Ginkgo biloba has been used medicinally for thousands of years. Today, it is one of the top selling herbs in the United States. Ginkgo is used for the treatment of numerous conditions, many of which are under scientific investigation. Available evidence demonstrates ginkgo's efficacy in the management of intermittent claudication, Alzheimer's/multi-infarct dementia, and "cerebral insufficiency" (a syndrome thought to be secondary to atherosclerotic disease, characterized by impaired concentration, confusion, decreased physical performance, fatigue, headache, dizziness, depression, and anxiety). Although not definitive, there is promising early evidence favoring the use of ginkgo for memory enhancement in healthy subjects, altitude (mountain) sickness, symptoms of premenstrual syndrome (PMS), and reduction of chemotherapy-induced end-organ vascular damage. Although still controversial, a recent large trial has shifted the evidence against the use of ginkgo for tinnitus. The herb is generally well tolerated, but due to multiple case reports of bleeding, should be used cautiously in patients on anticoagulant therapy, with known coagulopathy, or prior to some surgical or dental procedures.