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Background: Ashwagandha (Withania somnifera) is one of the most important Rasayana and Balya herbs in Ayurveda and is now among the most widely sold herbal supplements worldwide, largely for stress and anxiety. A growing number of randomised controlled trials and meta-analyses have tested these uses. Objective: To review the classical basis of Ashwagandha, its pharmacology relevant to stress, and the evidence from randomised controlled trials and meta-analyses on stress, anxiety, cortisol and sleep, along with safety. Methods: Narrative review of classical texts and of randomised controlled trials, systematic reviews and meta-analyses identified through PubMed, Google Scholar and publisher databases. Results: Individual randomised trials in chronically stressed adults, healthy adults and patients with anxiety or insomnia have reported reductions in perceived stress, anxiety scores and serum cortisol with Ashwagandha root or root-and-leaf extracts at 240–600 mg per day for 6–12 weeks. A 2024 meta-analysis of nine trials (558 participants) found significant reductions in perceived stress, Hamilton Anxiety Rating Scale scores and cortisol compared with placebo. A 2025 meta-analysis confirmed cortisol reduction but did not find a significant pooled effect on perceived stress, reflecting heterogeneity. Sleep benefits are supported by a separate meta-analysis. Adverse events are usually mild, but rare liver injury and possible thyroid effects have been reported. Conclusion: Ashwagandha has moderate-quality evidence for reducing stress, anxiety and cortisol in the short term. Larger independent trials, longer follow-up, standardised extracts and clinical populations with diagnosed anxiety disorders are needed.Keywords: Ashwagandha; Withania somnifera; stress; anxiety; cortisol; Rasayana; adaptogen; randomised controlled trial