Q I am a woman in my late 40s and I have sticky phlegm which makes me cough loudly before I can expel it from my throat. I often had episodes of bad coughs during my youth and most of my elderly family members died of pneumonia.
The phlegm and coughing are unbearable. As I need to spit out a lot of phlegm frequently during the day, my work is terribly affected.
Also, my nose is usually blocked as I sleep in an air-conditioned room. This causes me to feel tired most of the time. Please advise me on how to cure this problem and how to prevent any recurrence.
A It sounds like you have chronic cough, which is a persistent cough that lasts eight weeks or longer.
This problem can also be seen in illnesses such as asthma, post-nasal drip, sinusitis, gastro-oesophageal reflux disease and diabetes. Severe cases can result in vomiting, rib fractures and a feeling of light-headedness.
According to traditional Chinese medicine (TCM), a chronic cough likely stems from deficiencies in the lungs, spleen, heart, liver and kidneys, as well as pathogenic factors such as wind, cold, heat and dampness.
In TCM, the lungs dominate one's qi (vital energy). Yet, among the organs, the lungs are the most vulnerable to external pathogens, such as wind, heat, cold and dampness.
These pathogens disrupt the flow of qi through the lungs, causing abnormal secretions in the respiratory tract - which can trigger coughing with various symptoms.
For instance, wind is known to cause coughs with itchy throats, while coldness in the body leads to coughs with transparent phlegm and a blocked nose.
Heat, on the other hand, gives rise to sore throats. And if your body is invaded by a combination of heat and phlegm, you may have a cough with yellowish or greenish phlegm.
Another possible reason for your problem is a dysfunctional spleen. In TCM, this organ transforms food and nutrients into qi and blood. But when it becomes defective, the nutrients are converted into phlegm and dampness instead.
This blocks the regular activity of qi in the lungs. The person may then have a cough that is accompanied by phlegm, fatigue and a poor appetite.
Problems with the spleen are usually linked to ageing, chronic disease, smoking and a diet that comprises too much raw, cold, spicy and oily food.
TOO MUCH HEAT
The liver is yet another organ that can, albeit indirectly, cause coughs.
When one feels overly upset, anxious, worried or stressed, liver qi stagnates, which generates liver fire or excessive yang (the element responsible for heating organs).
This liver fire may attack the lungs, transforming fluids into phlegm and interrupting the flow of qi. This can lead to a dry cough, along with pain at the ribs and belching. The person may also find it difficult to expel his phlegm.
Meanwhile, there must be mutual regulation between the kidneys and the lungs for breathing to take place normally.
When the lungs' qi grows weak, this coordination breaks down, which can trigger coughs with lower back aches, frequent urination at night and breathlessness.
That is not the end of the story.
As the cough sets in, it weakens the function of the lungs even further. This, in turn, affects the kidneys, due to the close relationship between the two organs.
The negative impact can even reach the heart. This is because the lung's qi is also linked to the heart, which is responsible for transporting blood around the body.
When the lungs' qi is weak, blood flow will be weakened too. This creates blockages in the lungs, triggering coughs with chest pain and insomnia.
FIGHT PATHOGENS WITH HERBS
You can improve your condition by taking Chinese medicine. Other options include acupuncture or cupping therapy, which involves placing heated cups on the skin to enhance blood and qi circulation.
Wind can be dispelled from the body by taking herbs such as divaricate saposhnikvia root and fineleaf schizonepeta herb. This will alleviate any itchiness in the throat.
The liver and kidneys can be strengthened by herbs such as the Chinese thorowax root, white peony root and sweet wormwood herb.
To increase the yin (the element responsible for cooling organs) in the lungs, try coastal glehnia root, dwarf lilyturf tuber and solomonseal rhizome.
Excess heat in the lungs can be alleviated with baical skullcap root, white mulberry root-bark and heartleaf houttuynia herb - which will then reduce any yellowish and greenish phlegm that you may have.
Phlegm can also be further reduced by taking bitter apricot seed, perilla fruit, pinellia tuber and common coltsfoot flower.
Lastly, the spleen can be boosted with milkvetch root, largehead atractylodes rhizome and medicinal changium root.
In addition to taking herbs, you should not be directly exposed to wind, such as by standing under the air-conditioner.
Try to avoid emotional swings, anxiety and stress so that your liver can continue to function well.
Engage in regular exercise, such as taiji, brisk walking and yoga, for at least half an hour every day. This will boost your lung capacity and immunity.
Diet-wise, go for easily digested foods like porridge and soup, walnuts and lotus seeds. Eat small, regular meals and stay away from raw, cold, oily and spicy food, so as to reduce phlegm in the body.
On another note, because you have a family history of pneumonia, which is a potentially fatal condition, you may want to consider getting a pneumococcal vaccination.
Ms Lim Lay Beng, traditional Chinese medicine practitioner at YS Healthcare TCM Clinic at The Adelphi
A From your description, you have four main symptoms. They are sticky phlegm, a blocked nose, cough and tiredness.
These symptoms can be linked to three organ systems - namely, the nose, lungs and the stomach.
Normally, the problem starts in the nose, which can become inflamed from exposure to environmental factors such as cold air, dust and pollution. The severity of this inflammation depends on the degree of exposure to the environmental irritants and allergens and how reactive your nose is when exposed to them.
If your nose is highly reactive, it will become inflamed even with mild exposure to environmental factors. When inflammation occurs, the tissue will swell and block the nasal passages. When the blocked nose is severe, you may even have to open your mouth to breathe.
The swollen tissue activates the mucus glands, which then produce a lot of thick mucus that further clogs the nose. This thick mucus also contains a lot of chemicals, such as histamine and cytokines, which cause itchiness.
When these chemicals flow backwards into the throat, they will stimulate coughing.
Having a blocked nose and an itchy cough at the same time is likely to prevent you from entering deep, restful sleep.
People who do not get enough sleep will have increased secretion of a hormone that stimulates appetite (ghrelin). As a result, sleep-deprived people tend to eat more, exercise less and gain weight.
Having a blocked nose, cough and lack of sleep may also induce acid reflux, sending hydrochloric acid from your stomach to the nose and throat.
The acid will then worsen your throat irritation, making you cough even more, as well as irritate your nose and sinuses further. It is a vicious circle.
The good news is, the symptoms can be treated and reversed.
Medication, such as a steroid nasal spray, can reduce inflammation in the nose. A topical decongestant can help to unblock your nose, while antihistamines can reduce itchiness.
Simple surgical procedures may also be performed to unblock your nose, open up constricted sinus passages, straighten a crooked nasal septum or remove polyps, if any.
On the other hand, you should avoid heaty foods that induce acid reflux, such as spicy or deep-fried dishes. Avoid cold drinks as these will increase throat irritation and make you cough even more.
Even if you are feeling very tired, walking for 30 minutes, five times a week, will improve the function of your nose, lungs and stomach. I would also recommend light yoga or taiji to assist in healing.
Get enough sleep too, for it results in an increased production of the growth hormone, which helps you recover faster, while reducing the production of the stress hormone cortisol, a move that can strengthen your immune system.
Last, you may want to do relaxation therapy and meditation to get rid of stress. This will improve your immunity and accelerate the healing process.
Dr Kevin Soh, senior consultant ear, nose and throat surgeon at Mount Elizabeth Medical Centre