Ayurveda occupies an odd position in Indian public health. It is everywhere in the culture and comparatively thin on the ground in the formal outpatient statistics, which makes it easy to either overstate its reach or dismiss it altogether. This article argues that both readings miss what has actually happened over the last two decades. Drawing on national survey evidence, policy documents, clinical literature, and the growing body of social science work on medical pluralism in South Asia, it traces how Ayurveda moved from a culturally protected but administratively marginal system into a formally resourced arm of the state health apparatus, and asks what that shift has done for the functioning of the health ecosystem as a whole. Three contributions stand out. First, Ayurveda has extended the reach of primary care in places where biomedical staffing has chronically failed, though the mechanism is often about warm bodies and trust rather than about doctrine. Second, it has given the system a vocabulary and a set of practices for chronic, subclinical, and lifestyle-linked complaints, precisely the territory where a curative, episode-based biomedical model performs worst. Third, it has become an economic and regulatory object in its own right, with consequences for medicinal plant supply chains, rural livelihoods, and drug safety governance that are rarely discussed in the same breath as clinical outcomes. Against this, the paper takes seriously three critiques: the persistent thinness of high-quality efficacy evidence for many popular formulations, the risk that Ayurvedic personnel become cheap substitutes rather than genuine colleagues, and the commercial capture of the sector by wellness marketing. The conclusion suggests that the most defensible case for Ayurveda in Indian public health is not that it replaces anything, but that it makes a stretched and unevenly distributed system a little more elastic, and that this elasticity is worth protecting on its own terms rather than by pretending the evidence problem has been solved.