ayurvedic drugs and is classically described as a rasayana indicated in jaundice (kamala). Its promotion as an immune booster during the COVID-19 pandemic was followed by reports from India of acute hepatitis with autoimmune features after its use, and by a polarised debate between hepatologists and the Ayurveda community. This critical review appraises the published clinical reports, the quality of causality assessment, the question of botanical identity, mechanistic plausibility and non-clinical safety data, and interprets them from a Dravyaguna perspective. Clinical evidence comprises two Indian case series, a multicentre retrospective study of 43 patients, and individual reports from other countries. Injury appeared idiosyncratic and often immune-mediated, and was most severe in people with pre-existing chronic liver disease. Causality was graded mostly as possible or probable, without rechallenge and without species-level authentication of the consumed material. Substitution with hepatotoxic T. crispa is documented in trade but cannot by itself explain the reports, because most tested market samples were authentic and T. cordifolia also contains clerodane furanoditerpenoids. A good laboratory practice 28-day study in rats found no toxicity of an authenticated aqueous stem extract up to 1000 mg/kg/day, which is consistent with an idiosyncratic rather than intrinsic mechanism. We propose a minimum reporting dataset for suspected cases and practice cautions grounded in the classical principles of dose, duration and patient assessment.