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physiciansherbalformula
by U.S.A. Medical Doctor & Herbalist.

Cough

                                    

Heightened Cough Receptor Sensitivities of chronic coughers are treated by Natural herbal remedies for cough. 

Cough is not just a reflex defense mechanism by our respiratory system to expel the irritants. Treatment of cough is more than identifying the triggering stimulants of the afferent sensory receptors. Individualistic differential response patterns to cough stimulants are as critical as the afferent stimuli in producing different types of cough. 

Two major types of cough prone people with Heightened Cough Receptor Sensitivities are :

1) A subset with CHRONIC OVERPRODUCTION OF PHLEGMS due to  imbalanced energetic systems. The hypersecretors of phlegms have " weak spleen Qi, or Lung Qi, or stagnation of liver Qi " , have altered fluid metabolism, and are prone to noninfectious bronchial inflammations with productive cough from minor colds. In biomedical language, the sputum hyperproducers have altered or weak immune and neurohormonal functions, and suffer frequent bronchitis. They also have abnormal autonomic nervous system and adrenergic hormonal changes in response to both external and emotional stimuli. ( The hyperproducers of sputum, of whom the smokers may be a minority, are easily observed clinically, and  its conceptural category needs to be incorporated into a new paradigm of medicine. )  Modern culture is " phlegm culture " especially among the young and middle aged, because the life styles are conducive to producing phlegms. What are such life styles ? The primary one is 1) that of fiercely competitive, and individualistic mode of thinking and feeling, ( Frequent ups and downs of the emotions cause blockages of bioenergy and disturbances of " water metabolism " with build up of toxic waters called " Phlegms", most visibly expressed on the respiratory or gastrointestinal systems. ) and 2) that of a diet with too much dairy products such as cheese ( pizzas), milk, ice creams, etc. 

2) The second subset have " DRY BRONCHIAL MUCOSA ". Respiratory epithelia are a continuous layer from nasal cavities with mucosal layer into the small airways, and there is no reason to envision a perfect mucosal layer in susceptible individuals. The pathogenesis would be a) moderate+ sqamous metaplasia ( cellular morphology of organs such as skin, which is for mainly physical protection,and cannot produce defensive mucus ) of mucosa away from normal ciliated respiratory epithelia, b) Atrophy of mucus producing glands and goblet cells giving rise to thinner mucosal surface,( analogous to chronic atrophic gastritis), c) A novel concept of  "Deficient Heat in lung "  causing arteriolar dilation in submucosa and causing relative desication of mucosal surface of respiratory trees, ( analogous to dried up red tongue with little saliva and cracks )This category of individuals may have relatively " dry respiratory mucosa" predisposing them to heightened cough reflex from cold, viral infections, or any other triggers of cough reflex. In the language of chinese herbal medicine, these are  often the individuals with lung , or lung and kidney yin deficiency with lack of moistening the lungs. 

Often the offender of cough reflex can not be identified. It is not an ideal treatment to try to suppress the cough reflex loop by sedating the central nervous system. Our herbal remedies for cough work on causative mechanisms. For productive coughs, herbal remedies relieve the inflammations causing phlegms, and tonify the immunological functions to decrease the tendency to produce phlegms at the slightest stimuli. For dry coughs, herbal remedies moisten the lungs, enrich the immunological mucus layer, clear deficient lung heat, and decrease the heightened cough reflex.

 

A Few Words about PHLEGM: An example of a systemic disorder requiring a systemic herbal formula

 

Phlegm in herbal medicine is not confined to the sputums from the lungs. Phlegm includes sputum, any mucousy or thick secretions from  the stomach, and even interstitial edema and stasis in brain or soft tissues. Phlegm is any abnormal thickened fluids caused by a disorder of " fluid metabolism " or obstuction of the transportations of the fluids powered by the organ systems involving "lung, spleen, kidney, and liver " and "san jiao networks". Phlegms can accumulate in all parts of the body including the respiratory tract, digestive tract, in the " channels and collaterals" including the lymphatics and neurovascular tracts in soft tissues and the brain. Phlegms are always  pathological products of organ dysfuntions. The presence of significant phlegms can be observed by the tongue diagnosis. If a tongue has thick sticky, slippery, or greasy tongue coating covering part or the whole of tongue body which will not entirely come off easily with brushing, then that person has phlegms and some dysfunctions of one or more of organs ( lung, spleen, kidney, liver ). See below also a picture of a tongue with yellow sticky tongue coating. The phlegms may manifest with mainly sputums, but also addtional visible or invisible phlegms such as vomitting mucus, or even unclear mind. A corollary point is that to treat sputum from the lung one must treat phlegm and her causes.

 

To treat phlegm disorders including abnormal production of sputums from bronchitis or pneumonia, one must not only " dissolve phlegms", but also correct all the organ dysfunctions. Therapeutically bronchitis or pneumonias with sputum production requires first the correct diagnosis, and then second, prescriptions of not only phlegm dissolving herbs ( expectorant, antitussive, and lung antiinflammatory herbs), but also herbs that correct all the involved organ dysfunctions by either tonification or regulation of the circulation of qi and blood. An example of an approach for bronchitis with yellow sputum is to combine the herbs that 1) transform phlegm heat, 2) move qi and blood, and 3) tonify spleen qi. The best analogy for the phenomenon of phlegm production is inflammation which is a set of immunological reaction to body injury involving edema, blood stasis, debris and dead cells, and pathogenic bacteria. In cases of bacterial pneumonias or bronchitis, one cannot just use the cough suppresants ( phenergan with codeine) and expectorants ( guanifessin ) to calm the productive cough. One must use full hydration to promote the circulation to clear away the inflammatory debris and loosen the sputums, acetaminophen to bring down the fever, antibiotics to fight the pathogens, and finally the support of immune function by withdrawing the initial etiologies that lowered the immune system. If biomedicine has to use multiple strategies to heal pneumonia or bronchitis, so should natural herbal remedies for cough be approached by a complex formula with multiple herbs with different roles. 

 

There are 5 major categories of chronic cough according to the  biomedical model. 

1)Chronic or acute Bronchitis. Use Cough,White Phlegm   or   Cough,Yellow Phlegm

2) Postnasal Drip ( 34 % of chronic cough ) from rhinitis or sinusitis. This is the most common etiology for cough at night or upon getting up in Am in nonsmokers. Use Chronic Rhinitis for white phlegm stuck in the back of the throat or  Sinus Clear for yellow phlegm.  

3) Cough Variant Asthma ( Cough is the only manifestation of asthma ) supposedly causes 28 % of chronic cough in nonsmokers. Some people in this category do not respond well to asthma medications. Use  Persistent Cough& cold  or  Dryish Cough  or Dry Cough

4) PostViral Bronchial Hyperreactivity ( 18 % ) is  persistent cough after viral infection. This category is more common than 3) or 5). Treated well with Persistent Cough& cold or  Dryish Cough or Dry Cough

5) Gastroesophageal Reflux supposedly causes 18 % of chronic cough. This is an overrated reason for significant chronic cough. Half  the people suspected with reflux caused cough do not have heartburn,or acid regurgitation. Usually treatment of reflux is not effective for relieving cough.   

Finally, the issue is not what causes occasional cough, but what causes clinically significant cough. By this criterion, a large % of cough remains biomedically undefined. Modern biomedicine is an ongoing scientific methodology, and not the final answers. Home remedies such as honey, ginger, licorice, ginko, cinnamon, and schisandra, tried for years in Eastern herbal medicine, when used singularly, do not treat the root mechanisms of most coughs. Modernized herbal formulas can lead towards very effective treatments of various types of cough. 

The most commonly used herbs for transforming phlegm and directing lung qi down and arresting wheezing are listed below. These herbs are used mainly for the manifestations of cough and sputum production. One can find the details about these herbs in herbology information sites.

1. The major herbs for phlegm heat include peucedanum root, fritillaria bulb, thunbery fritillaria bulb, trichosanthis fruit and seed, bamboo shavings and saps, kelps, sargassum seaweeds.

2. The herbs for damp phlegm ( or cold phlegms) are ginger, pinellia rhizome, typhonium rhizome, white mustard seed, baloon flower root, inula flower, cynanchum root.

3. The herbs for directing lung qi down are apricot seed, aster root, coltsfoot, perrila fruit, loquat leaf, stemona root, mulberry root bark, lepidium seed.

Only a few of these herbs are studied by biomedical researches. But, numerous years of traditional experiences have proven them effective in treating cough, especially when appropriately combined with the herbs in the categories of tonifying and regulating the major organs and of promoting the circulation of qi and blood.

If one has chronic cough from postnasal drip, one likely has cough,  sometimes with gagging, with tickling in the throat, worse lying down at night, or in AM. With vasomotor rhinitis, cough is illicited often with a sudden drift of cold air or changes in air quality. One may not have significant runny nose, sneezing , or nasal congestion. For postnasal drip, go to allergy nasal section.   

 *Antioxidants and cellular biochemicals are Theoretical, preventive supplements for delaying cellular aging, but real human scientific trials are rare for proving  effective in  symptoms of  established disorders. **Well designed herbal formulas steadily untwine the root causes of ill symptoms and have been  proven by experiences during >2,000 years of Eastern medicine