Homeopathic Management of Acute, Subacute, and Chronic Coughs

Introduction to Homeopathy for Coughs

In this article, I explore the homeopathic management of common infectious coughs, addressing acute and post-infectious phases. The post-infectious phase has become especially significant since the onset of the COVID-19 pandemic, as acute coughs increasingly transition into subacute or chronic conditions. Timely interventions are crucial to prevent prolonged discomfort and ensure recovery.

Based on past and present data, homeopathy has consistently proven effective in treating various coughs. It often succeeds where various other typical therapies for coughs fail.

Classification of Coughs: Acute, Subacute, and Chronic

If we were to classify coughs based on their duration, they may be divided into acute (less than three weeks), subacute (three to eight weeks), and chronic (longer than eight weeks) categories. Subacute coughs often arise as post-infectious conditions. Chronic coughs significantly burden global health and are often exacerbated by overlapping factors like allergies, asthma, and post-infectious inflammation. This article focuses on infectious coughs during acute or post-infectious phases, excluding non-infectious chronic conditions like GERD or asthma.

Recognizing Red Flags in Severe Acute Coughs

Severe acute coughs require monitoring for red flags such as chest pain, weight loss, fever, breathlessness, or hemoptysis. These symptoms necessitate diagnostic measures like chest X-rays and may require urgent care or emergency referral.¹Proper evaluation is essential for patient safety.

Post-Nasal Drainage and Its Role in Cough Management

PND (post-nasal drainage) is characterized by excessive mucus from the upper respiratory passages. Its prevalence has increased since the COVID-19 pandemic, leading to widespread complaints of throat clearing and coughs. PND may result from allergies, COVID-19, sinusitis, or other respiratory conditions. Misdiagnosis, such as attributing PND secondary to Covid to allergies after a negative COVID-19 test, can delay treatment. Homeopathy is often highly effective for treating PND, w/ or w/o coughs.

Homeopathic Case-Taking and Management:

Etiology takes precedence over the “totality of symptoms.”

In homeopathy, we often prescribe based on the “totality of symptoms.” However, if the etiology (i.e. causation) of the condition is known, it takes precedence over the totality of symptoms.² Possible etiologies for coughs include allergies, asthma, cold temperatures, eating or drinking, grief, injuries, talking, shock, wet weather, and wind.² Examples: Coughing from acute fright would likely respond well to the remedy Aconitum napellus (whose etiology is fear and shock) regardless of the patient’s detailed symptoms. Or Arnica for coughs secondary to trauma since Arnica is a trauma remedy.

And, “characteristic” symptoms matter more than “general” symptoms:

It’s critical to note that selecting the suitable homeopathic remedy does not depend on the length of the illness- it depends on the presenting characteristic symptoms. Symptoms that are striking, unique, and unusual are known as “characteristic” symptoms, often described as “strange, rare, and peculiar” (SRP). “General” symptoms, such as “cough,” are insufficient without characteristic qualifiers like “worse lying down” or “better with warm drinks.” In homeopathy, after etiology, characteristic or SRP symptoms often matter more than other symptoms. SRP symptoms can quickly point to an effective remedy. For example, an SRP symptom of a Pulsatilla cough would be the absence of thirst while the mouth is dry. Another example of a characteristic symptom in a cough case would be a (dry) cough that is completely alleviated upon lying down (indeed a characteristic symptom). We have a rubric with one main remedy- Manganum (or Manganese). (Cough, dry-lying, amel: Manganum).

We must pay close attention to the nature or character of the cough. The character of the cough may be a barking or croupy cough, a productive cough versus non-productive, or dry versus wet.

One of the most important attributes of coughs is the moisture level (i.e., the amount of mucus) in the respiratory passages- we need to determine whether the cough is wet or dry. Dry coughs are unproductive and irritating. The person may have an annoying tickle with either no or a small amount of mucous. In contrast, wet coughs may be productive OR unproductive. In other words, non-productive coughs are often dry. Still, they can also be wet, as in an Antimonium tart cough (keynote is scanty expectoration despite the copious amount of phlegm behind the sternum). With wet coughs, the color of the sputum or expectoration is a factor we may consider when selecting the appropriate remedy.

A cough’s sound is equally important as determining whether we have a dry or wet cough. Sometimes, only the sound of a patient’s cough is enough to point us to the correct remedy. Some examples of common cough sounds include barking (can be a sign of croup), dry, hollow, paroxysmal (coughing fit), rattling, wheezing (often associated with blocked airways due to infection and/or asthma), whooping (caused by an infection called pertussis), and tight.²

In homeopathic case-taking, other attributes of coughs that matter are the LSMC (location, sensation, modality, and concomitants¹):

Location: The origin of the cough sensation (e.g., throat, behind the sternum).
Sensation: Descriptions like dryness, lump-in-throat, or chest pressure. Other sensations include choking, constriction in the throat or chest, lump in the throat, rawness, scratching, suffocating, tickling, and oppression.²
Modalities: Factors that aggravate or alleviate symptoms, such as fresh air or warm drinks. Modalities may include activity (ascending stairs, walking, talking), emotional state (excitement, anger), eating/drinking, posture, smells, time, temperature, and weather.
Concomitants: Additional symptoms accompanying the cough, such as nasal bleeding or digestive disturbances.

To find a remedy with some confidence, I suggest using what I call the “three or four-legged stool” rule: If you find a remedy whose 3 or 4 main keynotes match the patient’s characteristic symptoms, you can often feel rather confident that you have found a good remedy. Remember that the patient is a subset of the remedy, not vice versa.

Should we recommend a “constitutional” remedy for a cough or an “acute” remedy?

A “constitutional” remedy, covering all aspects of a case, not just the cough, often provides profound, lasting benefits. However, acute prescribing is more appropriate when “acute” symptoms deviate from the constitutional picture. For instance, Antimonium tart can resolve an acute scanty and rattling cough, followed by Phosphorus to balance a person’s constitution and finish the case.

Basic guidelines on the selection of potency and frequency of dosing of remedies

As a rule, lower potencies, such as 6c or 12c, typically once daily, work well for chronic coughs. For acute or subacute coughs, a medium potency of 30c (or potentially 200c or even 1M if needed), typically 2-3 times a day, depending on the severity and duration of the illness, is a safe rule. The more acute and severe the illness, the higher the potency.

What can you expect from homeopathic remedies in the treatment and management of coughs?

Homeopathic remedies typically provide rapid relief in acute and subacute cases, with noticeable improvement within hours. Chronic coughs respond more gradually, with steady progress over days or weeks.

Will one remedy be enough for treating a case of cough?

During semi-acute or chronic coughs, but especially with acute coughs, it’s important for patients to realize that they will likely need more than one homeopathic remedy to fully recover. I believe this has become more common since the start of the COVID-19 pandemic. If the symptoms change, the patient will likely require a different remedy. A skilled homeopathic practitioner knows how to adjust remedies as the patient progresses through the different stages of a cough.

An Overview of the Top Homeopathic Remedies for Coughs:

Here are the top remedies I often use for common coughs, addressing acute infectious and post-infectious phases. This list categorizes remedies as dry versus wet. Note that even in “dry” coughs, some mucus may be present, but dryness is the primary feature. Remember, not all the keynotes (i.e. main characteristic symptoms) for each remedy must be present in the patient.

Warning: If you or your loved ones are experiencing any type of cough, you must consult a licensed healthcare practitioner. The following information is intended to provide only a brief overview of the top most commonly used homeopathic remedies for coughs and to expose the reader to the depth of knowledge in homeopathic literature regarding the treatment of coughs. Selecting the correct remedy for each cough case often requires a skilled homeopathic practitioner.

Aconitum napellus (Aconite): Dry cough. One of our main remedies for the early stages of croup. Sudden onset pneumonia, especially if fear, anxiety, restlessness, shock, and/or palpitations are part of the symptomatology. Often very thirsty with urinary retention.
Anas barbariae (Oscillococcinum): Cough with body aches, headaches, fever, chills, fatigue, and sore throat. It’s one of our great flu remedies.
Antimonium tartaricum (Ant tart): Wet cough. Mucous in the lower respiratory tract. Rattling wet-sounding cough but can’t cough up the phlegm. Great weakness and debility. Shortness of breath. Effective for bronchiolitis, bronchiectasis, pneumonia, COVID, and post-COVID. Often suited for weak, debilitated patients. Effective for getting fluids out of the lungs. It is also known as a remedy for drowning. Similar to Carbo veg in some key ways. I have successfully used this remedy for the treatment of numerous cases of chronic congestion in lower respiratory passages, dating back for years or even decades. The results are nothing short of impressive.
Blatta orientalis: Wet cough. “Dyspnea with bronchial congestion. Accumulation of mucus causes rales and coughing. Asthma with difficult expectoration (e.g., chest congestion/mucus). Rhonchi or rales on auscultation. Chronic bronchitis. Allergic to dust mite.³ Worse with exertion. Worse from moldy and damp environments.
Bryonia alba: Dry cough. Dryness can occur anywhere or everywhere in the body, worse on the left side. Severe and often sharp pain with the cough, typically worse on the left side of the chest and/or extremities. Patients often have a dry mouth and are usually very thirsty, especially for cold water. Unilateral symptoms – all symptoms, including both pain and dryness, are generally worse on the left side of the body. Patients are often highly irritable and experience worsening symptoms with movement. It is critical to recognize the key characteristics of Bryonia in your patients since it appears to have been the most common remedy used to manage signs/symptoms associated with many cases of Covid and post-Covid. For more information on this remedy, refer to my 2022 AANP presentation on Covid and post-Covid.
Carbo vegetabilis: Known as “death reviver.” Pre or respiratory failure³, a last-stage remedy. Collapse due to weakness secondary to heart failure (CHF) and/or lung failure. Severe dyspnea or air hunger is the top remedy when gasping for air. Desires extra oxygen or fresh air (likes to be fanned or open the windows). Advanced stages of pneumonia. ER patient.³ Some phlegm.
Coccus cacti: “Hard, short, hacking coughs in paroxysms ending in copious mucous.”⁴ Often wet (but sometimes totally dry coughs).⁵ Violent coughs result in the expectoration of thick and ropy mucus that can cause nausea and vomiting. Choking cough. Next to Drosera (a dry cough remedy), one of our best whooping cough remedies. It is better with cold drinks or cold air, worse with becoming heated. A competitor is Ant tart. It also needs to be distinguished from Kali bich, which can also have thick, ropy mucus. Note that Kali bich is not paroxysmal and violent and is not as phlegmy.
Corallium rubrum: “Profuse secretion of mucous dropping through the posterior nares causing a dry, barking, rapid cough. Great exhaustion. Occasional ulceration and epistaxis. Worse cold or open air. Better with artificial heat.”¹ One of many good remedies for whooping cough.
Drosera rotundifolia: Violent, painful, & spasmodic dry coughs, worse after midnight. The severity of the cough can cause vomiting. Cramping of muscles likely due to neurological symptoms. One of our top remedies for Pertussis (or whooping cough).
Hepar Sulph: Cough may be dry or loose, but more often loose. Great sinusitis or otitis media remedy with severe pain in sinuses and/or ears. It can also be indicated for bronchitis, laryngitis, pleurisy, and pneumonia if the keynotes are present in the case. Very sensitive to cold and drafts. Cough is much worse with any exposure to cold- must stay completely covered up. Cough worse with cold drinks. Thick yellow phlegm. Worse at night. Suffocative attacks force the patient to sit up.²
Ipecac: “Almost always a totally dry cough. Irritated or tickling cough in paroxysms. Choking or gagging with cough. Frequently vomiting with the cough.”⁵ Suffocating and spasmodic cough. Shortness of breath. It has great difficulty bringing up phlegm, similar to Ant tart. Beefy red tongue with no coating. Better with fresh air and thirstless (similar to Pulsatilla). Also, it is a remarkable remedy for certain incapacitating nausea not relieved by vomiting.⁴ (Note: Pulsatilla, Ipecac, and Carbo veg may all want to stand by the window for fresh air, but they all have distinctly different keynotes, as can be seen here.)
Kali bichromicum (Kali bich): Wet cough. Top sinusitis/PND remedy. Thick and often darker green phlegm in the throat, which is difficult to cough up and leads to a need to clear the throat constantly. The nose is typically not runny. One of the other top remedies for Covid and post-COVID cough and PND. Think upper respiratory tract.
Phosphorus: Dry cough (similar to Bryonia), which is worse with deep breathing or talking; hoarseness (usually w/o pain), shortness of breath, high thirst (thirsty particularly for cold water, similar to Bryonia); feels warm or hot with possibly a burning sensation in the throat/eyes/ears/chest, unilateral (LEFT-sided) symptoms including left-sided lung symptoms (similar to Bryonia) but could also be bilateral, prefers the company of others (versus Bryonia who much prefers to be alone), possible epistaxis or bloody expectoration (a helpful concomitant symptom).
Pulsatilla nigricans: Wet cough. In my experience, discharges are often thin and clear but can also be yellow or green. The mouth is dry but often not thirsty (an SRP symptom). The nose and ears are also often congested when this remedy is indicated. Great remedy for otitis media. The cough is better outside in the open air. It’s worse in stuffy and warm rooms. Worse at night. Better with company. Often weepy and emotionally needy or clingy. Symptoms can move around in the body. For coughs that are typically looser in the day but dry at night.
Rumex crispus: “Dry, persisting, fatiguing cough. Involuntary urination. Better warmth, keeping mouth covered. Worse slightest inhalation of cold air.”¹ “Dry, incessant, violent, tickling cough. Tickle in the throat. Worse from uncovering. Even just sticking the head out of the covers excites a cough. Coughs as soon as his head hits the pillow. Mucus in throat. Worse inhaling cold air so that he may pull covers over his head.” ²
Spongia tosta: Dry cough. It is an extremely important and potent remedy for dry coughs only. The chest feels hollow. Coughs with a barking sound. Feels like breathing through a sponge or a few layers of towels. In my experience, patients need this remedy only a couple of times max. NOTE: I’d not recommend repeating this remedy more than 1-2 times unless the patient’s symptoms are alleviated with the remedy and then return a while later with the same characteristics listed above.
Stannum metallicum: Wet cough. Great overall weakness. Too weak to do anything. Dyspnea on slight exertion, even with talking. Weak respiration. A sensation of emptiness, hollowness, and severe weakness in the chest.⁴ (Note: Ant tart is a common remedy with great weakness in the lungs. Phosphorus is yet another remedy with great weakness in the lungs.) Can barely talk due to weakness in lungs; might present with laryngitis. Usually, there is much expectoration.

A Concise Summary of the Top Homeopathic Remedies for Coughs

Type of Cough	Top Remedies
Dry Cough	Aconitum, Bryonia, Drosera, Ipecac, Phosphorus, Rumex and Spongia.
Wet Cough	Corallium, Kali bich, Antimonium tart, Pulsatilla, Blatta orientalis, and Coccus cacti.
Coughs in a Patient with Extremely Weak Lungs	Antimonium tart, Carbo vegetabilis, Corallium and Stannum.

NOTE: The above remedies are my favorite cough remedies. You should also note that there are countless other homeopathic remedies for coughs, and you should not limit yourself to only the above remedies. For example, a cough patient may need the remedy Belladonna if (s)he presents with keynotes of Belladonna, including a flushed face, a pounding headache, and right-sided symptoms.

In conclusion, in a world where new respiratory germs are continuously on the horizon, considering how smoothly and rapidly homeopaths can often address various types of coughs and other respiratory complaints, it has become increasingly relevant and often critical for such patients to be referred to homeopaths by non-homeopathic practitioners.

References:

Tiwari, K. (n.d.). Homeopathy for coughs. [E-book].
Lewis, E. (n.d.). Tidbits 45: Homeopathic remedies for coughs. HPathy. Retrieved from https://hpathy.com/homeopathy-papers/tidbits-45-homeopathic-remedies-coughs/
Chung, Y. (2022, November). Role of homeopathy in RSV respiratory infections [Conference presentation].
Morrison, R. (1993). Desktop guide to keynotes and confirmatory symptoms (Blue Book). [Hahnemann Clinic Pub].
Morrison, R. (1998). Desktop companion to physical pathology (Red Book). [Hahnemann Clinic Pub].