Cough is a reflex phenomenon characterized by a sudden, violent expulsion of air from the mouth, with or without sputum, after deep inspiration and closure of the glottis. This is the most frequent respiratory symptom. Coughing is an important way to keep the throat and airways clear. However, involuntary excessive coughing means there is an underlying cause that compels the person to cough.
The cough may be dry or productive. In dry cough there is only explosive sound with no or little material coming out from the airways. Whereas a productive cough is one that brings up phlegm or sputum, at times mixed with pus or blood or both. Cough can be either acute or chronic. Acute cough usually appears suddenly, goes away within 2-3 weeks and is often due to common cold, flu, or sinus infection.
Chronic cough lasts longer than 2 to 3 weeks and is a symptom mostly of respiratory tract disease. Besides respiratory infections namely tuberculosis, other common causes of cough include chronic tobacco smoking, naso-bronchial allergy, bronchial asthma, chronic bronchitis with or without airway obstruction, lung abscess, bronchiectasis and bronchogenic tumours, reflux disease of gastrointestinal system, air pollution, heart failure, valvular heart disease and certain medicines used for the treatment of high blood pressure. The diagnosis of the cause of cough is essential before definitive therapy is initiated.
Painful cough in association with fever indicates respiratory tract infection. Intermittent, ineffectual and exhausting cough occurs in chronic bronchitis and bronchial asthma and it is generally worst at night or on waking. Cough may be loose and readily productive of sputum in bronchiectasis and early stages of bronchial cancer. Sputum production may be a relatively late development in lung tuberculosis.
Loud and harsh cough without explosive character called stridor is found in whooping cough and in the presence of laryngeal or tracheal obstruction. Cough usually aggravates with change in temperature or weather. The explosive character of normal cough is lost in laryngeal paralysis. A short troublesome cough of old people due to chronic bronchitis recurs every winter and it is called winter cough. Cough due to smoking is usually dry and irritating. Clinical and radiological evaluation is usually diagnostic in a large majority of cases. While definitive therapy may wait diagnosis, symptomatic treatment usually provides relief.
Ayurveda considers Kasa (cough) as a disease for which a specific line of treatment and various remedies are prescribed. Simple herbal remedies such as Pippali can successfully treat uncomplicated cough, if patients observe the prescribed precautions along with medication.
- (1) Exposure to fumes and dust, sudden change of temperature in the surrounding, dry and spicy foods, chilled water and food, leafy vegetables and heavy meals should be avoided.
- (2) Soft, hot and easily digestible meals, edibles like honey, small cardamom, fresh ginger, radish, meat soup, goat milk and resins help to control cough.
- (3) It is advisable to resort to sleeping during the day and not to suppress urges of stools, urination and belching. Cough symptom can be controlled easily with frequent drinks of warm water, mental relaxation and with less talking.
Pippali (Piper longum Linn.)
Pippali powder is a single-ingredient herbal formulation made from the fruits of long pepper, an aromatic climber with perennial woody roots. The fruits are harvested around January while still green and unripe, as they are most pungent at this stage and of high medicinal value. Harvested fruits are dried in the sun till they turn grey or blackish. Use of Pippali as a multipurpose drug is first documented in Charaka Samhita, where it is listed among Rasayana (rejuvenative and immuno-enhancer) drugs and largely mentioned for the treatment of cough, respiratory distress, gastro-intestinal disorders, pulmonary tuberculosis etc. Besides codified knowledge about its uses, Pippali is largely used as a home remedy and in folk medicine. Long pepper is a commonly used spice in India and other Asian countries and its medicinal usage is quite popular, particularly for the treatment of common ailments of childhood. Regarded as a drug of choice for cough of different origins, Pippali powder is widely used by Ayurvedic practitioners in India not only for symptomatic control but also for the treatment of root causes of cough affecting the naso-respiratory, digestive and blood systems. This popular plant medicine is even indicated for naso-respiratory allergy and tuberculosis of lungs and for immunodeficiency conditions.
Pippali is described in the Ayurvedic Pharmacopoeia and in formulations in Ayurvedic Formulary of India. Being simple, the formulation can be easily prepared at home for personal use. Scientific studies have proven its bio-availability enhancing, liver protective and immuno-stimulatory actions.
Pippali powder is made from dried fruits of Piper longum.
|English name||Long pepper|
|Latin name||Piper longum Linn.|
Main chemical constituents
Essential oil and alkaloids – piperine, sesamin and piplartine.
As per the Ayurvedic Pharmacopoeia of India, quality standards determining the identity, purity and strength of long pepper fruits are based on the following aspects:
|Foreign matter||Not more than 2%|
|Total ash||Not more than 7%|
|Acid insoluble ash||Not more than 0.5%|
|Acid-soluble extractive||Not less than 5%|
|Water-soluble extractive||Not less than 7%|
Pepper powder under the microscope shows deep, moss-green colour, fragments of parenchyma, oval or elongated stone cells, oil globules and starch grains.
Method of preparation
- (1) Dried long pepper fruits are cleaned and powdered in a grinder or mortar.
- (2) Powder is sieved through mesh of 85 size and kept in an airtight plastic or glass container.
- (3) Exposure to moisture should be avoided. It is advisable to prepare at least 50 grams of powder at a time.
Blackish green powder with aromatic odour and pungent taste.
Pippali powder has anti-inflammatory, anti-phlegmatic, decongestant, anti-spasmodic, expectorant, anti-allergic, appetizer, anthelmintic, immunostimulatory and tonic properties.
Dose and mode of administration
The adult dose of the formulation is 1 gram to 3 grams and the children’s dose is 125 mg to 250 mg, two or three times a day, mixed with honey or warm water. Honey is the best vehicle for consuming Pippali powder. Jaggery or liquorice root powder may be used in place of honey, if the cough is dry, irritating and persistent. Warm water should be taken after consuming the medicine to facilitate its swallowing and fast absorption.
Indications and uses
- (1) Pippali powder is indicated for acute and chronic cough due to common cold, pharyngitis, laryngitis, bronchitis, naso-respiratory catarrh, respiratory allergy, asthma and smoking.
- (2) Non-specific cough is adequately manageable with Pippali Churna.
- (3) The formulation is also effective in controlling symptoms associated with cough-like sneezing, hiccough, nasal discharge, fever, poor appetite, indigestion, etc.
Precautions and safety aspects
- (1) Pippali is regarded as safe in recommended doses. Ayurvedic literature does not specifically mention any toxicity or adverse effects from the use of Sitopaladi powder like formulations, which include Pippali. However, long-term use of Pippali alone is not recommended in Charaka Samhita. Scientific studies have shown 750-800 mg/kg dose as LD-50 value of piperine in mice.
- (2) Do not consume Pippali powder without mixing properly with honey or warm water.
- (3) Fried and spicy foods, chilled drinks, curd, yogurt, smoking and exposure to cold should be avoided while suffering with cough. Frequent sipping of warm water helps a lot to facilitate the effect of the medicine in controlling cough whether dry or productive.
- (4) Patients with cough lasting over 10-15 days should take proper medical advice for exact diagnosis of underlying cause and for needful treatment.
- (5) Patients with diabetes mellitus and obesity should use the formulation without honey or jaggery. Similarly, sugar and jaggery should not be taken with Pippali for long-term use in overweight and obese individuals suffering from chronic cough.
- (6) The formulation could alleviate cough resulting from lung tuberculosis and tumour or cancer of respiratory tract, but it is not the remedy for these underlying conditions.
- (7) If the sputum is mixed with blood or frank blood is coughed out, do not attempt to treat cough with Pippali powder.
- (8) Stop medication with Pippali powder, if symptoms aggravate and dryness of mouth, excessive thirst and burning sensation in the body and urine appear.
- (9) Owing to the hot and lubricating nature of Pippali, its excessive and long-term use is contraindicated in Ayurvedic literature. Ignorance about this fact may lead to untoward symptoms.
- (10) Individuals with heat-dominating temperament and body constitution and menstruating and pregnant women should be careful in observing any unwanted effects while consuming Pippali powder. In case of adverse effects medical advice should be sought promptly.
- (11) Proper medical advice should be taken, if cough accompanies difficulty in breathing, swelling of face or feet, high grade fever, expectoration with foul-smelling yellowish-green phlegm, blood in sputum, difficulty in lying down, night sweating and unintentional weight loss.
- (12) Pippali powder has a potent antifertility activity; therefore, it must be used with caution in the first trimester of pregnancy. Women planning for pregnancy should avoid use of Pippali powder. However, the baby is not harmed if a lactating mother is taking this medication.
- (1) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. IV. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2004 p. 91-92.
- (2) India, Ministry of Health and Family Welfare. The Ayurvedic formulary of India. Part II. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2000. p. 49-56.
- (3) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda & Siddha, New Delhi, 2001. p. 475.
- (4) Sharma PC. Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 474.
- (5) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 473, 475.
- (1) Annamalai AR, Manavalan R. Effects of trikatu and its individuals components and piperine on gastrointestinal tract, trikatu. Indian Drugs. 27, 1990.
- (2) Dhanukar SA & Karandikar SM. Evaluation of anti-allergic activity of piper longum. Indian Drugs. 1984; 21: 377-83.
- (3) Dhanukar SA, Karandikar SM, Desai M. Efficacy of piper longum in childhood asthma. Indian Drugs. 21, 1984.
- (4) Warrier PK et al. Eds. Indian medicinal plants. Vol. IV. Madras: Orient Longman Ltd., 1997.
- (5) Kirtikar KR & Basu BD. Indian medicinal plants. Vol. III. Allahabad: LM Basu, 1988.
- (6) Kurup PNV, Ramadas VNK, Joshi P. Handbook of medicinal plants. New Delhi: Central Council for Research in Ayurveda and Siddha, 1979.
- (7) Pharmacological investigations of certain medicinal plants and compound formulations used in Ayurveda and Siddha. New Delhi: Central Council for Research in Ayurveda and Siddha, 1996.
- (8) Sharma PV. Classical uses of medicinal plants. Varanasi: Chaukhambha Visvabharati, 1996.
- (9) Sharma PV. Dravyaguna vijnana. Vol. II. Varanasi: Chaukhambha Bharati Academy, 2001.
Source: Traditional Herbal Remedies for Primary Health Care - WHO