Good afternoon:) I'm looking at a case of a 48-year-old female with a history of inflammation and dampness. Tonsilitis as a child, thyroid nodules (no autoimmune but hypothyroid), uterine fibroids (previous myomectomy) and adenomyosis. The adenomyosis is causing significant pain. Also struggles with borderline iron deficient anemia. Tongue is pale pink, swollen, with peeled sides, scallops, a stomach crack which is furred and yellowish in the lower jiao, and definitely more coated in the lower jiao. Significant blood stagnation on underside of tongue. Upon examination for hysterectomy due to adenomyosis, it was discovered that her kidneys are leaking protein and blood. Subsequently, following blood testing, and a kidney biopsy, her nephrologist has ruled out autoimmune issues and damage due to ibuprofen overuse. In short, the diagnosis is membranous glomerulopathy. The remedy...get rid of the inflammation. They have labeled the cause of the inflammation as idiopathic. In other words, "We don't know where it's coming from, but we need to get rid of it." Their plan is to regulate her blood pressure to address the inflammation as it has been high and erratic, although the biopsy didn't indicate kidney damage due to high blood pressure. She is hesitant to take Losartan, low dose, which is what they have prescribed. She's convinced that her kidney inflammation is related to the adenomyosis, and the hysterectomy will help. Which it most certainly will, especially with the pain. That being said, I see this as a larger pattern, which will continue even though the diseased organ is removed. I also want to mention that she has always had high inflammatory markers. CRP, C3 compliment (no cancer proteins), etc. She has started taking Kidney Support Compound with added Dan Shen, and Reishi for her kidney function and inflammation. As per my recommendation, she has started seeing an acupuncturist for past trauma and her kidneys. I told her I have no doubt her liver is getting worked on too. (2 miscarriages...both at 20 weeks. Probably related to her long standing pattern) I would like to offer her some recommendations for systemic inflammation, blood pressure, blood sugar regulation (her glucose is suspicious) and stress relief (She has a history of being fried). Here is what I'm thinking (after consulting your Adaptogens book for days and days!) and re-reading your case study recommendations for guidance. Question: She likes tea. Could I or should I substitute Gotu Kola for Jiaogulan in the Jiaogulan tea formula, and have her add 5 ml of Milky Oats? Or just leave it alone? Question: Are there any other additional useful herbs for either nephritis or systemic inflammation I am overlooking? Tumeric keeps coming to mind as this patient also has MTHFR C677 double copy. It would be great for Phase II liver detoxification, but wasn't sure if the energetics of the herb were a good fit for her kidney situation. Question: Have you ever seen or heard of nephritis caused by a viral component? As in, chronic EBV? Finally: Am I wrong is thinking this is a case of long-standing Liver Qi and blood stagnation, which has overacted on the spleen/stomach, which has now turned its wrath onto the kidneys? Thank you, David. Hopefully, I have given you enough information to answer my questions, but not so much as to make you think I am submitting a case for you to work up:) Jami

The adenomyosis is causing significant pain (and usually bleeding). Also struggles with borderline iron deficient anemia (which is probably due to the adenomyosis and/or Kidney bleeding). She’s convinced that her kidney inflammation is related to the adenomyosis (although unusual it is definitely possible) She has started taking Kidney Support Compound with added Dan Shen, and Reishi for her kidney function and inflammation. (Good) Question: She likes tea. Could I or should I substitute Gotu Kola for Jiaogulan in the Jiaogulan tea formula, and have her add 5 ml of Milky Oats? Or just leave it alone? (It is difficult to get decent dried Gotu Kola and it is expensive, I think the original formula makes more sense, but adding fresh oat tincture or glycerite to the tea would be fine) It would be great for Phase II liver detoxification, but wasn’t sure if the energetics of the herb were a good fit for her kidney situation. Turmeric would be fine, perhaps Bupleurum, Schisandra, Shan Zhu Yu (Cornus fruit) Question: Have you ever seen or heard of nephritis caused by a viral component? As in, chronic EBV? yes post- viral glomerular nephritis is not uncommon and many viruses including EBV have been associated with kidney inflammation. Finally: Am I wrong is thinking this is a case of long-standing Liver Qi and blood stagnation, which has overacted on the spleen/stomach, which has now turned its wrath onto the kidneys? I don’t know, I do not know the long-term history of the case and I do not see clear signs of liver qi stagnation, more signs of blood stagnation from what you mentioned, and stomach/spleen qi deficiency. If there is long term spleen qi deficiency it can cause abnormal bleeding, puffy tongue, scalloped edges, and spleen – kidney dysfunction. see article which is free on-line: World J Gastroenterol. 1998 Feb 15; 4(1): 2–6. Published online 1998 Feb 15. doi: 10.3748/wjg.v4.i1.2

David, Thank you very much for your insight. Two final questions: 1. Her glomeruli aren't damaged, just the tubules. The damage has been caused very slowly. Any thoughts on what could cause this? 2. Obviously, she is experiencing edema and her doctor has recommended Lasix, to which her pharmacist (good for him/her) said is contraindicated in kidney disease. Her edema is around her eyes and in her fingers in the morning, and then it moves downward into her feet and ankles as the day goes on. Can herbs with diuretic properties be used with membranous glomerulopathy? Celery Seed, Parsley, Dandelion leaf, etc.? She would really like to stay away from pharmaceuticals if there are safe, gentle and effective alternatives. What would you recommend? Would lymphatic herbs be of benefit as well? I think that was more than two questions. In my defense, I did tell you in the phone interview that I had hundreds. I should probably up that amount:)

1. Her glomeruli aren’t damaged, just the tubules. The damage has been caused very slowly. Any thoughts on what could cause this? Heavy metals, pharmaceutical medications (contrast dyes, antibiotics, anesthesia), Diabetes, environmental toxins, MI, stroke, etc 2. Obviously, she is experiencing edema and her doctor has recommended Lasix, to which her pharmacist (good for him/her) said is contraindicated in kidney disease. Her edema is around her eyes and in her fingers in the morning, and then it moves downward into her feet and ankles as the day goes on. Can herbs with diuretic properties be used with membranous glomerulopathy? Celery Seed, Parsley, Dandelion leaf would be my choice, perhaps with Nettle leaf, etc.? She would really like to stay away from pharmaceuticals if there are safe, gentle and effective alternatives. What would you recommend? Would lymphatic herbs be of benefit as well? I don’t think so, but Cleavers is an aquaretic and lymphagogue, so you could try it as well.

David, Thank you. A note of interest: It has recently been discovered that this individual is more than likely what is considered a "DES Daughter". Her mother was given this synthetic estrogenic hormone to prevent a miscarriage while undergoing an emergency appendectomy while3 months pregnant. Military records have been requested as the emergency appendectomy was administered on a military installation in 1973. It would certainly help to explain why she has had the problems she has experienced over her lifetime. She is also MTHFR homozygous for the C677 gene mutation, which has also not been very helpful! She found this out after her 2 miscarriages when the OB was suspicious and ran a panel for this SNP. Thank you for your insight in helping me help her navigate this kidney issue. Jami

Interesting, They supposedly stopped using DES in 1971, in the military who knows ? As I have mentioned in class, really understanding the health effects of gene SNP’s very preliminary and especially if homozygous. It is interesting but to say it has a well understood causal relationship with chronic health concerns is premature in most cases.