Evidence-based herbal approaches for dry, tickly cough using demulcent herbs.
Tickly cough refers to a dry, non-productive cough characterized by persistent throat irritation without mucus production.
Demulcent herbs contain natural compounds (polysaccharides) that create a protective coating over the throat lining [6,7]. These herbs show evidence for relieving dry cough by physically protecting irritated tissue and reducing inflammation [6,7,8].
Strong evidence:
Honey works better than both placebo and usual care for nighttime cough in children. A Cochrane review of 6 clinical trials with 899 participants found honey reduced cough frequency by about one episode per day compared to no treatment, and improved sleep quality for both children and parents by approximately one point on a seven-point scale [1]. A BMJ review of 14 clinical trials found honey more effective than usual care for symptom relief and cough frequency, with all studies showing consistent benefits [2]. Recommended dosing ranges from 2.5-10ml (about half to two teaspoons) before bedtime [1].
Important safety note: Never give honey to infants under 12 months old due to botulism risk from bacterial spores [3].
Moderate evidence:
Marshmallow root (Althaea officinalis) has regulatory approval for dry irritating cough from both German Commission E and the European Medicines Agency based on traditional use and limited clinical data [4,5]. A consumer survey with 822 participants reported rapid symptom relief from marshmallow root extract for dry cough [6]. The herb contains about 20% mucilage (primarily polysaccharides including pectin) that forms a protective coating over irritated throat tissue [6,7]. Animal studies found significant reductions in coughing from both throat and lung irritation [8].
Licorice root (Glycyrrhiza glabra) shows cough-suppressing activity through both direct throat-coating effects and actions in the brain’s cough centers. Animal studies found several compounds in licorice reduced cough frequency by 30-78% [9]. The European Medicines Agency recognizes licorice’s traditional use for cough, recommending 1.5g in 150ml tea for bronchitis or cough [10].
Licorice has significant safety concerns: as little as 100mg daily of its active compound (glycyrrhizic acid) can raise blood pressure [11]. This compound affects hormones that regulate blood pressure and electrolytes, potentially causing low potassium, high blood pressure, irregular heart rhythm, and muscle problems [11]. Not recommended for people with high blood pressure, heart conditions, or kidney disease [11]. Maximum safe dose: 100mg glycyrrhizin daily for short-term use only (4-6 weeks maximum) [11].
Limited clinical evidence:
Slippery elm (Ulmus rubra) inner bark contains abundant mucilage with throat-coating and cough-suppressing properties [12]. The FDA classifies it as generally recognized as safe (GRAS) [12]. However, clinical evidence is minimal and sustainability concerns are significant: Dutch Elm Disease has decimated wild populations, with no viable cultivated sources currently available [13,14]. Ethical sourcing requires harvesting only from naturally fallen or already-cut trees [13,14].
Herbal combination formulas containing ivy, primrose, and thyme show strong evidence in a meta-analysis, with patients 40% more likely to report cough improvement [15], though the benefits come from the combination rather than individual throat-coating effects.
Clinical trials of cough remedies measure:
A change of 1.0-1.3 points on a 7-point scale represents meaningful improvement [1,2]. Reduction in sleep disruption of about 1 point on the same scale indicates significant benefit for quality of life [1].
Primary approach: Marshmallow root cold infusion
Cold water extraction preserves the delicate compounds (mucilaginous polysaccharides) while avoiding starch extraction that happens with hot water [16,17]. Preparation: 1-2 tablespoons dried cut marshmallow root per 8 oz (240ml) cold water, steeped 4-12 hours, then strained [16,17]. The resulting liquid has a mildly sweet taste with a characteristic slippery texture [18].
German Commission E recommends 6g root or equivalent preparations daily; syrup dosing at 10ml single dose [4]. Dosing frequency: every 2-4 hours during acute symptoms to maintain the protective coating, which lasts about 2-4 hours per dose [19].
The mucilage forms a protective layer over the throat lining, physically shielding irritated tissue while reducing inflammation [6,7,8].
Concentrated preparation for nighttime use:
Marshmallow-honey syrup combines the evidence for both ingredients. Method: Simmer 14g (½ oz) dried marshmallow root in 1 liter water, reduce volume by half through gentle heating, strain thoroughly, then combine with equal volume raw honey (1:1 ratio) while warm but not hot (to preserve honey’s active compounds) [20]. Refrigerate; stable for about 1 month [20]. Dosing: 5-10ml (1-2 teaspoons) before bedtime and as needed for nighttime cough [1,20].
Licorice as adjunct only:
Due to blood pressure and heart concerns, licorice should be used in small amounts as a flavor enhancer and anti-inflammatory addition rather than a primary remedy [10,11]. Safe short-term dosing: 0.5-1g powdered root 1-3 times daily, with total daily glycyrrhizin intake below 100mg when accounting for all sources (teas, lozenges, candies) [9,10,11]. Maximum duration: 4-6 weeks [11].
| Herb | Evidence Level | Mucilage Content | Safety Profile | Sustainability | Primary Use |
|---|---|---|---|---|---|
| Marshmallow | Moderate (regulatory approval, consumer survey with 822 participants) [4,5,6] | ~20% [6,7] | Excellent; generally recognized as safe, including in pregnancy/lactation with caution [21] | Sustainable; widely cultivated | First-line throat coating |
| Honey | Strong (Cochrane review, BMJ meta-analysis) [1,2] | N/A (different mechanism) | Good; digestive symptoms 12% vs 11% placebo; not for infants under 12 months [1,3] | Sustainable | First-line, especially nighttime |
| Licorice | Moderate (animal studies, traditional use) [9,10] | Moderate | Significant concerns; blood pressure, heart, drug interactions [11] | Sustainable; cultivated | Addition only, short-term |
| Slippery elm | Limited clinical evidence [12] | High | Excellent; generally recognized as safe; not recommended in pregnancy due to documented effects on pregnancy [12] | Poor; endangered wild populations [13,14] | Avoid due to sustainability |
Immediate relief (within minutes to 2 hours): The throat coating provides physical protection and a soothing sensation upon contact with irritated tissue [16,17,18].
24-48 hours: Honey shows measurable reduction in nighttime cough frequency and severity within the first night of use [1,2]. Marshmallow consumer survey reports “very rapid onset of effects” [6].
3-7 days: Progressive improvement in cough frequency, severity, and sleep quality with consistent use of throat-coating herbs. Combination herbal formulas show significant benefit by days 7-9 of treatment [15].
Duration of coating effect: Individual doses provide symptom relief for about 2-4 hours, requiring frequent re-dosing (3-6 times daily) during acute symptoms [19].
Quantifiable measures:
Cough frequency log:
Severity rating:
Sleep quality:
Functional impact:
Response to intervention:
Baseline measurement: Track for 2-3 days before starting treatment to establish your pattern, then continue tracking during treatment. Meaningful improvement: reduction of 1 or more points on severity scale, 30% or greater reduction in frequency, or 1 or more hours of additional continuous sleep [1,2].
[1] Oduwole O, Udoh EE, Oyo-Ita A, Meremikwu MM. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;4(4):CD007094. [[research/studies/honey_cochrane_2018]]
[2] Abuelgasim H, Albury C, Lee J. Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis. BMJ Evid Based Med. 2021;26(2):57-64. [[research/studies/honey_meta_bmj_2020]]
[3] American Academy of Pediatrics. Botulism: Causes, Signs, Symptoms and Treatment. HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/infections/Pages/Botulism.aspx [[bibliographies/tickly-cough]]
[4] German Commission E. Althaeae radix (Marshmallow Root). Bundesanzeiger 1989;43. [[bibliographies/tickly-cough]]
[5] European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). Assessment report on Althaea officinalis L., radix. EMA/HMPC/436679/2015. [[bibliographies/tickly-cough]]
[6] Fink C, Schmidt M, Kraft K. Marshmallow Root Extract for the Treatment of Irritative Cough: Two Surveys on Users’ View on Effectiveness and Tolerability. Complement Med Res. 2018;25(5):299-305. [[bibliographies/tickly-cough]]
[7] Mahboubi M. Marsh Mallow (Althaea officinalis L.) and Its Potency in the Treatment of Cough. Complement Med Res. 2020;27(3):174-183. [[bibliographies/tickly-cough]]
[8] Nosál’ová G, Strapková A, Kardosová A, Capek P, Zathurecký L, Bukovská E. [Antitussive action of extracts and polysaccharides of marsh mallow (Althea officinalis L., var. robusta)]. Pharmazie. 1992;47(3):224-6. [[bibliographies/tickly-cough]]
[9] Wang C, Chen L, Xu C, et al. A Comprehensive Review on Phytochemistry and Biological Activities of Glycyrrhiza spp. Molecules. 2022;27(5):1450. [[bibliographies/tickly-cough]]
[10] European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). Assessment report on Glycyrrhiza glabra L. and/or Glycyrrhiza inflata Bat. and/or Glycyrrhiza uralensis Fisch., radix. EMA/HMPC/571119/2010. [[bibliographies/tickly-cough]]
[11] Medsafe New Zealand. Liquorice - All sorts of side effects and interactions. Prescriber Update Articles, December 2019. https://www.medsafe.govt.nz/profs/PUArticles/December2019/Liquorice-side-effects-interactions.htm [[bibliographies/tickly-cough]]
[12] National Library of Medicine. Slippery Elm. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Last updated 2020. [[bibliographies/tickly-cough]]
[13] United Plant Savers. Slippery Elm (Ulmus rubra). Species At-Risk List. https://unitedplantsavers.org/species-at-risk-list/slippery-elm-ulmus-rubra/ [[demulcent-herbs-tickly-cough-research]]
[14] Herbal Reality. Slippery Elm Sustainability: What Practitioners and Consumers Should Know. https://www.herbalreality.com/herbalism/sustainability-social-welfare/slippery-elm-sustainability-what-practitioners-consumers-should-know/ [[demulcent-herbs-tickly-cough-research]]
[15] Wagner L, Cramer H, Klose P, et al. Herbal Medicine for Cough: a Systematic Review and Meta-Analysis. Forsch Komplementmed. 2015;22(6):359-68. [[bibliographies/tickly-cough]]
[16] Learning Herbs. Marshmallow Root Cold Infusion Remedy. https://learningherbs.com/remedies-recipes/marshmallow-root/ [[demulcent-herbs-tickly-cough-research]]
[17] Mommypotamus. 7 Marshmallow Root Uses (And How To Prepare It). https://mommypotamus.com/marshmallow-root/ [[demulcent-herbs-tickly-cough-research]]
[18] Epicure Delight. What Does Marshmallow Root Taste Like? https://epicuredelight.com/marshmallow-root-taste/ [[demulcent-herbs-tickly-cough-research]]
[19] Wholistic Living. Demulcent Herbs: Unlocking Potential for Gut Health. 2023. https://wholeisticliving.com/2023/06/19/demulcent-herbs/ [[demulcent-herbs-tickly-cough-research]]
[20] Acorn and Oak Apothecary. Marshmallow Root Cough Syrup. https://acornoak.com.au/marshmallow-root-cough-syrup/ [[demulcent-herbs-tickly-cough-research]]
[21] National Library of Medicine. Marshmallow. Drugs and Lactation Database (LactMed®). Last updated 2021. [[bibliographies/tickly-cough]]