Tips for Kicking a Cough

Back when I was a graduate student doing my internship in Chinese Medicine, I got my first patient whose chief complaint was a lingering cough, and I remember thinking, “This will be easy.” Boy, was I naïve. Even under the guidance of an elder practitioner, it took months of treatment for it to resolve. In the nearly two decades since then, coughs have often proven stubborn. Luckily, they usually run their course within a few weeks – with or without intervention – and I’ve found some herbs that can often speed up the recovery process.

First, a few words on coughs and how they work. The respiratory tract (airway) consists of two main regions. The upper part includes the nasal cavity, sinuses, pharynx (the area where the back of the nasal cavity becomes the throat) and is sometimes considered to include the larynx (“voice box”). This is the site of most common colds, or “upper respiratory infections” (URI’s). Coughs coming from this area are usually due to throat irritation and post-nasal drip, and are pretty responsive to treatment.

The lower respiratory tract consists of the trachea (“windpipe”), the tubes through which it branches into the lungs – the bronchi, the smaller bronchioles, and finally the little sacs called alveoli – and sometimes the larynx. All but the smallest of these passageways are lined with cough receptors, which are highly sensitive to light touch. The presence of phlegm (or dust, or certain chemicals) triggers the cough reflex. Coughing is a cooperative effort between the diaphragm, abdominal muscles, the muscles between the ribs (intercostals), and the structures of the airway – an attempt to forcibly expel whatever’s in there.

Sometimes it’s effective – what we refer to as a “productive cough” – but when the respiratory passages are inflamed and dry, or full of sticky, tenacious phlegm, a cough can go on and on. The hard part is that coughs themselves can be debilitating. We lie down to sleep, the phlegm spreads out, post-nasal drip trickles down, and the cough worsens. It degrades the restorative value of sleep, and the continuous spasmodic contraction of our muscles wears us out, sapping us of the energy to cough in a productive way.

The herbs I’ll discuss here are for these acute forms of cough. Coughs that occur for much longer and those that are due to weakness, asthma, or damage to the lungs fall into the chronic category and they’re beyond the scope of this article because they require more comprehensive treatment.

I have taken and prescribed nearly every Chinese and Western herb that’s commonly used for cough, and they rarely work as well as I hope. That cough reflex is difficult to overcome – and, really, you would only want to suppress it if you were doing something to address the underlying problem. I’ve found that when I’m more accurate about discerning the type of cough (dry / moist, strong / weak, clear phlegm / yellow phlegm), my treatments are usually more effective, but the herbs I’ll introduce today are usually beneficial for most types of cough.

• Mullein: Mullein is a fuzzy, sage-colored plant that grows all over the place in the United States. I see it nearly every day. The leaves and yellow flowers are excellent for coughs. Adults can take an ounce of dried leaves or flowers and steep covered (don’t simmer) in a few cups of just-boiled water. Strain it to avoid drinking the little hairs, and drink it, divided into three portions, over the course of the day.
• Pine, Spruce, and Fir Needles: All of these evergreen needles are useful for coughs and are rich in vitamin C. You can throw a handful of them into a bowl of hot water, put your face over it, cover your head and the bowl with a towel, and inhale the steam. Then you can drink the resulting tea. Or you can just brew a strong tea by simmering a large handful in a couple cups of water. Keep it covered and the heat low, so you don’t lose all the essential oils. I like to chew spruce, fir, and pine needles when I’m out on walks, and the ones that work best for coughs tend to be those with the best, strongest flavor.
• Thyme leaves: Thyme has long been a popular herb in Europe for coughs, and it probably has some antimicrobial effects (one of the noteworthy compounds in the herb, called thymol, is the active ingredient in Listerine and various antiseptic cleaners). The flavor is rather strong, so the usual dose is just one to two teaspoons of the dried herb steeped in a cup of water. I don’t have great faith in thyme on its own, but it can be a useful adjunct herb combined with others.
• Ginger: Ginger’s pungency is good for opening the respiratory tract. The dried herb is considered “hotter” than the fresh stuff, so I use the dried product more for coughs will lots of clear or white phlegm, and the fresh herb more for coughs with yellowish phlegm. You can use approximately a thumb-sized piece of ginger, sliced or grated, simmered for a few minutes in about a cup of water (do this multiple times a day).
• Licorice root: Licorice is a mild herb for coughs, but it’s a nice adjunct with other herbs, especially when the throat and/or respiratory tract feels raw and sore. Licorice is sweet and mucilaginous, and has a calming effect on spasmodic coughs and a soothing effect on mucous membranes. You can use approximately 2 teaspoons per day. Keep in mind that prolonged use of licorice or high doses can cause a temporary elevation of blood pressure (usually not more than about ten points systolic).
• Hyssop leaves: This common garden herb is a member of the mint family and has a longstanding reputation, especially in Europe, as a useful herb for coughs and sore throats. Several times a day, steep two to three teaspoons of the dried herb (or much more of the fresh herb) in a cup of water to make a pleasant tasting tea. Hyssop is mild, and therefore best combined with other herbs.
• Horehound leaves: Horehound also has a longstanding reputation in Europe and northern Africa as a valuable herb for respiratory complaints, and it’s one of the main ingredients in Ricola cough drops. I’ve noticed that it’s not much used in the United States, perhaps because the FDA claims it has no value in the treatment of cough, but I had one profound experience with it about 20 years ago, when I made some horehound tea and it completely stopped a nagging cough in about a day. You can make a tea using about two to three teaspoons of the dried herb in a cup of boiled water.
• Slippery Elm Bark and Marshmallow Root: These herbs are soothing to mucous membranes and especially appropriate for dry coughs. You can add one or both to your cough formula (approximately a teaspoon per cup of tea) to add a “demulcent” effect that will also soothe your throat.
• Nigella Seed Oil: This herb, also known as “black seed” or “black cumin,” has been trendy recently, though perhaps for good reason. A number of studies show it has promise in the treatment of a variety of health issues, and there’s rather robust research on its value in respiratory problems (asthma, in particular). For cough, you can take a teaspoon of the oil at a time, in a cup of hot water. You can also try rubbing the oil on your chest, over your lungs.
• Umckaloabo root: This African relative of the geranium is useful for upper respiratory infections. It’s available in raw, dried form as well as tinctures and homeopathics. The easiest form to take is as the commercial product Umcka. It’s one of very few substances that can legally claim to benefit the common cold. The specific verbiage allowed by the FDA is, “shortens severity and reduces duration of upper respiratory symptoms.” I always have some of the powdered form of Umcka in the house, which I mix into hot teas to add some additional potency.
• Pineapple Juice: I don’t know of any research on pineapple juice for coughs, but it’s a popular folk remedy, often drunk warm and seasoned with cinnamon, cayenne, or black pepper. I don’t know why it would be beneficial in coughs and I haven’t tried it myself, but it may have something to do with the activity of the enzyme bromelain that it contains. In any case, it’s not likely to hurt – especially if it gets you to drink more fluids.
• Water: Speaking of fluids, staying well hydrated is super important when you have a cough, as it helps keep the mucous in a more liquid state so that it can be more readily expelled. Also, immune function just tends to work better when you’re getting enough water. Other than possibly consuming some pineapple juice with it, it’s best to stick to pure water or tea, rather than juice or sweetened beverages.

Choose a few of these substances, use them simultaneously and consistently (like, all day long), and get as much rest as you can. If necessary, sleep in a semi-upright position to reduce nighttime coughing.

Whenever I write articles on herbs I wonder if I’m doing the field of herbal medicine a disservice by simplifying it and presenting it in such a way as to suggest we can choose herbs simply based on the symptoms we want to treat, without respect for the diagnosis. But I feel the need for accessible home remedies is more important. In the case of the herbs above, they are all quite safe and unlikely to do any harm. However, if your cough persists, if it is severe, if you cough up blood, or if anything else alarming happens, or if you intend to use these herbs on small children, please consult with a qualified healthcare practitioner.

Be well and breathe freely,

Dr. Peter Borten