Ayurvedic medicine for cough

A cough is a symptom with a dozen causes, and the honest answer about Ayurvedic medicine is that it soothes several of them well and does nothing at all for the ones that matter.

First, which cough it is

• A dry tickle after a cold, worse at night, that has outlasted everything else by three weeks. Common, harmless, irritating.
• A chesty cough with phlegm that comes up and gives relief. Different problem, different medicine.
• A cough that only comes on lying down, with a stuffy nose and post-nasal drip. Sinus and allergy, not chest.
• A cough with wheeze and breathlessness, worse in the cold or after exertion. That is asthma until proved otherwise.
• A cough that has run for months in a non-smoker on a blood pressure tablet. Some of those tablets cause exactly this, and no syrup will help while the tablet continues.
• A cough with heartburn and a sour taste, worse after meals and at night. Reflux, and it is frequently missed.

What we prescribe, by type

• For the dry, hacking night cough: a licorice-based preparation, mulethi, taken as a churna or a lozenge. It coats and it genuinely soothes. Long courses are limited, because licorice raises blood pressure and drops potassium.
• For a chesty cough: a decoction of tulsi, ginger and pepper, or a vasaka-based syrup. Vasaka thins and loosens secretion. It is effective and it is not for pregnancy, and it is not for anyone with a liver problem.
• For the lingering post-viral tickle: pippali with honey, or with ghee in a small dose. Pippali is heating; it suits the cold, clear, watery picture and aggravates a burning throat.
• Sitopaladi churna for the child with a winter cough and no fever, which is one of the few pediatric uses we make.
• Steam, warm fluids and honey at bedtime, which are not Ayurvedic discoveries but work, and are part of every course we give.
• Nothing here is chosen from the cough label. It is chosen from the picture: the tongue, the phlegm, the fever, the night, the breathlessness.

What the evidence actually supports

• Honey and thyme both have small trials behind them for night cough in children. Modest benefit, better than nothing, and honey is not for a baby under one year.
• Ginger and tulsi have anti-inflammatory and mild antimicrobial activity in the laboratory. Laboratory activity is not a clinical trial, and we do not present it as one.
• Vasaka appears in preparations used in respiratory care and has some human work behind it as a bronchodilator and expectorant. It is one of the more interesting plants on this page.
• Licorice soothes. That is a real effect on a real symptom and it does not need to be oversold.
• No herbal cough preparation shortens a bacterial infection, and none of them treat pneumonia.

What these medicines do not treat

• Pneumonia. Fever, breathlessness, chest pain, a rust-coloured sputum, and a person who is deteriorating by day. That needs a chest X-ray and antibiotics.
• Tuberculosis. India carries a large burden of it, and a cough of more than two to three weeks with evening fever, night sweats and weight loss is TB until tested. There is a free national diagnostic and treatment programme, and herbal care alongside it is a support, never an alternative.
• Asthma. Inhaled steroids and bronchodilators are the treatment. Herbal syrups do not control an airway that is inflamed, and children who are kept on syrups instead of preventers end up in emergency care.
• Whooping cough, which is contagious, dangerous in infants, and vaccine-preventable.
• A cough that is someone's only symptom of heart failure, lung cancer, or a swallowed foreign object.

The cough that lingers

• After a viral infection, the airways stay irritated for three to eight weeks. This is the most common reason a perfectly well person keeps coming back for cough medicine.
• It is not a new infection, it is healing. The tickle is triggered by cold air, laughing, dust and talking.
• Soothing medicine helps the symptom. Time fixes the cause. Anyone promising to clear a post-viral cough in four days is describing something else.
• If it goes past eight weeks, it stops being a lingering cough and becomes a chronic cough that needs a proper workup.

When to stop and be seen

• Breathlessness, or a cough that comes with difficulty catching your breath at rest.
• Blood in the sputum, even a streak. Get it looked at.
• Fever for more than three days, or a fever that returned after settling.
• Night sweats with weight loss, or a cough that has lasted more than three weeks.
• A child breathing fast, pulling in under the ribs, too young to feed, or with blue lips. That is same-day, not a syrup.
• Chest pain that is not muscular, a swollen leg on one side, or a cough that began after a flight.
• Anyone on chemotherapy, steroids, or with no spleen, where a chest infection moves fast and quietly.

Dose, duration and the honest limits

• Cough courses are short by design: one to two weeks, reviewed, then stopped or changed. A cough that needs the same bottle for six weeks is a cough that needs a diagnosis.
• Licorice is limited in anyone with hypertension, heart disease, kidney disease or low potassium, and in pregnancy.
• Vasaka is avoided in pregnancy and in liver disease.
• Honey is never given under one year. Pepper and pippali are reduced to small doses in children and in anyone with a burning sensation or piles.
• A syrup with sugar is a poor choice for a person whose sugars are uncontrolled; the churna or tablet form is used instead.
• What these medicines are good for is the ordinary, self-limiting, winter cough that has been making life miserable for a fortnight. That is worth treating properly. It is not the whole of a cough, and pretending otherwise is how the dangerous ones get missed.