Q: I am a 51-year-old woman and I have been coughing continuously for more than a year. I have seen many doctors and tried many types of medicine but it is not getting better.
Sometimes, something tickles my throat and I will then cough uncontrollably and be out of breath.
There is no phlegm except when I had a bout of flu recently.
I saw an ear, nose and throat doctor, who said that I have a sensitive nose and gave me a spray to be used regularly. The result of my chest X-ray was normal.
A specialist checked my abdomen and said I had gastric reflux. I was given an anti-reflux drug which I have taken for a few months. However, the cough still persists.
I do not smoke or drink. I have been avoiding spicy, fried and oily food, chicken, oranges and cold drinks.
Please advise what other kinds of treatment I should seek for my persistent cough and what kinds of food may be of help.
A: In traditional Chinese medicine (TCM), a chronic cough is probably due to a deficiency in the functions of the lungs, spleen, liver and kidneys.
A good flow of qi (energy) and blood is required for good health.
The lungs control respiration. Among the organs, the lungs are the most vulnerable to external pathogens, such as "wind", "heat", "cold", "dryness", "dampness" and phlegm.
These pathogens disturb the flow of qi in the lungs, causing abnormal secretions in the respiratory tract and inducing coughing.
For instance, "wind" triggers a cough with itchiness in the throat, as you described, while "heat" triggers a cough with a sore throat.
When the spleen is dysfunctional, instead of transforming food nutrients into qi and blood, it converts them into phlegm and "dampness".
These block the flow of qi in the lungs and trigger a cough with phlegm, fatigue and poor appetite. This is usually associated with a diet which consists mainly of raw, cold, spicy and oily food, and excessive alcohol intake.
Anxiety, worry or stress can lead to qi stagnation in the liver and generate "fire" in the liver. The "fire" may attack the lungs, transforming fluid in the lungs into phlegm, interrupting the qi flow and triggering a dry cough with acid reflux (acid from the stomach flows backwards into the food pipe).
Normal respiration depends on mutual regulation of qi by the lungs and the kidneys. When the qi in the lungs is weak, the lungs will fail to coordinate with the kidneys, leading to respiratory problems such as coughing with lower backache.
Chinese medicine, acupuncture and cupping can help improve your condition by strengthening your organs and dispelling the pathogenic factors.
Cupping involves using fire and cups to create a vacuum on the skin to enhance blood and qi circulation.
Chinese medicine such as coastal glehnia root, dwarf lilyturf tuber and solomonseal rhizome increase yin in the lungs to ease a dry cough.
Yin is the aspect linked to coldness and moisture. In TCM, a balance of yin and yang, which is linked to heat and dryness, is required for good health.
Divaricate saposhnikovia root and fineleaf schizonepeta herb dispel "wind" and reduce itchiness in the throat.
Milkvetch root, medicinal changium root, largehead atractylodes rhizome and Indian bread strengthen the spleen.
Chinese thorowax root, white peony root, tree peony bark, processed rehmannia root and sweet wormwood herb strengthen the liver and kidneys.
Eat easy-to-digest food, such as porridge, pork and fish, to enhance nutrition and strengthen your lungs and digestive system.
Keep to small regular meals and avoid heavy meals as well as raw, cold, oily and spicy food to enhance your digestive system.
You should avoid having the wind, fan and air-conditioning blow directly on you, to prevent tickles in your throat.
Put on warm clothing to prevent any infection in your respiratory system, such as a cold or flu.
Avoid becoming tired, anxious and stressed to strengthen the function of your liver and enhance qi circulation.
Sleep early, at about 10pm, and have sufficient rest to enhance your immune system.
Do regular exercise, such as taiji, brisk walking and yoga, at least half an hour every day, to improve your immune system and lung capacity.
Ms Lim Lay Beng,traditional Chinese medicine practitioner at YSHealthcare TCM Clinic
Detailed scan needed to diagnose constant hacking
A: More than a year is quite a long time to be coughing.
It is good to know that your chest X-ray was normal.
However, for someone suffering from a cough for longer than a year, I would suggest a more detailed computed tomography (CT) scan of your lungs.
This may be more helpful in giving a clear explanation of what is causing your cough.
Phlegm and mucus from the sinuses (hollows in the bones of the face around the nose) may drip backwards and irritate or stimulate the throat, resulting in a cough.
This process, called a post-nasal drip, may happen especially when the nose is sensitive due to an allergy.
The allergic reaction could be triggered by inhaling an allergen into the nasal passage, such as grass pollen or dust mites in the environment, or eating certain types of food.
The allergic reaction causes the release of histamines in the nasal mucosa (nose skin). This results in sneezing and the production of mucus.
Acid from the stomach may reflux (backflow) upwards through the oesophagus (food pipe) into the throat, leading to laryngo-pharygo-reflux, and hence, a persistent cough.
This can be triggered by eating certain types of food.
Dealing with the sinus issues, finding out what inhalant or food you are allergic to and avoiding these allergens may help reduce the post-nasal drip and cough.
Nose sprays and anti-histamines may help too.
The acid reflux problem will improve with the avoidance of fried, oily food, chilli, spices, tomatoes, oranges, grapes, lemon, coffee, tea and other acidic compounds.
Eat smaller but frequent meals.
Anti-reflux medication may help as well.
If your symptoms still persist, please consult a doctor.
Dr Kenny Pang,ear, nose and throat surgeon at Asia Sleep Centre
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