This largely Appalachian species is restricted to relatively acid, infertile soils. In addition to its distinctive mottled (grayish/silvery with darker green veins) and hastate-deltoid leaves, its rhizomes are long, fleshy and whitish (versus short, subligneous and yellowish-brown in the pubescens group). The remarkable western disjunction in EDMO was documented by Price (1901): "On Bear Creek... rather common under beech trees and on decayed stumps." No coll. could be found at MO to support this record, but there is a Jun 1898 coll. of Pr from "Torrent" (in the "mts" of WOLF); see also notes under Trautvetteria carolinensis. To the southwest, there is also a disjunct record from Robertson Co, Tenn. (SERNEC).