A case of affective psychosis and cognitive impairment is described. The pa
tient had a history of cerebrovascular disease and had been ingesting large
quantities of a complex herbal tonic prior to presentation. Diagnostic iss
ues are discussed. Relevant literature on cerebrovascular disease and herba
l remedies is reviewed. We propose a stress-diathesis model to account for
this patient's illness and we advise caution in the use of complementary th
erapies in patients with compromised cerebrovascular status. Appropriate pr
actice guidelines are outlined.