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Background: Swarna bhasma (calcined gold) is one of the most valued rasayana (rejuvenative) medicines of Ayurveda, used for immunity, cognition, debility and chronic disease, and given to children as Swarnaprashana. Its use has expanded rapidly, but the supporting evidence is scattered. Objective: To review the evidence on the immunomodulatory, neuroprotective, antioxidant and anticancer effects of Swarna bhasma, together with its composition, bioavailability and safety. Methods: A critical narrative review of physicochemical, in vitro, animal and clinical studies of Swarna bhasma and Swarnaprashana. Results: Swarna bhasma consists of nanocrystalline metallic gold, often in micron-sized aggregates, with large variation between commercial products (gold content 32–98 wt%). Gold is absorbed to a measurable degree in rats and humans. Animal studies report augmentation of non-specific immunity, Th1-type responses with reduced parasite load in experimental leishmaniasis, attenuation of stress-induced neurochemical changes, protection in ischaemia models, and nootropic effects. Clinical studies of Swarnaprashana in infants and a prospective study in cancer exist but are small and heterogeneous. Safety studies are reassuring in the short term but limited in duration. Conclusion: Preclinical evidence for immunomodulatory and neuroprotective effects is consistent but comes from few laboratories and poorly characterised products. Well-designed clinical trials with characterised products and gold pharmacokinetics are needed before rasayana claims can be considered established.