A significant number of herbal products have been associated with hepatotoxicity. There are few clinical or laboratory manifestations that suggest specifically that liver injury is the result of a specific herbal. Compounding this difficulty is that the patient may have liver disease from another cause, may be taking other potentially hepatotoxic products, or may be taking a contaminated herbal product. Clinicians should consider herbal products in the differential diagnosis when evaluating patients with new-onset hepatotoxicity. © 2006 Elsevier Inc. All rights reserved.