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. These are:
(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.
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.