Ayurveda rests on a classical literature of real depth. The Charaka Samhita is the great compendium of internal medicine, the Sushruta Samhita covers surgery in detail that includes reconstructive procedures, and the Ashtanga Hridaya organises the material for teaching. These are working medical texts with case reasoning, diagnostic categories and pharmacology, transmitted and commented on for many centuries.
The modern situation is institutional. India supports Ayurveda through a dedicated government ministry, colleges award degrees, and practitioners are registered, so it operates as a licensed system of medicine rather than as folk practice. It is also a large export industry.
Two questions follow and they are separate. The first is efficacy, where the picture is mixed in the way it is for any large pharmacopoeia: some preparations have plausible active constituents and some trials are encouraging, while much of the published research is of low methodological quality, and the classical framework of the three doshas has not been demonstrated as a physiological reality.
The second is safety, and it is more concrete. Analyses of marketed Ayurvedic products, including those bought in Western retail and online, have repeatedly found preparations containing lead, mercury or arsenic at levels above accepted limits. Some of this is contamination; some of it is deliberate, since one branch of the tradition uses processed metals and minerals as ingredients.
Regulators in several countries have issued warnings on that basis.