Not a gentle herb: a powerful immune-suppressing root, strongest for inflammatory joint disease, where it matched standard drugs on symptoms and two-year joint damage. It also cuts kidney protein loss and lupus activity. Suppressed ovarian function and sperm production lead the harms, with liver, gut, kidney and bone-marrow injury. Most reverse on stopping. Trial quality remains the weakest link. (Full Review)
| Marker | Target | Why |
|---|---|---|
| ALT | 10–26 U/L women, 10–33 U/L men | Earliest signal of liver-cell injury |
| AST | 10–26 U/L | Confirms liver injury; flags muscle origin |
| Total bilirubin | 0.2–0.8 mg/dL | Harmless enzyme rise vs failing liver |
| Creatinine and eGFR | eGFR above 80 mL/min/1.73 m² | Kidney toxicity, about 1 in 17 users |
| Urine albumin-to-creatinine ratio | Below 10 mg/g | Kidney benefit and new barrier injury |
| White cell count with neutrophils | 4.5–8.0 × 10⁹/L; neutrophils above 2.0 | Marrow suppression before it is dangerous |
| Platelet count | 175–350 × 10⁹/L | Second marrow marker; often moves first |
| hs-CRP | Below 1.0 mg/L | Objective measure of inflammatory suppression |
| ESR | Below 15 mm/h women, below 10 mm/h men | Complements hs-CRP; used in activity scores |
| FSH | 3–8 IU/L, days 2–4 of cycle | Rising values signal ovarian suppression |
| AMH | No universal target; change from own baseline | Cumulative ovarian damage, any cycle day |
| Semen analysis — concentration and motility | Above 16 million/mL, above 42% motile | Measures the expected fertility suppression |
| Hepatitis B surface antigen | Negative | Latent infection likeliest to reactivate |
Cadence: Baseline panel; liver enzymes and blood count at weeks 2 and 4, then with creatinine and urinary protein every 4 weeks through the first three-month course and every 8–12 weeks on later courses. Inflammatory markers and disease-activity scoring at weeks 12 and 24.