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Background: Ashoka (Saraca asoca (Roxb.) W.J. de Wilde) is the pre-eminent uterine tonic of Ayurveda. Its bark, alone or as the fermented preparation Ashokarishta, is widely prescribed for heavy menstrual bleeding (Asrigdara or Raktapradara) and other gynaecological disorders. Rising demand for a slow-growing, now vulnerable tree has made substitution and adulteration of the bark common. Objective: To review the classical uses, phytochemistry, experimental pharmacology and clinical evidence for Ashoka in gynaecology, and to examine the extent and consequences of adulteration. Methods: Charaka Samhita, Bhavaprakasha Nighantu and Bhaishajya Ratnavali were reviewed. PubMed was searched up to October 2026 for studies on Saraca asoca, Ashokarishta, heavy menstrual bleeding and quality control of Ashoka bark. Findings were synthesised narratively. Results: Ashoka bark is rich in tannins and flavan-3-ols, notably epicatechin, catechin and gallic acid, together with procyanidins, flavanol glycosides and the lignan glycoside lyoniside. Experimental studies show inhibition of prostaglandin synthesis, anti-inflammatory activity and suppression of oestrogen-induced endometrial thickening in rats. Clinical evidence consists of an uncontrolled study of an Ashoka-based syrup in 228 women with heavy menstrual bleeding, which reported reduced blood loss, and an ongoing randomised trial of Ashokarishta against tranexamic acid. Market studies using pharmacognostic, chromatographic and DNA methods repeatedly found commercial Ashoka samples derived from other species, most commonly Polyalthia longifolia. Conclusion: Ashoka has a coherent pharmacological rationale as an astringent, anti-inflammatory uterine tonic, but controlled clinical evidence is still awaited. Authentication of raw material by chemical and DNA markers, cultivation and conservation are as important to its future as clinical trials.