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Musculoskeletal - Case study - chronic tendinitis

by Paul Bergner

Medical Herbalism 01-31-97 8(4): 14, 16

In my clinical work, I find that I spend more time on diet and lifestyle than I do actually dispensing or prescribing herbs, and this other work often solves the problem, whereas an herbal “band-aid” may not. Many of us work with people who have fallen through the cracks in both conventional and alternative medicine, and take the time the others are unwilling to or cannot afford to spend reviewing the lifestyle diet. My average intake is two-hours, and has been known to run three. Working in Boulder, CO, a mecca for alternative and new age types, I frequently treat long-term vegetarians who are not careful about their diet, and supplementation and correction of the diet is more important than the herbal treatment itself.

Modern vegetarians are prone to some deficiencies:

Essential fatty acid deficiencies.

Omega-3 series fatty acids have as one of their end-products in the body the anti-inflammatory 3-series prostaglandins. Vegetarian diets are usually poor in these fatty-acids, which are abundant in wild fish and game. The best legal vegetable source is flax seed oil (hemp oil is better). Of the common vegetarian foods, soy oil is the most abundant in this family of fatty-acids, but amounts come nowhere near those in fish or game, and the amount of oil consumed in non-oil soy products is low. One result of such a deficiency is a hyper-allergenic and hyper-inflammatory state of the body — a deficiency of the antiinflammatory 3-series prostaglandins, and an excess of inflammatory products from the immune system.

Some signs of essential fatty acid deficiency:

dry skin

dry hair, lacking luster

dry mucous membranes

cracked nails



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    Medical Herbalism: Clinical Articles and Case Studies    

immune weakness

chronic inflammation or allergies



cardiovascular disease

Vitamin C deficiencies

Many of the vegetarians I treat don’t eat that many fruits and vegetables. Instead of meat, potatoes and a few vegetables and fruits, they substitute grains, beans, cheese, and a few vegetables and fruits. Under high stress, instead of stopping at Macdonalds, they grab a vegetarian fast food sandwich at a health food store. The stress of modern life increases the need for vitamin C, because it is necessary to produce adrenal hormones. The result for the produce-poor vegetarian is sub-clinical scurvy. The first clinical effects are lack of vitality and mental depression, from the deficient adrenal secretions, and immune weakness. A more serious effect is weakness and degeneration of the connective tissues, as seen in poor wound healing and easy bruising.

Mineral deficiencies

Industrial-farm produced fruits and vegetables are mineral-poor because of progressive depletion of soil minerals. Meat and fish, depending on what they eat, can be an excellent source of minerals. Vegetarians who don’t eat enough produce, or who eat only our commercially grown produce, can easily develop deficiencies not only of the proven-essential minerals, but of trace minerals found in the soil and normally occurring in human extracellular fluid.


A thirty-eight year old woman had been vegetarian for eight years. For the first five years of this diet, her occupation was cleaning houses, and by the fifth year, she began to experience tendinitis in both arms from the wrist to the elbow. She did a “cleansing program” at the time, which included supplements of flax seed oil, and the condition improved. Several years later, the condition returned, more severe, with the tendons of the knee inflamed as well. She had been treated with no effect by an M.D, chiropractor, osteopath, and physical therapist. She came to me after about eight months of constant inflammation. Her mental state appeared to be detached and slightly depressed, her vitality low, and her skin quality poor.

Her diet diary revealed a high-content of starches and proteins, with few fresh fruits or vegetables. The only apparent source of omega-3 series fatty acids was occasional tofu, which, being cooked and processed, probably contains little of the fatty acid. She was already taking a broad-spectrum vitamin and mineral supplement, as part of another “cleansing program,” but no specific supplemental vitamin C was included beyond 250 mg, and she was taking no flax seed oil. The knee inflammation interfered with her accustomed exercise of jogging or cycling. She had recently taken up water exercises.
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    Medical Herbalism: Clinical Articles and Case Studies

Tendinitis usually follows a traumatic injury, and my analysis was that the repeated stress of her cleaning job on her arms and knee was causing repeated injury to her weakened tendons.


Deficiency of vitamin C, resulting in degeneration and brittleness of the connective tissues.

Omega-3 series fatty acids deficiency, resulting in an increased tendency to inflammation.


Provide immediate relief for the inflammation while addressing the underlying deficiencies.


Curcumin (from Curcuma longa), commercial preparation

Dose: as indicated on the bottle, as needed

Action: antiinflammatory

Bromelain, commercial preparation

Dose: as indicated on the bottle, as needed

Action: antiinflammatory

Licorice (Glycyrrhiza glabra) tea

Dose: two cups of standard decoction per day

Action: antiiflammatory

Chamomile (Chamomilla recutita) and yarrow (Achillea millefolium), equal parts

Dose: Make a strong hot infusion (one ounce of herb per quart of water) in sufficient quantity to soak the arms twice a day.

Save the infusion in the refrigerator, reheat, and reuse for four days. reapply as needed.

Action: antiinflammatory
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    Medical Herbalism: Clinical Articles and Case Studies    

Vitamin C to bowel tolerance for one month, followed by 2 grams of vitamin C on a regular basis thereafter.

Action: Strengthen tissue integrity

Flax seed oil, commercial preparation (refrigerated).

Dose: Take twice the indicated dose on the label for thirty days, then take the indicated dose on a regular basis thereafter.

Action: nutritive, antiinflammatory

Increase fresh fruits and vegetables in the diet.


The patient called on the phone after sixty days. Of the recommended herbal treatments, she had only complied by taking two capsules of licorice powder twice a day. She did comply with the vitamin C and the flax seed oil recommendations. Bowel tolerance for the vitamin C was about 4 grams. She was currently taking two grams, still with occasional looseness of the stools. Her inflammatory condition had cleared completely. She said that although she no longer had any pain, she felt that her tendons were “not quite right.” She did not comment on whether she had increased fruits and vegetables in her diet.


Time-release vitamin C capsules for better tolerance.

Calc flour and calc phos cell-salts, 6x, take once a day.


Although this patient was clearly suffering from sub-clinical scurvy, and the vitamin C helped improve the case, her bowel-tolerance was fairly low. Many people can take about eight grams of vitamin C before they start to experience loose bowels, and some people can take much more than this. Bowel-tolerance levels should not be used for diagnosis of vitamin C status.
Copyright 2001 Paul Bergner    279