Pterocarpus marsupium Roxb., commonly known as Indian kino, is a traditionally important medicinal plant widely used in Ayurvedic medicine for the management of diabetes, obesity, inflammation, and various infections. This review summarizes the ethnomedicinal uses, phytochemical constituents, pharmacological activities, and safety profile of Pterocarpus marsupium. The plant is rich in bioactive compounds such as flavonoids, polyphenols, stilbenoids (including pterostilbene), tannins, and terpenoids, which contribute to its therapeutic potential. Preclinical studies demonstrate significant antidiabetic, antihyperlipidemic, antioxidant, antimicrobial, hepatoprotective, anticancer, and anti-metabolic syndrome activities. Mechanistic evidence suggests that these effects are mediated through reduction of oxidative stress, enhancement of glucose uptake, modulation of lipid metabolism, inhibition of aldose reductase, and anti-inflammatory pathways. Acute toxicity studies indicate a high safety margin with no considerable adverse effects at experimental doses. Although experimental findings strongly support its traditional applications, further clinical investigations and standardization studies are required to validate its efficacy and ensure safe therapeutic use. Pterocarpus marsupium represents a promising natural candidate for managing metabolic and lifestyle-related disorders.