Coughing is a reflex that keeps your throat and airways clear. Therefore, coughing helps heal your body or protect yourself. However, having a persistent cough can be exhausting. The physical action of coughing depletes your energy reserves and disrupts your sleep. A chronic cough can also cause headache, dizziness, excessive sweating, urinary incontinence, or fractured ribs, especially in women with fragile bones. Coughs can be either acute or chronic. Acute coughs begin suddenly and usually last no more than 2 to 3 weeks and chronic coughs last longer than 2 to 3 weeks.

Causes

An occasional cough is normal. But a cough that persists for long periods of time may signal an underlying problem. Some causes of coughs include:

• Respiratory infections: cold, influenza, sinusitis, bronchitis, croup, pneumonia or tuberculosis
• Respiratory disorders:  asthma, emphysema, cystic fibrosis, bronchiectasis, cystic fibrosis, interstitial lung diseases, sarcoidosis, chronic obstructive pulmonary disease, or lung tumors
• Argies
• Cardiovascular diseases: heart failure, pulmonary infarction or aortic aneurysm
• Stomach acid backs up into the esophagus: Gastroesophageal reflux disease
• Conditions affecting the lung tissue: mediastinal masses
• Environmental pollutants: smoking, dust or smog
• A foreign body can sometimes be suspect
• Some medications: ACE inhibitors

Conventional treatment

The treatment of cough is determined by the cause. However, patients may get symptomatic relief from expectorants which help thin the mucus and make it easier to cough mucus up when you have a productive cough, and from suppressants which control or suppress the cough reflex and work best for a dry, hacking cough that keeps you awake.

Chinese medicine

In Chinese medicine, cough can be caused by either exogenous pathogenic factors or endogenous origins (the impairment of internal organs).  The exogenous pathogenic factors include wind, cold, heat and dryness; the endogenous factors may originate lung or other related organs such as liver, spleen or kidney, which eventually lead to the dysfunction of lung, causing cough. Exogenous cough arises as a new illness, with abrupt onset flowing exposure to cold, and is accompanied by nasal mucosal congestion and discharge, sneezing, an itchy throat, distending headache, generalized body aches, aversion to wind or cold, and fever. Endogenous cough is generally chronic, with slow onset. There usually are symptoms of other visceral organs, such as fatigue and weakness, chest distention, flank pain, anorexia, diarrhea, or other symptoms.

Cough can be treated by acupuncture, herbals or some other modalities of Chinese medicine, alone or combination of different modalities, depending on individual situation.

Clinical classifications and treatment principles

A. Exogenous pathogenic factors

Wind-Cold

• Symptoms and signs: Cough with a heavy sound and thin, white sputum, fever, headache, stuffy and runny nose, anhidrosis
• Tongue:  Thin white coating
• Pulse:  Floating and tight
• Treatment principle:
  • Disperse the wind
  • Dispel the coldness
  • Clear lung
  • Suppress cough

Wind-Heat

• Symptoms and signs: Cough with a high husky sound and thick white or yellow sputum, fever, chilliness, headache, sore throat, thirst, yellow nasal discharge
• Tongue:  Thin, yellow coating
• Pulse:  Floating and fast
• Treatment principle:
  • Disperse the wind
  • Eliminate the heat
  • Clear lung
  • Dissolve sputum

Wind-Damp

• Symptoms and signs: Profuse mucus, heavy/loose/thick cough, feelings of heaviness in the body
• Tongue:  Greasy, thick coating
• Pulse:  Floating and slippery
• Treatment principle:
  • Disperse the wind
  • Eliminate Dampness
  • Dissolve sputum

Wind-Dry

• Symptoms and signs: Dry choking cough with a husky sound and thick or blood-tinged sputum, itching and dryness of throat, sore throat, dryness of nose and lips, headache, stuffy nose, fever, aversion to wind
• Tongue:  Red tip, dry
• Pulse:  Floating
• Treatment principle:
  • Disperse the wind
  • Moisten the lung

B. Impairment of internal organs

Live-fire attacking the lung 

• Symptoms and signs: Coughing possibly blood-tinged, costal pain, irritability
• Tongue:  Red with yellow coating
• Pulse:  Wiry and rapid
• Treatment principle:
  • Eliminate liver fire
  • Smooth qi
  • Suppress ascended qi

Phlegm-dampness accumulating in the lungs

• Symptoms and signs: Cough with a heavy sound and profuse white sputum, fullness and oppressive sensation over the chest and epigastrium, fatigue, poor appetite, nausea, vomiting, diarrhea
• Tongue:  White and greasy tongue coating
• Pulse:  Soft-floating and smooth
• Treatment principle:
  • Tonify the spleen
  • Dry dampness
  • Eliminate sputum
  • Relieve cough

Phlegm-heat stagnation in the lungs

• Symptoms and signs: Rapid breathing with harsh voice, cough with difficult expectoration of thick yellow sputum, or odorous or bloody sputum, chest pain, dry mouth, constipation
• Tongue: red tongue with yellow or yellow and greasy coating
• Pulse:  rapid and smooth
• Treatment principle:
  • Eliminate the heat
  • Dissolve sputum
  • Peace the lug
  • Relieve cough

Lung-yin deficiency

• Symptoms and signs: Longstanding cough with a little amount of white mucous or blood-streaked sputum, dry throat, hoarseness, flushed cheeks, afternoon fever, feverish sensation over the palms, soles and the chest, insomnia, night sweating, fatigue, emaciation
• Tongue: red tongue with scant coating
• Pulse: Thready and rapid
• Treatment principle:
  • Nourish yin
  • Moisturize the lungs
  • Dissolve sputum
  • Suppress cough

Lung-qi deficiency

• Symptoms and signs: Longstanding cough with very low sound, cough accompanied by asthma, thin, clear and white sputum, poor appetite,  shortness of breath and oppressive sensation over the chest, low spirit, tiredness, spontaneous sweating, aversion to coldness
• Tongue: light color and white coating
• Pulse: weak
• Treatment principle:
  • Nourish qi
  • Warm the lung
  • Dissolve sputum
  • Suppress cough

Clinical studies of Chinese medicine for cough 

Evaluation by survival analysis on effect of traditional Chinese medicine in treating children with respiratory syncytial viral pneumonia of phlegm-heat blocking Fei syndrome.Yang Y et al. Chinese Journal of Integrative Medicine. 2009;15(2):95-100. OBJECTIVE: To objectively evaluate the clinical effect of traditional Chinese medicine in treating children’s respiratory syncytial viral pneumonia (RSVP) of phlegm-heat blocking Fei syndrome (PHBFS). METHODS: A single-blinded multi-center, blocked, randomized and parallel-controlled method was adopted. The clinical study was carried out on 206 children with RSVP-PHBFS who were assigned to two groups, 108 in the test group treated through intravenous dripping of Qingkailing Injection () in combination of oral intake of Er’tong Qingfei Oral Liquid () and 98 in the control group with intravenous dripping of ribavirin injection in combination with oral intake of potassium guaiacol sulfonate oral liquid, all for 10 days. The clinical efficacy was evaluated and compared at the end of the trial from various aspects by three methods including comprehensive efficacy, post-treatment main symptoms score difference and survival analysis of the main symptoms. RESULTS: After treatment, in the test group, 60 patients were cured, 36 markedly alleviated, and 12 improved. In the control group, 41 were cured, 38 markedly alleviated, 18 improved and 1 unchanged. Comparison on the comprehensive efficacy between the two groups shows a better efficacy in the test group (chi(2)=4.4527, P=0.0348). Scores of the main symptoms were lowered after treatment in both groups, the difference was 22.41+/-4.99 scores in the test group and 17.61+/-6.34 scores in the control group, being more significant in the former (t=-5.99, P<0.01). Survival analysis shows that there was significant difference between the two groups in the effect initiating time on such symptoms as fever, cough, copious sputum, shortness of breath, and rales, which was earlier in the test group (P<0.01 or P<0.05). CONCLUSION: Evaluation of the efficacy of traditional Chinese medicine in treating children with RSVP-PHBFS by using the three methods jointly could better show the objectivity of the evaluation.

Sixty-eight cases of child chronic cough treated by moxibustion. Cui X, et al. J Tradit Chin Med. 2009;29(1):9-10. OBJECTIVE: To observe the therapeutic effects of moxibustion for chronic cough in children. METHODS: 68 child cases of chronic cough were treated by moxibustion. RESULTS: 54 cases were cured, 13 cases improved, and one case failed. The cure rate was 79.2%, with a total effective rate of 98.5%. CONCLUSION: The moxibustion therapy has definite therapeutic effect for children chronic cough.

Influence of garlic moxibustion on the therapeutic effect in re-treatment patients of tuberculosis. Zhao XP and Lü HQ. Zhongguo Zhen Jiu. 2009;29(1):10-2. OBJECTIVE: To observe the therapeutic effect of moxibustion in re-treatments patients of tuberculosis. METHODS: Fifty-three cases were randomly divided into an observation group (n = 31) and a control group (n = 22). They were treated with routine chemotherapeutic program of western medicine with garlic moxibustion on main points Feishu (BL 13), Gaohuang (BL 43), Shenzhu (GV 12), etc. added in the observation group. The therapeutic effects were assessed by clinical symptoms and signs, X-ray, CT examination and laboratory indexes. RESULTS: The focus absorbing rate of 87.1% in the observation group was better than 63.6% in the control group (P < 0.05); the rate of bacteria-turned negativity in sputum was 90.5% in the observation group which was better than 56.3% in the control group (P < 0.05); the observation group in improvement of hypodynamia, night sweat and cough was superior to the control group (all P < 0.05). CONCLUSION: Moxibustion can increase the therapeutic effect for the re-treatment patient of tuberculosis.

Observation on therapeutic effect of low energy He-Ne laser acupoint radiation on infantile cold. Zhou GY et al. Zhongguo Zhen Jiu. 2008;28(9):662-4. OBJECTIVE: To search for an effective therapy for infantile cold. METHODS: Two hundred and fifty-five cases were randomly divided into a laser group (n = 130) and a medication group (n = 125). The laser group were treated with lower energy He-Ne laser radiation at Tiantu (CV 22), Renying (ST 9), Dazhui (CV 14), Fengmen (BL 12), etc. and the medication group were treated mainly with oral administration of Amantadine tablets. The therapeutic effect was assessed after treatment of 5 days. RESULTS: The laser group in alleviation of cough, nasal obstruction, rhinorrhea, sputum sound were significantly better than the medication group (P < 0.001, P < 0.01); the cured rate was 68.5% in the laser group and 42.4% in the medication group, the former being better than the latter (P < 0.001). CONCLUSION: The low energy He-Ne laser acupoint radiation has a significant therapeutic effect on infantile cold.

Effects of alligator Zhikegao on relieving cough dispelling phlegm and anti-inflammation. Xu DH et al. Journal of Chinese Materia Medica. 2007;32(10):961-5. OBJECTIVE: To research the effects of Alligator Zhikegao on relieving cough, dispelling phlegm and anti-inflammation. METHOD: The coughing tests in mice, the phenol red secreting tests in mice, ear edema tests in mice,and paw edema tests and subcutaneous cotton ball granuloma in rats were adopted for observing the related pharmacological effects of Alligator Zhikegao. RESULT: Alligator Zhikegao could obviously prolong the latent period and decrease the times of mouse coughing, and remarkably inhibit the mouse ear edema (P < 0.001), the rat paw edema and the hyperplasia of subcutaneous cotton ball granuloma in rats. Alligator Zhikegao 11.70 g x kg(-1) could significant improve the carbonic clearances of macrophages (P <0.05) and the hemolysin level in serum (P <0.01). CONCLUSION: Alligator Zhikegao has significant effects on relieving cough, dispelling phlegm, anti-inflammation and immunological regulation.

Therapeutic effect of Zhuang medicine medicated thread moxibustion on asthma of lung deficiency type. Li G. Zhongguo Zhen Jiu. 2005;25(3):181-3. OBJECTIVE: To observe effects of zhuang medicine medicated thread moxibustion on asthma of lung deficiency type. METHODS: Seventy-two asthma of lung deficiency type were randomly divided into Zhuang medicine medicated thread moxibustion group and an acupuncture-moxibustion control group. They were treated by moxibustion 1-2 times each day, for 21 days. The therapeutic effects, serum immunoglobulin (Ig) and complement-3 (C3) contents, pulmonary function, and symptoms and signs were investigated. RESULTS: There was no significant difference between the two groups in the total therapeutic effect, but the clinical control rate in the treatment group was higher than that in the control group. The Zhuang medicine medicated thread moxibustion could obviously improve cough, dyspnea, and respiratory function, increase levels of IgG and C3, and decrease level of IgE. CONCLUSION: Zhuang medicine medicated thread moxibustion has a better therapeutic effect on asthma of lung deficiency type, with safety.

Evaluation on clinical efficacy of treatment of children pneumonia by combined internal-external therapy of TCM. OBJECTIVE. Wang XF et al. Chinese Journal of Integrated Traditional & Western Medicine. 2005;25(6):537-9. To evaluate the clinical efficacy of combined internal-external therapy of TCM on children pneumonia. Adopting multi-center, randomized, controlled, double blinded principle, children with pneumonia were divided into 2 groups. Besides the basic treatment of western medicine, to the 406 children in the treated group internal administering of Chinese recipe prescribed according to syndrome differentiation and external applying of Fuxiong plaster were given additionally, while to the 411 children in the control group simulative placeboes were given for instead. The clinical efficacy of treatment on disease and syndrome, improvement of TCM syndrome and physical signs of lung between the two groups were compared after treatment. RESULTS: The cured-markedly effective rate of treatment on disease and syndrome was 97.3%, 95.1% in the treated group and 89.8%, 86.6% in the control group, respectively, the differences of the two indexes between the two groups were significant (P < 0.05). The improvements on physical signs of lung, symptoms as cough, dyspnea and sputum expectorating in the treated group were significantly better than those in the control group (P < 0.05). CONCLUSION: It was showed that the combined internal-external TCM treatment, which could significantly enhance the clinical efficacy, is an effective therapy for children pneumonia.

Clinical study of wind-warm and pulmonary heat syndrome treated with integrated traditional Chinese and Western medicine.  Zhang CJ et al. Journal of Chinese Integrative Medicine. 2005;3(2):108-10. OBJECTIVE: To investigate the clinical effectiveness of Toubiao Qingfei (expelling exterior evil and clearing lung) Decoction (TBQFD) on wind-warm and pulmonary heat syndrome. METHODS: Forty-six subjects were randomized into treatment group and control group. Patients in the control group were treated with Western medicines, while patients in the treatment group were treated with Western medicines and TBQFD. The therapeutic effects and improvement of symptoms in both groups were observed. RESULTS: The durations of fever, cough and absorption of pulmonary inflammatory focus in the treatment group were 1.52, 3.52 and 6.25 days respectively, which were significantly shorter than those in the control group (P<0.05). CONCLUSION: TBQFD can improve the symptoms, such as fever and cough, and can promote the absorption of infection and shorten the clinical course of wind-warm and pulmonary heat syndrome.

Clinical study on treatment of severe acute respiratory syndrome with integrative Chinese and Western medicine approach. Li J et al. Chinese Journal of Integrated Traditional & Western Medicine. 2004;24(1):28-31.  OBJECTIVE: To summarize the clinical characteristics of severe acute respiratory syndrome (SARS) and observe the therapeutic effect with integrative Chinese and western medicine (ICWM) approach in treating patients with SARS. METHODS: Forty-eight patients selected from the authors’ hospital, whose diagnosis confirmed as SARS were analyzed to sum-up the diagnostic type and basic feature of patients and the chief clinical characteristics. All the patients were randomly divided into the trial group and the control group, 24 in each. The control group was treated with the western medical therapeutic program and the trial group was treated with ICWM therapeutic program. The differences between the two groups were compared in terms of development of illness, time of using corticosteroid and absorption time of pulmonary inflammatory lesion, etc. RESULTS: Most patients were youth and adult aged between 18 to 40 years old, the initial symptom was mainly the high fever, accompanied with general soreness, chest stuffiness and cough, etc. The hospitalization time, body temperature fluctuation sustaining time and time of using corticosteroid in the trial group were shorter than those in the control group, showing significant difference (P < 0.05). ICWM treatment showed a better effect in defervescence and inflammatory lesion absorption time, but with no statistical significance. CONCLUSION: Patients of SARS are mainly youth and adults in the prime of life, fever always appears as the initiation of illness and some accompanying symptoms would appear. As compared with the western treatment, ICWM treatment could evidently shorten the course of illness, prevent the rebounding of fever and reduce the time of using corticosteroid.

Treatment of cough and dyspnea due to acute bronchitis by plaster for cough and dyspnea–a report of 735 cases. Chen Z et al. J Tradit Chin Med. 2002;22(1):5-8. In the light of the theory of treating the internal disease externally, an externally used plaster for treating cough and dyspnea due to acute bronchitis (Ke Chuan Yi Tie Kang) was successfully applied to 735 cases of acute bronchitis (the treatment group), with the other 423 cases treated with routine western drugs as controls. The results showed that the cure rate in the treatment group was significantly higher than that in the control group (P < 0.01); and that in the treatment group, the cure rate for the wind-cold type of acute bronchitis was significantly higher than that for the wind-heat type of acute bronchitis (P < 0.01).