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Introduction: Ayurvedic formulations often contain metals and minerals intentionally processed through Shodhana and Marana to produce Bhasma (calcined preparations). While these herbo-mineral formulations have been used therapeutically for centuries, concerns have emerged regarding heavy metal toxicity, especially when preparations are improperly manufactured. Modern toxicological studies highlight risks of lead, mercury, and arsenic contamination, whereas standardized formulations have demonstrated safety in clinical use. This review examines the traditional rationale, risks, and pharmacological safety studies of heavy metals in Ayurveda. Methods: A systematic review was conducted by analyzing Ayurvedic classical texts (Rasatarangini, Rasaratna Samuccaya, Charaka Samhita, Sushruta Samhita), pharmacopoeial standards, and modern studies retrieved from PubMed, Scopus, Web of Science, and AYUSH Research Portal. Inclusion criteria were experimental toxicology, pharmacological safety studies, and clinical evaluations of heavy-metal-containing Ayurvedic formulations. Exclusion criteria included non-peer-reviewed reports and non-Ayurvedic detoxification methods. Results: Classical texts emphasize purification (Shodhana) and incineration (Marana) to detoxify metals and convert them into therapeutic nanoparticles. Modern analytical studies confirm that properly prepared Bhasma exist as nano- to micro-particles with organometallic complexes, distinct from raw toxic metals. However, non-standard preparations and contamination contribute to reported cases of lead nephropathy, arsenic neuropathy, and mercury toxicity. Preclinical studies show that standardized Bhasmas (e.g., Abhraka Bhasma, Swarna Bhasma, Tamra Bhasma) are safe within therapeutic ranges, with some demonstrating immunomodulatory, antioxidant, and adaptogenic activity. Clinical evidence supports safety when pharmacopoeial standards are met. Discussion: Traditional Ayurvedic processing aligns with principles of detoxification and biotransformation. Modern studies confirm safety for standardized formulations but raise concerns regarding unregulated manufacturing. Future directions include stringent quality control, advanced analytical validation, and large-scale clinical safety trials. Conclusion: Heavy metals in Ayurvedic formulations pose risks when improperly processed but can be safe and therapeutically beneficial when classical Rasa Shastra methods and pharmacopoeial standards are followed. Integrating Ayurveda with modern toxicological validation is essential for ensuring safety in global healthcare.

KEYWORDS: Ayurveda, Bhasma, heavy metals, pharmacological safety, toxicity