Guidelines for treating cough with Homoeopathy

Cough- watch dog of our lung & homeopathy 

Dr. Abhijit Chakma^*

Introduction:
Cough is an explosive expiration that provides a normal protective mechanism for clearing the trachea-bronchial tree of secretions and foreign material. By this mechanism it prevents and reduces the chance of apparent damage to the lungs. That is why cough has been referred to as the ‘Watch dog’ of the lungs (vide ref. Cecil Essentials of Medicine; 3^rd edition; Page no. 126).

Cough is provoked by mechanical or chemical stimulation of the airways. When excessive or bothersome, it is also one of the most common ailments for which medical attention is sought. And in our day to day practice also we often come across patients complaining of cough either of acute or chronic in nature.

Cough itself is not a disease; rather it is the reflection of some underlying disease process. It guides us to know the underlying disease. The different types of cough and their individual characteristic features, lad us to understand the hidden disease process and thus help us in taking appropriate measures towards the case before us. Apart from types and characteristics of different coughs, the quality of the expectoration is another aspect, from where we can understand many things.

Aims & objectives:
 The object to discuss this topic is to explore the different characteristic features of cough associated with different diseases. Observation from physician’s point of view is very much important to diagnose the disease as well as prescription purpose. So, in this topic more emphasis is given upon the different observable signs & symptoms of cough.

The aim is also to explore the proper guidelines in treating the patients suffering from cough along with management also, keeping in mind the basic principles of Homoeopathy.

While discussing the different indicated medicines associated with conditions of cough, I have rather resorted to the repertorial approach and to be more precise my discussion has been limited within 3 repertories –Kent’s Repertory, Repertory of the More Characteristic Symptoms of the Materia Medica by C. Lippe and Homoeopathic Medical Repertory by R. Murphy. 

Origin of the word ‘cough’:
It is very much exciting to explore the birth of the word ‘cough’, the so commonly used term; we never felt the need & never recollect also. Let us have an insight into it. The origin is from the Middle High German “Kuchen” which translates as ‘to breathe heavily’, to the French Old English “Cohhian” which means ‘to shout’, to the Middle English “Coughen”. It is from these words the current word “Cough” was derived. 

Causes of cough:

1. Infection:

A)  Acute: Laryngitis, tracheitis, bronchitis, bronchiolitis, pneumonia, whooping cough.

B) Chronic: Pulmonary tuberculosis, chronic bronchitis, chronic laryngitis, bronchiectasis, lung abscess.

1. Mechanical irritation:

• A)    Inhalation of dust (pneumoconiosis), irritant gases, chemical fumes, tobacco smoking.
• B)    Foreign body in larynx or bronchi.
• C)    Post nasal drip in chronic sinusitis.
• D)    Compression of air passages-

1. Extramural- Aortic aneurysm, pulmonary neoplasm, mediastinal masses, enlarged left atrium in mitral stenosis.
2. Intramural- Bronchogenic carcinoma or adenoma, foreign body, broncho-spasm (asthma), granulomatous endobronchial disease.

E)     Pressure or tension on air passages- Pulmonary oedema, interstitial fibrosis, atelectasis, pericardial effusion, pneumothorax.

• Irritation of pleura: As in all types of pleural inflammation. 
• Pulmonary oedema: It also includes impending pulmonary oedema. 
• Reflex: From reflex irritation of vagus as in wax in external ear or otitis media, distension of stomach, sub diaphragmatic abscess.
• Thermal stimulus: Inhalation of cold air especially in asthmatics and those with intercurrent infection. 
• Habit cough: When a patient has suffered from some prolonged illness in which cough has been a prominent feature, the cough may at times persist as a habit long after the cause has ceased to operate.
• Psychogenic: May be found in obsessive neurosis. 

Special Importance in Pediatrics:

1. Upper respiratory infection.
2. Common cold.
3. Childhood asthma.
4. Bronchiectasis.
5. Measles.
6. Whooping cough.
7. Foreign body in air passages.
8. Smoke (passive smoking) / dust inhalation.
9. Cystic fibrosis.
10. Postnasal discharge. 

Classification:
A cough can be classified by its duration, character, quality, and timing. The duration can be either acute if it is present less than three weeks, sub-acute if it is present between three and eight weeks, and chronic when lasting longer than eight weeks. A cough can be non-productive (dry) or productive (when sputum is coughed up). Few important types of cough with their character are mentioned below- 

Type of cough	Character of cough	Disease conditions
Dry or unproductive	Cough without any expectoration.	In upper respiratory tract infection, pleurisy, early stage of pulmonary tuberculosis, bronchogenic carcinoma, smoker’s cough, interstitial fibrosis, bronchial asthma, tropical eosinophilia, pulmonary infarction, psychogenic or habitual cough.
Wet or productive	Cough with expectoration. Changes of posture can also set off coughing and free expectoration of sputum at any time of day is common in these patients.	Bronchiectasis, lung abscess, fungal infection.
Paroxysmal	Cough tends to occur in bouts lasting for variable duration with cough-free intervals in between.	Bronchial asthma, cardiac failure, whooping cough.
Cough with wheezing	Presence of wheezing sound due to passage of air through narrowed passages.	Bronchial asthma, tropical eosinophilia, chronic bronchitis.
Barking	Harsh, loud, `seal like’ cough, disturbing to the hearer, but perhaps not to the patient himself or herself.	Paroxysmal or occasional in hysteria (functional).
Nocturnal	Cough occurs mainly during night hours.	Asthma, pulmonary oedema, posterior nasal drip in chronic sinusitis, reflex oesophagitis.
Bovine/Brassy/Gander/ Leopard’s growl	Cow-like cough which results from the loss of the explosive phase of normal coughing consequent upon the failure of the cords to close the glottis.	In laryngeal paralysis from involvement of recurrent laryngeal nerve e.g. in aortic aneurysm, superior mediastinal syndrome.
Staccato	There is paroxysmal cough ending in a whoop.	In whooping cough.
Croupy	Harsh, hoarse cough.	In laryngeal infection.
Hacking / Hawking	Short, dry, irritable cough frequently repeated.	In congestive condition of pharynx, upper air passages and smoker’s cough, also tropical eosinophilia.
Recent worsening in case of chronic cough.	Chronic cough being worse very recently.	It is a common presenting symptom of bronchial carcinoma.
Cough related to meals	A bout of coughing with food or when lying down after a meal.	It suggests hiatal hernia, trachea-oesophageal fistula or oesophageal diverticula.
Cough related to exertion	With exertion there is onset of cough.	In early left ventricular failure.
Spluttering	While coughing few masses of mucus flies out from mouth.	In trachea-oesophageal fistula.
Toneless, whispering, aphonic cough	Low pitched cough as if whispering.	In destructive lesions of vocal cord especially tuberculous ulcer or neoplasm.
Suppressed and painful	Cough is suppressed because chest pain is aggravated by coughing (also by deep breathing).	In pleurisy.

Type & character of cough and their importance:
So, just by observing and understanding the character of cough, we can know the underlying pathology. It helps us in diagnosis as well as proper management and treatment of the case.

A classical illustration is the short dry painful cough in which the patient tries to prevent the cough because it is causing more pain at an area of the chest and often presses that painful area with the hand when the cough occurs. This is cough of dry pleurisy. The clinician must remember that any cough if severe and of long duration can produce pain in the chest wall. Every cough with pain in the chest wall is not pleurisy.

Macroscopic observations of sputum and inferences:

1. A.    Quantity:
   1. Scanty: Mostly found in asthmatic attack, in early stages of pneumonia and bronchitis.
   2. Moderate: In chronic chest complaints like bronchitis and tuberculosis.
   3. Large: In bronchiectasis, lung abscess, chronic bronchitis, cystic fibrosis,  empyema or subphrenic abscess or amoebic liver abscess rupturing into bronchi. 

1. B.     Appearance:
   1. Watery: Found in pulmonary congestion or acute pulmonary oedema, alveolar cell carcinoma, ruptured hydatid cyst.
   2. Mucoid: Sticky sputum containing increased mucin in acute or chronic bronchitis, asthma, weakened bronchial musculature, pneumoconiosis, early stages of pulmonary tuberculosis and sometimes bronchogenic carcinoma.
   3. Mucopurulent: Almost in all infections of bronchi and lungs. Sputum may be coin like, the sputum when expectorated into fluid taking on the shape of flattened discs. Such sputum indicates cavitation of any type. Mucopurulent sputum when large in amount as in bronchiectasis may separate into three layers when collected in a conical glass.
   4. Purulent: Indicates infection somewhere in the respiratory tract, large quantities of purulent sputum in bronchiectasis, lung abscess, chronic foetid bronchitis, pulmonary tuberculosis and gangrene of lung. 

1. C.    Colour of sputum:
   1. Blackish: Due to inhalation of carbon in coal miners, copious black sputum (melanoptysis) may occur when there is breaking down of lung tissue.
   2. Rusty (or Khaki): Due to altered blood mixed with tenacious sputum in lobar pneumonia.
   3. Small yellow sulphur granules: In actinomycosis of lungs.
   4. Reddish: Indicates presence of blood, fresh or altered.
   5. Frothy pink: In pulmonary oedema.
   6. Creamy yellow: In staphylococcus infection.
   7. Sticky brown to red sputum: In Klebsiella (Friedlander’s) infection.
   8. Currant jelly: Due to the presence in the sputum of blood tinged lung debris is likely to occur in influenza and bronchogenic carcinoma.
   9. Dark brown purulent material: It is like anchovy sauce in amoebic lung abscess.
   10. Green: Along with musty odour, this green coloured sputum found in pseudomonas infection.
   11. Blood oyster: Fresh blood embedded within mucopurulent sputum in tuberculosis.
   12. Rubbery brown plugs: In allergic broncho-pulmonary aspergillosis.
   13. Chalky white and gummy consistency: In pulmonary aspergillosis. 

1. Odour of sputum: A foul odour indicates infection with anaerobes, fusiform bacilli and may occur in lung abscess, bronchiectasis, bronchial carcinoma, foetid bronchitis, gangrene lung. 

A cough may fail to produce expectoration, because there is nothing produced or as secretions are swallowed (as is almost universal in children) or there is severe airway obstruction or because of weakness (patient cannot give enough effort to bring up the expectoration) or because the secretions are too viscid.

A child below the age of 7 years cannot bring out the proper sputum and readily swallows the material. This is so important that in modern medicine laboratory practice AFB in suspected tuberculosis in such child is detected not by sputum examination but if needed then by search for AFB in gastric aspirate.

Complications of cough:

1. Cough syncope: Prolonged coughing can reduce venous return, impair cerebral blood flow, thus cerebral oxygenation and result in syncope. This is called ‘cough blackout’. Some cases can have actual focal haemorrhage in the brain.
2. Rib fracture: Possible especially in pathological conditions like multiple myeloma, osteoporosis and osteolytic metastasis. This is especially applicable for elderly.
3. Spontaneous pneumothorax: From rupture of emphysematous bulla.
4. Hernia: At weak hernia sites.
5. Vomiting: Especially in children.
6. Subconjunctival haemorrhage.
7. Prolapse.
8. Ulcer in the frenulum of the tongue. 

Miasmatic analysis of cough:

Psora	Pseudo-psora	Syphilis	Sycosis
-Cough is dry, teasy, spasmodic, annoying. -There is scanty mucus expectoration and usually tasteless. -Patients are basically better from keeping quiet, lying down.   Disease conditions: Bronchitis, pulmonary TB, smoker’s cough, bronchial asthma, tropical eosinophilia.	-Cough is deep and prolonged. -Worse from morning and when lying down in evening. -Expectoration is purulent and in the advanced cases, greenish yellow, often offensive and usually sweetish to taste or salty.   Disease conditions: Bronchiectasis, lung abscess, pulmonary TB, gangrene of lung.	-Cough of one or two distinct barks like dog. -Cough of very long duration and very much troublesome. -Cough of this group mainly aggravates at night.   Disease conditions: Bronchial asthma, hysteria, pulmonary oedema, whooping cough.	-Cough is generally bronchial and always having bronchitis, hard dry racking coughs. -Coryza with much sneezing followed by days of coughing spells. -Cough has a less expectoration, so a great deal of coughing is required to raise it, hence the prolonged teasing cough. -Often trouble begins in early autumn and in winter. -Cough <from exposure to cold air or dampness.   Disease conditions: Bronchial asthma, bronchitis.

The homoeopathic prospective:
The treatment of cough, according to the laws of the homoeopathic system may be divided into 2 parts-

1. The selection of the remedy.
2. The administration of the remedy. 

Selection/Choice of the remedy: This depends entirely and exclusively upon the symptoms, which are to be gathered with the greatest attention and the most careful investigation. These symptoms are by no means restricted solely to the character and peculiarities of the cough as such; but it is imperatively & indispensively necessary that they include also the periods and conditions of aggravation of the cough, as well as the other simultaneous morbid phenomena (concomitant); and this must be done, even though these latter phenomena may appear to stand in no relation whatever or in a merely accidental relation  to the cough itself and may not at present be susceptible of a physiological explanation (vide ref. Homoeopathic Treatment of Hooping Cough by C. von Boenninghausen, translated with additions by C. Dunhum, New York, 1870; Page no. 17).    

In order to fulfill these requirements, we have endeavored so to arrange the 1^st part of this work that under the name of each of the remedies which follow in alphabetical order should be comprised the following items. 

1^st– a brief diagnosis of the cough itself, involving-

1. The general character of the cough.
2. The exciting cause of the cough.
3. The expectoration, with reference to the manner of raising it and to its character. 

2^nd– under the ‘aggravation’-

1. The period of the day.
2. The circumstances that are especially observed to exist as conditions which exercise a greater or less influence upon the provocation & aggravation of the paroxysm of coughing and which often materially contribute to give to the cough an individual character. 

3^rd– the 3^rd heading called ‘concomitants’ comprises a selection of concomitant symptoms, some of which occur simultaneously with the cough, while others are observed as something abnormal or morbid, affecting the patient at other times.

These three steps when followed systematically, serve, by exclusion of other remedies which either do not present these symptoms or present them but incompletely, to assure the choice of the most appropriate remedy for the case in hand.

We have considered it indispensable to append to the 1^st part, which strictly speaking, constitutes the text of the work, a second part under the title ‘Index to the symptoms’ (Repertory), which may serve to indicate where the vary numerous symptoms are to be found, and, to assist the memory in the search for them. Through proper explanation, confirmation or rejection and through comparison among the group of remedies the indicated remedy will be chosen.

Administration of the remedy: The indicated remedy should be given in proper potency and dose as the case demands.

Comments of few stalwarts on different cough:
Our Master Dr. Hahnemann has said in preface of Drosera (Materia Medica Pura, Vol-VI, Page-288, 2^nd edition), that after designating this plant (Drosera) as one of the most powerful vegetable drugs, and deservedly extolling its great curative power in many epidemic Whooping coughs and specifying that a single smallest dose of the decillionth potency (30^th) is quite sufficient to effect a cure, he uses the following words: ‘Be careful to avoid giving a second dose immediately after the 1^st dose, for it would infalliably not only prevent a favorable issue, but also be the cause of considerable mischief, as I know from experience’.

He also used altogether similar language with reference to another remedy viz. Cina, which likewise stands in the front and gives the assurance that ‘the 30^th potency manifests, most completely, the curative power of the drug’. 

As per Dr. C. M. F. von Boeninghausen, whooping cough is one of the dangerous children’s diseases during his time. It was tough job for the homoeopaths to treat these patients as most of these cases were muddled up by the allopathic medication. His advice was that a suitable homoeopathic medicine in high potency should be given in minimal dose, dissolved in water, a tea-spoonful being given morning and evening for rapid cure.

REPERTORY ON COUGH:
In discussing the reportorial part on cough, I mainly focused on the important causations of cough, modalities, different sensations, concomitants and character of cough. For easy and quick search of related rubric (s) of causation, sensation, modalities, all are separately arranged. This part can be used as therapeutics of cough while attending the different cases of cough. There is also another separate chapter on expectoration which contains fewer details but important characteristics of expectoration.

COUGH
The main remedies are: Acon., ars., bell., bry., carb-v., caust., cham., chin., cina., coc-c., con., Dros., Hep., hyos., ign., ip., kali-c., lach., lyc., merc., nat-m., Nux-v., Phos., Puls., rumx., sang., Sep., spong., stann., Sulph.

1. A.    Character of cough

ASTHMATIC: Ant-t., Ars., Cina., Cupr., Dros., Ip., Nux-v.

BARKING: Acon., Bell., Dros., Hep., Spong., Stram.

• day and night: Spong.
• dog, like a: Bell., lyss.
• drinking cold water, amel.: Caust., coc-c.

CLOCK, like tick of, in its regularity: Nicc.

CROUPY (also Crowing): Acet-ac., Acon., ars-i., ars., bell., brom., calc-s., carb-ac., chin., chlor., cina., gels., Hep., Iod., ip., Kali-bi., kali-m., lac-c., Lach., Phos., phyt., rumx., Samb., sang., Spong., Stram.

• waking, only after: Calc-s.
• winter, alternating with sciatica in summer: Staph.
• with sopor, stertorous breathing and wheezing, with open mouth and head thrown back; the child starts up, kicks about, is on point of suffocating, turns black and blue in face, after which cough with rattling breathing sets in again, suffocations and paralysis, of lungs appear unavoidable: Samb.

DRY: Acon., Alum., Ars-i., Ars., Bell., Brom., Bry., Calc-s., Calc., Carb-an., Chin., Hyos., Ign., Iod., Kali-c., Lach., Mang., Nat-a., Nat-m., Nux-v., Petr., Ph-ac., Phos., Puls., Rumx., Spong., Sulph., Tub.

• blood, with discharge of: Zinc.
• chronic dry cough in pining boys: Lyc.
• emaciated boys, in: Lyc.
• ends in raising black blood: Elaps.
• following a cold: stict. (Clarke).
• in scrofulous children: Bar-m.

EXPLOSIVE: Caps., rumx., sil., stry.

• escape of fetid, pungent air, with: Caps.

GRASPING throat during: Acon., all-c., ant-t., bell., dros., hep., iod., lach.

• larynx involuntarily, at every cough, feels as though larynx would be torn: All-c.

HOARSE: Acon., All-c., Bell., Brom., calc., Carb-v., Caust., Dros., dulc., eup-per., Hep., Kali-bi., kali-i., lac-c., lach., lyc., rhus-t., rumx., sil., spong., Stann., verb.

HYSTERICAL attack of, women: Cocc., der., gels., ign., nux-m., plat., verat.

INABILITY to: Ant-t., dros., nat-s., ox-ac., sulph.

• pain, from: Nat-s.

METASTATIC, with the sound of croup: Cupr.

MINUTE guns, short, hacking cough, like: Cor-r.

NERVOUS: Caps., dros., hep., hyos., ign.

• anyone enters the room, when: Phos.

OLD people: Am-c., ambr., ammc., ant-t., bar-c., psor., seneg.

PANTING: Calad., dulc., mur-ac., phos., rhus-t.; sul-ac.

PERIODIC:

• day, every other: Anac., lyc., nux-v., sep.
• hour same, every day: Lyc., sabad.

RAPID, until patient falls back as limber as a rag: Cor-r.

RESONANT: Kali-bi.

SERIES, in: Phos., sumb.

SONOROUS: Stram.

STERTOROUS: Cact.

STUDENTS, of: Nux-v.

SYMPATHETIC: Card-m., dros., Lach., Naja.

TONELESS: Calad., card-b., cina., dros.

TRUMPET-TONED: Verb.

WHISPERING sounds has a: Card-b.

WHISTLING: Hep., laur. sang., spong.

WHOOPING: Carb-v, Dirc., Dros., Kali-s.

1. B.     SENSATION

ACRID fluid through posterior nares, sensation of, from: Kali-bi.

CARBON (COAL), as from vapour of: Arn., puls.

CHOKING sensation; fauces from to bifurcation of bronchia: Syph.

CRAWLING, sensation of: Aeth., apis., cahin., caust., con., kreos., nux-m., psor., rhus-t., squil.

CRUMB, feeling as of a, in larynx, from: Bry., coc-c., Lach., pall., plb.

DOWN, sensation of, in throat-pit, from: Calc., cina., ph-ac., sulph.

DRY, stomach, as if from: Bry., Sep.

FEATHER, as from:

• sensation of, or awn of barley in trachea: Rumx.

FILLING up, sensation as of, in throat, from: Apis., ars., sil.

FOREIGN body, sensation as of, in larynx: Am-caust., arg-m., Bell., brom., dros., hep., lach., lob., phos., ptel., rumx., sil.

• sensation of, in trachea, from: Hyos., kali-c., Sang., sin-n.

GREASE, sensation as if throat irritated by smoke of rancid: Hep.

HAIR, sensation of, in trachea: Sil.

ICY cold air, in air passages, sensation of, from: Cor-r.

• irritation, larynx in, from: as if some fluid had gone the wrong way: Lach.
• loose: skin hanging in throat, sensation of, from: Alum.

OVERPOWERING, as if larynx were tickled by a feather in evening before sleep: Lyc.

PLUG, sensation of a, in larynx, from: Spong.

• sensation as of a, moving up and down in trachea, from: Calc.

RE-ECHO, seems to, in stomach: Cupr.

SALT food and pepper in larynx, as if from: Crot-h.

SMOKE, sensation of, in trachea, from: Ars., bry., nat-a.

SPOT in larynx, as if from dry: Cimic., Con., crot-h.

SUGAR, dissolving in larynx, as if was: Bad.

TEARING, sensation, cardiac region: Elaps.

TUBE, sounds as if he coughed in a: Osm.

WORM, sensation as if a, crawled up from pit of stomach in throat, from: Zinc.

1. C.    CAUSATION

AGITATION, from: Cist.

ANGER, from: Ant-t., arg-m., arn., cham., coloc., ign., staph.

CELLARS, air of: Ant-t., nux-m., sep., stram.

CHAGRIN and trouble: Ign., ph-ac.

CHICKEN-POX after: Ant-c.

CHILL, after: Apis., cimx., nux-m., phos., samb.

COITION, after: Tarent.

CRAMPS,  in chest, from: Bell.

DANCING, after: Puls.

DEBAUCH, after: Nux-v., stram.

DRINKING, cold drinks, from: Sil.

DRY COUGH, measles after: Stict. (Clarke).

DRY COUGH, smoking, from: Thuj.

ERUPTIONS, suppressed, from: Dulc.

EXERTION, violent, from: Ox-ac.

FISH, from eating: Lach.

FLUIDS, loss of animal, from: Chin., cina., ferr., ph-ac., staph.

FRIGHT, from: Acon., bell., ign., rhus-t., samb., stram.

GONORRHOEA, suppressed, after: Benz-ac., med., sel., thuj.

GRIEF: Arn., asar., cham., ph-ac., phos.

HÆMORRHOIDS, after the appearance of: Berb., euphr., sulph.

HEARTBURN, from: Carb-s.

HEAT, after: Bell.

HUNGER, from: Kali-c., mag-c.

ITCH, suppressed, after: Psor.

LIFTING heavy weight: Ambr.

LUMP in throat, from: Bell., calc., coc-c., lach.

MANUAL labor, from: Led., nat-m.

MEASLES, after: Arn., calc., carb-v., Dros., eup-per., euphr., hyos., ip., kali-bi., kali-c., nat-c., Puls., sang., sulph.

MEAT, after: Staph.

MENSES, suppressed, from: Cop.

PARTURITION, after: Rhus-t.

PEPPER, from: Alum., cina.

PLEURISY, in: Acon., ars., bry., ip., lyc., sulph.

PRESSURE, on the goitre, from: Psor.

PUTTING, out the tongue, from: Lyc.

REMITTENT fever, during: Podo.

SEA wind, from: Cupr., mag-m.

SNOWFALL, exposure to, in children, from: Sep.

SPLENIC troubles, from: Card-m.

VACCINATION, after: Thuj.

VARIOLA, during: Plat.

• after: Calc.

VEXATION, after: Acon., ant-t., ars., bry., Cham., chin., cina., Ign., iod., nat-m., nux-v., ph-ac., sep., Staph., verat.

VINEGAR, after: Alum., ant-c., sep., sulph

1. D.    MODALITIES

DAYTIME:

• day, every other, violent coughs: Anac., lyc., nux-v.
• hour, at the same: Lyc., sabad.
• menses, before: Graph.
• only: Am-c., arg-m., calc., Euphr., ferr., lach., mang., phos., rumx., staph.
• which makes by quite breathless: Nat-m

MORNING:

• daybreak amel.: Syph.
• dressing, while: Seneg.

FORENOON:

• 11 a.m.; dry cough from tickling behind upper half of sternum, while sitting bent forward: Rhus-t.

NOON:

• lying down, amel.: Mang.

NIGHT:

• 3 a. m.: Am-c., ars., Kali-ar., Kali-c.
• daybreak, until: Nux-v.
• only: Ambr., caust.
• waking from the cough, two hours after sleep: Aral.

AIR:

• close, agg.: Brom., nat-a.
• cold, amel.: Calc-s., coc-c., kali-s.
• damp cold: Calc., chin., Dulc., iod., lach., nit-ac., sulph.,
• draft of: Acon., calc., caust., chin., ph-ac.
• dry, cold: Acon., Hep., phos., spong.

AUTUMN: Caps., cina., iod., kreos., lac-ac., verat.

• and spring: Cina., kreos., lac-ac.

BEER, agg.: Mez., nux-v., rhus-t., spong.

COFFEE, agg. : Caps., caust., cham., cocc., ign., nux-v., sul-ac.

• odor of : Sul-ac.

CONSOLATION, agg.: Ars.

CONSTANT: vomiting amel : Mez.

DAMP room, agg.: Bry.

DIARRHOEA amel.: Bufo.

DRY: smoking amel.: Tarent.

EATING, from: highly-seasoned food agg.: Sulph.

EXCITEMENT: Cham., cist.,  Spong.

FLATUS, passing amel.: Sang., rumx.* (*Clarke).

FOG agg.: Sep.

FROSTY, weather amel.: Spong.

FRUIT agg.: Arg-m., mag-m.

HANDS, must hold chest with both, while: Arn., bor., Bry., cimic., Dros., eup-per., kreos., merc., nat-m., nat-s., phos., sep.

• holding pit of stomach amel.: Croc., dros.
• abdomen amel.: Con.
• must hold head with: nicc. (Clarke).
• must hold testes on coughing: zinc. (Clarke).

ICE CREAM, at first amel., then agg.: Ars-h.

KNEELING, with face toward pillow amel.: Eup-per.

LABOR, following difficult, or abortion, with backache and sweat: Kali-c.

LACTATION, during: Ferr.

LYING agg.:

• hands and knees on, amel.: Eup-per.
• only on lying: Caust.
• only when lying down; was obliged to sit up and cough it out, then had rest: Con.
  • face, great rattling of mucus, which appears to be low down in chest, while cough does not seem to reach there, only to throat-pit, consequently hard cough does not reach phlegm unless he lie on his face when he brings up a greenish-yellow or a pale greenish-yellow gelatinous mucus without taste : Med.

MILK agg.: Ambr., ant-c., ant-t., brom., kali-c., spong., sul-ac., zinc.

MOTION agg.: rapid : Nat-m., puls.

MUSIC agg.: Ambr., calc., cham., kali-c., kreos., ph-ac.

NOISE agg.: Arn., ph-ac.

ODORS, strong: Phos., sul-ac.

PIANO, when playing: Ambr., Calc., cham., kali-c., kreos., ph-ac.

POTATOES, agg.: Alum.

PREGNANCY, during: Calc., caust., con., ip., kali-br., nux-m., phos., puls., sabin., sep., vib.

READING, aloud: Ambra., dros., Mang., meph., nux-v., Phos., stann., tub.

RAISED, child must be, gets blue in face, cannot exhale: Meph.

SALT food: Alum., con., lach.

SIT UP, must and cough it out, when had rest: Con.

SMOKE of all kinds agg.: Euphr., ment.

SOUR food: Ant-c., brom., lach., nat-m., nux-v., sep., sulph.

SPRINGS up, child, and clings to those around; calls for help in a hoarse voice, bends backward and grasps at larynx: Ant-t.

STOOLS, frequent, amel.: Bufo.

STORM, before: Phos.

• thunder, before: Phos., sil.

STRANGERS, child coughs at sight of: Ambr., ars., bar-c., phos.

STRETCHING out the arms: Lyc.

SUGAR agg.: Zinc.

• amel.: Sulph.

SUN, agg.: Ant-t., coca.

SURPRISE, happy agg.: Acon., merc.

SWEETMEATS agg.: Med., spong., zinc.

TEA agg.: Ferr., spong.

• hot, agg.: Spong.

THINKING of it agg.: Bar-c., nux-v., ox-ac.

WALKING:

• amel.: Astac., dros., grat., ign., phos.
• fast: Cench., coca., merc., nat-m., puls., seneg., sep., sil., squil., stann.

WEATHER, change of: Dulc., erig., lach., nit-ac., phos., rumx., sil., spong., verat., verb.

• damp: Bar-c., calc., carb-v., cur., dulc., iod., lach., mang., nat-s., phyt., rhus-t., sil., spong., sulph.
• hot: Lach.
• stormy: Mag-m., phos., rhod., sep., sil., sulph.
• warm, wet: Iod.

WHINING, during: Acon., ars., cina.

WINE: Acon., ant-t., arn., bor., ferr., ign., lach., led., stann., stram., Zinc.

• amel.: Sulph.

WINTER: Acon., cham., coc-c., dulc., eupi., kreos., nit-ac., plan., psor., rumx., stann., staph.

WRITING: Cina.

YAWNING: Arn., asaf., cina., mur-ac., nux-v., puls., staph.

1. E.     CONCOMMITANT

BREAKFAST:

• before: Alumn., kali-c., murx., seneg., sulph.
• during: Alum., alumn., seneg.
• after, amel.: Alumn., aspar., bar-c., coc-c., kali-c., lach., murx.

CHILL, before: Apis., eup-per., Rhus-t., rumx., samb., tub.

• during: ars., bell., bry., chin-a., chin., ferr., Phos., psor., puls., Rhus-t., rumx., Sabad., sep., tub.
• after: Apis., cimx., nux-m., phos., samb.

HOLD, cough obliges him to, himself inwardly: Coff.

HUNGER, violent, with: Nux-v., sul-ac.

SNEEZING, ends in: Agar., arg-n., bell., squil., sulph. 

EXPECTORATION

BALLS, in shape of: Agar., arg-n., coc-c., lyc., med., ph-ac., sil., squil., Stann., sulph.

BLOODY, spitting of blood:

• black: Elaps., nit-ac.
• bright-red: Acon., arn., Bell., calc., carb-v., Dulc., Hyos., ip., kali-bi., led., merc., phos., rhus-t., Sabin., sec., zinc.
• dark: Am-c., ant-c., arn., asar., bism., bry., cact., canth., Cham., chin., Croc., elaps., eupho., kreos., lyc., mag-c., nit-ac., nux-m., Nux-v., ph-ac., phos., puls., sel., sep.,
• drunkards, in: hyos.; led., nux-v.; op.
• fall, after a: Ferr-p., mill.
• heart disease, valvular, with: cact., lycps. (Boericke).
• lactation, during: Ferr.
• menopause, during: lach. (Boericke).
• periodical attacks: kreos. (Boericke).

COPIOUS:

• paroxysmal cough, after each: Agar., alumn., anan., arg-n., Coc-c., kali-bi., sulph.

DIFFICULT, aged people: Ammc.

EASY, morning and profuse: arg-m. (Boericke).

EPITHELIUM, exfoliate: Chin-s.

FLIES forcibly out of mouth: Bad., chel., kali-c.

LIVER-COLORED: Puls.

PURULENT: Anac., ant-t., arn., ars-i., ars., calc-s., Calc., carb-an., carb-s., chin-a., Chin., cimx., cod., Con., dig., dros., ferr., Kali-c., kali-n., kali-p., kali-s., kreos., Lyc., merc., Nat-a., nat-c., nit-ac., nux-m., ph-ac., Phos., plb., puls., rhus-t., Sep., Sil., stann., staph., sulph.

RUSTY: Acon., arn., ars., atro., Bry., Lyc., phos., pyrog., rhus-t., sang., squil.

SKIN, like dead: Merc-c.

TASTE of

• bitter: Ars., Cham., cist., dros., merc., nit-ac., nux-v., Puls., sep., verat.
• salty: Alum., ambr., Ars., calc., cann-s.,  carb-v., chin., graph., , Lyc., mag-c., merc-c., merc., nat-c., nat-m., nux-m., ph-ac., Phos., Puls., Sep., stann.
• sour:  Bell., Calc kali-c., merc., Nux-v., Phos., puls., sulph.
• sweetish: Calc., dig., kali-c., Phos., plb., puls., sabad., sanic., squil., Stann.

WHITE

• albuminous : Agar., Alumn., apis., Arg-m., ars., bar-c., caust., Coc-c., ferr., kali-bi., laur., med., mez., Nat-m., nat-s., ph-ac., Phos., sel., Seneg., sil., stann. 

Characteristic features of some drugs in cough: 

1. Antimonium tartaricum: Symptoms come slowly. Dr. Nash says- ‘no matter what the name of the trouble, whether it be bronchitis, pneumonia, whooping cough or asthma, if there is a great accumulation of mucus with coarse rattling, or filling up with it, but at the same time, there seems to be inability to raise it, Tartar emetic is the first remedy to be thought of. This is true in all ages and constitutions, but particularly so in children and old people. There is one symptom is very apt to be present in these cases, i.e. great drowsiness, sometimes accounting to coma…’ 

1. Causticum: Kent says- ‘it is a deep-acting medicine: cures phthisis, especially quick consumption. Cough with the sensation that he cannot cough deep enough to start the mucus. Cough relieved by a swallow of cold water and worse by bending forward. Cough continual, with each cough escape of urine….’ 

1. Coccus cacti: It is the main remedy which we can think of with people who smoke. Also a great remedy in cases of COPD. Striking is that he starts coughing when he brushes his teeth. Must sit up as soon as the cough begins. Aggravation from heat and in the morning. 

1. Drosera rotundifolia: Coughing attended with epistaxis. It may also indicate Ipecac. Here the timing is important; always after midnight. It is a hoarse cough and usually they hold the stomach, because it hurts when coughing. We should always suspect a history of tuberculosis. Cough < from drinking, singing or talking. 

1. Hyoscyamus niger: Dry cough which is < when lying down and > by sitting up. Useful particularly in old people. 

1. Ipecacuanha: Kent says- ‘useful for bronchitis of infancy….here we are to distinguish it from Ant. tart. Both have rattling cough and breathing; both have vomiting. Ipecac corresponds to the stage of irritation, hence the symptoms are- paroxysmal character; red face, thirstlessness, violent whooping with convulsions and vomiting of all that he eats. Moreover Ipecac symptoms come on hurriedly.

Ant. tart corresponds to the stage of relaxation. When the lungs are too weak to expel the mucus, the coarse rattling comes on’.

1. Kali carbonicum: Paroxysmal cough with gagging and vomiting, hence its value in whooping cough. In one epidemic of whooping cough it is recorded that, where the symptoms were not those of Drosera, Kali carb. proved curative. The curious symptom that suggested its use being a bag-like swelling between the upper lid and the brow. This swelling seems peculiar to Kali carb. 

1. Rumex crispus: Cough with stitching pain through left lung just below left nipple. Aggravation from inspiring cold air and at night. The change of temperature from warm to cold produces cough. Everything that is cold produces cough. The cough clearly ameliorates when covering up, when pulling the blankets and sheets over the head. Several other remedies like Phosphorus & Spongia have cough < breathing cold air, but none so markedly as Rumex. 

1. Stannum metallicum: COPD patients with extreme weakness. So weak they even can’t talk. Hoarseness. Cough is provoked when laughing, talking or singing. Like everything with Stann. it comes slowly and goes slowly. Nothing is ever acute with Stann. It is the process of a few weeks. 

1. Sticta pulmonaris: Cough attending or following measles, where sleeplessness is a frequent concomitant (should be compared with Coffea cruda). The cough is at first dry, but later on may become loose. 

Conclusion:
It is written in the book ‘ The Concept of Miasms in Homoeopathy and New Era’ by Dr. K. D. Kanodia that- Homoeopathy was discovered as a science, practiced as an art, followed as a religion and treated as a politics. According to the author, Homoeopathy is quite safe, but if used wrongly it can become harmful and even dangerous.

The whole discussion was the initiation of an attempt to highlight the different characters of cough with all its attributes. The sole aim is to enhance the quality of our prescription and day to day case taking rituals.

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¹This paper is previously presented by the author in a seminar at National Institute of Homoeopathy, Kolkata.

^*Dr. Abhijit Chakma; MD (Hom.),
Senior Research Fellow (H), Clinical Research Unit for Homoeopathy,
¼ Main Road, Colonel Chowmuhani, Krishnanagar,
Agartala, Tripura- 799001
E-mail: dr.abhijit24@gmail.com