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    A midsagittal view of the brain, showing key structures in and around the hypothalamus. This chapter first considers neuroendocrine functions and the pituitary gland.

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    The growth rate of botanical sales in the United States is estimated to increase at a rate of approximately 12% per year.3 Surveys conducted in the United States have indicated a 460% increase in the use of botanicals in a mere sevenyear period (1988–1993).3 In 1994, 50 million Americans used botanical products and spent $5.1 billion on them,4,10 all as out-of-pocket expenses. It is suggested that about 17% of Americans combine the use of herbs with their medications.18 Among hospitalized patients in the United States, about 196,000 deaths occur annually due to adverse reactions to medicines.23 Even though the number of adverse events or death from botanicals may pale in comparison, they nevertheless remains important due their interference with the drug therapy.19 The issue of properly communicating with physicians about the use of herbs becomes more important when dealing with surgery patients. The mainstream physicians are yet to catch up with this popular demand, pHYSICIAN’S PERSPECTIVES Despite the fact that millions of out-of-pocket dollars are being spent on purchasing botanicals by the public.

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