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8 An Evidence-Based Review of
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Medicinal Plants for Cough Management
Cited by Avicenna
Motahare Nayebzadeh1, Fatemeh Etemadpour1, and Parmis Badr
1
Department of Phytopharmaceuticals (Traditional Pharmacy), Shiraz University of
2,3
*
Medical Sciences, Shiraz, Iran; 2Phytopharmaceutical Technology and Traditional
Medicine Incubator, School of Pharmacy, Shiraz University of Medical Sciences,
Shiraz, Iran; 3Pharmaceutical Sciences Research Center, Shiraz University
of Medical Sciences, Shiraz, Iran
Abstract
Cough is a defensive response to clear the airways from excessive secretions or irritating foreign objects.
Some patients suer from excessive or troublesome coughs that need to be treated repeatedly. Cough
may also be due to a respiratory infection such as pneumonia, u, or tuberculosis. Acute bronchitis,
asthma, lung cancer, and smoking are other reasons for coughs. In Canon of Medicine, cough (soal) is de
ned as a corporeal eort or movement to repulse an annoyance from the lungs or related organs. is
action contains the two phases of thoracic expansion and thoracic contraction, leading to movement of
the diaphragm. Sometimes, other organs like the esophagus, stomach, liver, or the whole body (e.g., in
fevers) are involved. Avicenna has specically focused on the causation for each disease. Like other dis
eases, cough can be categorized according to four temperaments. Each type has a distinct protocol for
treatment; therefore, physicians have to consider this point for choosing the most practical prescriptions
for each patient. e principles and traditional methods of treating this type of disease, especially the
medicinal plants used, and the associated new research ndings are discussed in this chapter.
-
-
Cough is a defensive response to clear the
airways from excessive secretions or irritant
foreign objects. Some patients experience
overactive or troublesome coughs that need
repetitive treatments (McGovern et al.,
2018). Cough can also be due to a respiratory tract infection such as pneumonia, flu,
or tuberculosis. Acute bronchitis, asthma,
*Email: badrp@sums.ac.ir
288
Introduction
lung cancer, and smoking are other reasons
for coughs (Chung and Pavord, 2008; Sultana et al., 2016). In Canon of Medicine,
cough (soal) is defined as a corporeal effort
or movement to repulse an annoyance from
the lungs or related organs. This action contains the two phases of thoracic expansion
and thoracic contraction, leading to movement of the diaphragm. Sometimes, other
organs like the esophagus, stomach, liver, or
© CAB International 2023. Medicinal Plants Used in Traditional Persian Medicine
. H. Schulz, Seyed Ahmad Emami and Farsad Nadjafi)
(eds
DOI: 10.1079/9781800621671.0008
Cough Management 289
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the whole body (e.g., in fevers) are involved.
Avicenna has specifically focused on the
causation for each disease. Based on his
viewpoint, three types of causes underlie the
cough (Avicenna, 1993):
• Bādieh causes: Meaning external reasons,
for example experiencing cold weather;
drinking cold water; breathing smoky or
dusty air; eating foods with sour, caustic, astringent, or acrid taste; and suffering tracheal obstruction while eating
or drinking.
• Wāseleh causes: Meaning internal inter-
mediate-free reasons, including warmth,
coldness, wetness, and dryness according to traditional medicine contexts, or
exceeding in one humor including bile,
sanguine, phlegm, and black bile in the
respiratory system.
• Sabeghe causes: Meaning internal reasons
acting via intermediates, such as fullness
(emtelʼ a).
Like other diseases, cough can be categorized according to four temperaments. Each
type has a distinct protocol for treatment;
therefore, physicians have to consider this
point for choosing the most practical prescriptions for each patient:
• Cold (bāred) cough: Cold weather inten-
sies it, while warm weather makes cold
cough lighter. e patients more or less
complain about cold catarrh.
• Warm (hār) cough: It is accompanied by
inammation, thirst, redness of face,
and large pulses.
• Wet (ratb ) cough: Old people with wet
temperaments experience this kind of
cough. ey often suer from croaky
voice and snoring.
• Dry (yābes) cough: Movement and hun-
ger worsen it. Motionlessness, bathing,
and drinking liquids have positive effects on this cough type.
Medicinal Plants Cited in Canon of
Medicine for Cough Management
In this chapter, antitussive medicinal plants
recommended in Canon of Medicine are
reviewed, and supportive relevant evidence
for their efficacy is presented. Tables 8.1, 8.2,
8.3, and 8.4 present the collected results.
Acacia senegal (L.) Willd.
Gum acacia (gum arabic) or senegal gum is
extracted from the stems and branches of
Acacia senegal. This gum consists of glycoproteins and branched complex polysaccharides rich in galactose and arabinose. It is
known to be a demulcent and is also used in
medications for throat inflammation and
sore throat (Kariduraganavar et al., 2014;
Lopez-Torrez et al., 2015). It is reported to
be used traditionally as an internal and external anti-inflammatory agent (Ali et al.,
2009). Gum arabic is widely used in the
pharmaceutical and food industries as a stabilizer, emulsifier, food additive, etc. (Dave
and Gor, 2018). Other uses of gum arabic include treatment of kidney diseases, asthma,
oral cavity lesions, diarrhea, diabetes, and
dry coughs in amoebic dysentery. Antipyretic,
astringent, emollient, analgesic, antimicrobial,
and liver tonic properties are also known.
The antioxidant and protective activity
against toxicities of the heart, kidney, and
liver in rats was also claimed (Singh et al.,
2015). In an in vitro study, bark extracts of
A. senegal in different solvents showed activities against selected Gram-negative and
Gram-positive multidrug-resistant (MDR)
organisms (Lawrence etal., 2015).
Adiantum capillus-veneris L.
Adiantum capillus-veneris plant contains several
compounds including triterpenoids, flavonoids, phenyl propanoids, carotenoids, mucilages, tannins, saponins, oleananes, glycolic
acid, lactic acid, coumarins, phytosterols, and a
bitter substance named capillarin. Filicane and
adiantone plant substances from the triterpenoid group include isoadiantone, 3-methoxy-4hydroxyfilicane, isoadiantone-B, and 3,4-dihydroxyfilicane in the hexane fraction, and
capillirone and cotillion in the ethanolic extract
of A. capillus-veneris fronds. Additionally, the most
No. Scientific name Synonym Arabic name Persian name Common name Family
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1 Acacia senegal (L.)
Willd.
2 Adiantum capillus-
veneris L.
3 Althaea officinalis L. Althaea officinalis subsp . micrantha Dost ál
4 Commiphora
gileadensis (L.)
C. Chr.
5 Commiphora myrrha
(Nees) Engl.
6 Cordia myxa L. Cordia myxa var. domestica (Roth) C.B. Clarke
7 Cucurbita pepo L. Cucurbita pepo subsp . ovifera (L.) D.S. Deck er
8 Cydonia oblonga Mill. Cydonia oblonga f. lusitanica (Mill.) Rehder
9 Drimia maritima (L.)
Stearn
10 Ferula gummosa Boiss. – Baˉrzad Baˉrzad Galbanum Apiaceae
11 Ferula persica Willd. Ferula puberula Boiss. & Buhse, Ferula szo witziana
12 Glycyrrhiza glabra L. Glycyrrhiza glabra var. glabra, Glycyrrhiza glabra var.
13 Hyssopus officinalis L. Hyssopus officinalis subsp . aristatus (Godr .) Nyman
Acacia senegal var. fistula (Schweinf.) Oliv .
Acacia senegal subsp . modesta (Wall.) Roberty
Adianthum truncatum Burm.f. Sh’r al-’arz Pari syaˉvoshaˉn Maidenhair Pteridaceae
Althaea officinalis var. pseudoarmeniaca Polg.
Commiphora opobalsamum L. Balasaˉn Balasaˉ n Opobalsam Burseraceae
Commiphora myrrha var. molmol Engl. Mur makky Mur True myrrh Burseraceae
Cordia myxa var. ixiocarpa (F. Muell.) Domin
Cucurbita pepo var. texana (Scheele) D.S. Decker
Cydonia oblonga var. maliformis (Mill.) Rehder
Cydonia oblonga f. marmorata (Dippel) C.K. Schneid.
Cydonia oblonga f. pyramidalis (Dippel) Rehder
Cydonia oblonga f. pyriformis (Dierb.) Rehder
Drimia maritima subsp . maura (Maire) Förther &
Podlech
var. kandavanensis Bornm. & Gouba
glandulifera (Waldst. & Kit.) Regel & Herder
Hyssopus officinalis subsp . canescens (DC.) Nyman
Hyssopus officinalis subsp . montanus (Jord. & Fourr.)
Briq.
Aqaˉqyaˉ Samgh-i ‘raby Gum arabic Fabaceae
Khatmy Khatmy Marsh mallow Malvaceae
Dabq Sipistaˉ n Assyrian plum Boraginaceae
Qarʿ Kaduˉ Pumpkin Cucurbitaceae
Safarjal Bih Quince Rosaceae
Isqyl Pyaˉ z-i dashty Squill Asparagaceae
Sakbıˉnaj Sakbıˉnih Sagapenum Apiaceae
Suˉ s Mihak Licorice Fabaceae
Zuˉ faˉ Zuˉ faˉ Hyssop Lamiaceae
290 Motahare Nayebzadeh etal.
14 Linum usitatissimum L. Linum usitatissimum var. stenophyllum (Boiss.)
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Rech.f.
15 Liquidambar orient alis
Mill.
16 Malva sylvestris L. – Khubbaˉzy Panirak Common mallow Malvaceae
17 Myrtus communis L. Myrtus communis Blanco aˉs Muˉ rd Myrtle Myrtaceae
18 Nymphaea alba L. Nymphaea alba var. alba Nyluˉ far Nyluˉfar White water rose,
19 Opopanax chir onius
(L.) W.D.J . Koch
20 Papaver somniferum L. Papaver somniferum subsp. setigerum (DC.) Arcang. ˉKhashkhash
21 Pinus gerardiana W all.
ex D. Don
22 Pistacia terebinthus L. Pistacia terebinthina St.-Lag.
23 Pistacia vera L. – Fustuq Pistah Pistachio Anacardiaceae
24 Plantago ovata Forssk. Plantago ovata var. fastigiata (E. Morris) S.C. Meyers &
25 Prunus dulcis (Mill.)
D.A. Webb
26 Viola odorata L. Viola odorata f. odorata Banafsaj Banafshih Sweet violet Violaceae
Liquidambar imberbis Aiton Mıˉ’ih saˉ ’ilah Mıˉ’ih Oriental sweetgum Altingiaceae
Dorema chironia (L.) M. Hiroe
Laserpitium chironium L.
Maspeton chironium (L.) Raf.
Opopanax chironium (L.) W.D.J. Koch
Pinus gerardii J. Forbes Jalghuˉ zih Chalghuˉzih Chilgoza Pinaceae
Terebinthus communis Dum. Cours.
Terebinthus vulgaris Dum. Cours.
Liston
– Al-lawz al-
Kataˉn Kataˉn Flax, linseed Linaceae
white nenuphar,
European white
water-lily
Jaˉwshıˉr Jaˉwshıˉr – Apiaceae
Kvknaˉr Poppy Papaveraceae
al-aswad
Habbat
al-khazrˉa’
Bazr qatuˉnaˉ’ Isfarzih Psyllium Plantaginaceae
hulw
Banih Terebinth Anacardiaceae
Baˉdaˉm-i shıˉrıˉn Sweet almond Rosaceae
Nymphaeaceae
Cough Management 291
Table 8.2. In vitro studies on antitussive medicinal plants cited in Canon of Medicine.
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292 Motahare Nayebzadeh etal.
Plant
Acacia senegal (L.)
Willd.
Adiantum
capillus-veneris
Althaea officinalis L. Seed The 200 mg/ml concentration of essential oil and methanol extract is more effective
Commiphora
gileadensis (L.)
C. Chr.
a myrrha
(Nees) Engl.
Cucurbita pepo L. Lea
Part Result
Bark extract Acetone extract was found to be effective against all organisms such as Escherichia
coli, Stretptococcus pyogenes, Bacillus cereus, Vibrio cholerae, Staphylococcus
aureus, Bacillus subtilis, Pseudomonas aeruginosa, Shigella dysenteriae,
Clostridiium perfringens, Salmonella typhi, and Listeria monocytogenes, except
Campylobacter jejuni, followed by methanol, chloroform, ethyl acetate, and hexane
extracts, while petroleum ether extract was found least effective
Leaf Methanol fraction showed maximum ZI against MDR bacterial strains
L.
Leaf Ethanolic extract can normalize p38 and NF-κB activations in mice as well as
increase spleen inde
against respiratory pathogens
Aerial parts Chloroform and petroleum ether fractions inhibited COX-2 enzyme activity at IC
10 and 5 mg/ml, respectively
Aerial parts Syringic acid exhibited weak antimalarial activity in comparison to chloroquin and
artemisinin against the tested strains
Aerial parts Triterpenes and the flavonols mearnsetin and quercetin showed antioxidant activitities
without exhibiting any cytotoxic effects on HL-60 cells
Plant extract Ethyl acetate fraction extract of dry plant material exhibited antibacterial activity against
S.aureus, MRSA, and P. aeruginosa with IC50 of 75, 95, and 150 mg/ml, respectively
Four compounds exhibited weak antimicrobial activity against Candida glabrata and
Mycobacterium intracellulare with IC50 values of 10 and 15 mg/ml, respectively, in
comparison to amphotericin B at 0.15 mg/ml for C. glabrata and ciprofloxacin at
Oil Myrrh oil has antiviral activity against influenza A Puerto Rico 8/34/H1N1 virus
Resin Myrrhter
ves
Oil Activity against Actinetobacter baumannii, Aeromonas veronii biogroup sobria,
0.3 mg/ml for M. intracellulare
Myrrh oil at 25 and 50 μg/ml in mixture with vitamin E acetate showed a reduction in
viral replication in a dose-dependent manner
penes A and B have potent anti-inflammatory activity by inhibiting NO oxide
production
Antibacterial activity against Providencia stuartii, P. aeruginosa, Klebsiella
pneumoniae, E. coli, Enterobacter aerogenes, and Enterobacter cloacae
Candida albicans, Enterococcus faecalis, E. coli, K. pneumoniae, P. aeruginosa,
Salmonella enterica subsp . enterica serotype typhimurium, Serratia marcescens,
and S. aureus at the concentration of 2.0% (v/v)
x by LPS induction
of
50
Reference
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(2014)
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(2021)
E. aerogenes in comparison with aqueous one
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Cydonia oblonga Mill. Seed Methanolic extract of freeze-dried seeds is the most powerful antioxidant in this plant
Seed Seed extract at 500 μg/ml concentration has antiproliferative activity against renal
cancer cells
Drimia maritima (L.)
Stearn
F erula gummosa
Boiss.
Ferula persica Willd. Root Umbelliprenin at concentration of 500 μg/ml has activity against B. subtillis, B. cereus,
Glycyrrhiza glabra L. Root Bronchodilatory effect by ↑ cGMP and ↓ PDE5 activation
Hyssopus
officinalis L.
Malva sylvestris L. Stem/seed Antimicrobial activity against Aggregatibacter actinomycetemcomitans
Myrtus communis L. Fruit ↓ Expression of IL-1β, TNF-α, eNOS, and IL-6
Nymphaea alba L. Flower The extract can be significantly effective in the treatment of HCV with or without
Pistacia vera L. Nut Pretreatment with natural raw shelled pistachios (0.01, 0.1 and 0.5 mg/ml) and
Plantago ovat a
Forssk.
Bulb Activates caspase, also increases ROS, Bax/Bcl-2 ratio, and mRNA expression of
CHOP, TRIB3, GADD34, and ATF-4 as stress markers
Essential oil/
oleogum
resin
Root Chloroform extract containing compounds persicasulfide A and persicasulfide B
Root Umbelliprenin has inhibitory effect on the growth of Leishmania major
Aerial part 5–10 μl of the essential oil can inhibit E. coli, S. aureus, and S. pyogenes
Fruit Antioxidant activity through scavenging free radicals and inhibiting lipid peroxidation
seed HCV drug extract has anti-inflammatory and bacterial activity against Porphyromonas
Alcoholic essential oil and oleogum resin of F. gummosa had inhibitory effect on
Acinetobacter strains
E. coli, K. pneumoniae, S. typhi, S. aureus, and Staphylococcus epidermidis
showed potent antifungal activity
another anti-HCV drug
roasted salted pistachio kernels exhibited a considerable protection against
LPS-induced inflammation
gingivalis, A. actinomycetemcomitans, Fusobacterium nucleatum, and Prevotella
intermedia pathogens
Alizadeh etal. (2013)
Silva etal. (2004)
Al-Snafi (2016b)
Hamzeloo-Moghadam etal.
(2018)
Afshar etal. (2016)
Sattar and Iranshahi (2017)
Sattar and Iranshahi (2017)
Cough Management 293
Sattar and Iranshahi (2017)
Liu etal. (2008)
Süleyman etal. (2010)
Vahabi etal. (2019)
Kutlu etal. (2021)
Serce etal. (2010)
Koushik etal. (2015)
Paterniti etal. (2017)
Reddy etal. (2018)
IC50, half maximal inhibitory concentration.
294 Motahare Nayebzadeh etal.
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Plant
Adiantum capillus-
veneris L.
Part Model Species Result
Leaf Acute asthma by histamine
aerosol
Leaf LPS-induced PGE production
2
Guinea pig Anti-asthmatic effect of the ethanolic extract is
more effective than that of the other plant
RAW264.7
mouse
Ethanolic extract can normalize p38 and NF-κB
activations in mice as well as increase spleen
index by LPS induction
Leaf Hypoxia condition Rat Ethanol extraction can modulate Bax/Bcl-2
apoptotic index ratio and remodeling of
pulmonary epithelial cells
Leaf Paw edema induced by formalin Mouse and rat Anti-inflammatory activity of ethyl acetate fraction
by ↓ NO and TNF-α levels
Leaf Colitis induction by rectal
injection of acetic acid 3%
w/w
Wistar rat Aqueous and hydroalcoholic extracts have ulcer
healing, anti-inflammatory, and antioxidant
activities by ↓ IL-6, NO, TNF-α release, and
NF-κB activation
Cordia myxa L. Fruit Tracheal muscle Sheep Tracheal relaxation activity of alcoholic extract
through ↑ NO synthesis by cytosolic Ca
2+
Fruit Acetic acid and formalin test Mouse Alcoholic extract has analgesic and anti-
inflammatory activity in the formalin test
Fruit Colitis induced by intrarectal
administration of acetic acid
Rat Anti-inflammatory effect by modulating Zn, Mn,
Cu, and Se levels
Fruit DTH and MI test BALB/c mice Aqueous extract has an immunomodulatory effect
on immune cells
Cydonia oblonga Mill. Seed Tracheal tissues Rabbit Bronchodilatory effect by Ca
Glycyrrhiza glabra L. Root Tracheal rings precontracted
with acetylcholine, KCl, and
Guinea pig ↑ Latency time of collapse and ↓ lung overflow in
TSMCs
2+
antagonism Janbaz etal. (2013)
histamine
Root DTH reaction CBA/CaLac
↑ Cellular immune response
mouse
Root Citric acid-induced cough Guinea pig ↓ Citric acid as a major cause of cough
Root Inflammation and airway
BALB/c mouse ↓ IgE level, ↓ leukoctye count, ↓ total protein
hyperresponsiveness induced
by intraperitoneal ovalbumin
and Al(OH)3 administration
Reference
Kumar etal. (2012)
Yuan etal. (2013)
Yadegari etal. (2019)
Haider etal. (2011)
Khoramian etal.
(2020)
Al-Bayati (2008)
Ranjbar etal. (2013)
Al-Awadi etal. (2001)
Rashid Ali etal. (2015)
Liu etal. (2008)
Borsuk etal. (2011)
Saha etal. (2011)
Dogan etal. (2020)
Hyssopus
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officinalis L.
Root Cough induced by SO gas
2
Root Acute lung injury induced by
LPS
Aerial
Asthma model by ovalbumin BALB/c mouse ↓ Expression of MMP-9 and TIMP-1 by collagen
part
Albino mouse ↓ Up to 35.62% of coughs in 60 min
BALB/c mouse ↓ TLR-4/NF-κB pathway activity and protects lung
tissue
deposition, the proliferation of smooth muscle,
and mucus secretion
Aerial
Asthma model by ovalbumin BALB/c mouse ↓ IgG level and ↑ ratio of EOS and modulates the
part
immune system
Myrtus communis L. Fruit Hepatic ischemia-induced Rat ↓ AST, MDA, and ALT markers, additionally ↑
MEGX concentration
Nymphaea alba L. Flower Renal oxidative trauma by
Fe-NTA
Pistacia vera L. Nut Treatment with natural raw
shelled pistachios
Wistar rat ↓ γ-Glutamyl transpeptidase, xanthine oxidase,
lipid peroxidation, and H2O2 generation
Rat ↓ CAR-induced histological paw damage,
neutrophil infiltration, and nitrotyrosine
formation
Plantago ovat a
Seed Intestinal inflammatory HLA-B27 rat ↓ Leukotriene B4, NO, and TNF-α
Forssk.
Viola odorata L. Flower Lung damage by formalin NMR rat V. odorata can prevent lung injury equal to the
efficacy of hydrocortisone
Flower Hepatotoxicity by ethanol Wistar rat Both leaf and flower extracts have significant
antioxidant activity
CAR, carrageenan; DTH, delayed type hypersensitivity; MI, mitotic index; PGE2, prostaglandin E2.
Jahan and Siddiqui
(2012)
Lee etal. (2019)
Ma etal. (2014a)
Ma etal. (2014b)
Ferchichi (2012)
Koushik etal. (2015)
Paterniti etal. (2017)
Sarfraz etal. (2017)
Koochek etal. (2002)
Habibi etal. (2019)
Cough Management 295
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