Mai Men Dong Tang (Ophiopogon Decoction) is not taught as a particularly important formula in textbooks, and as a result, many practitioners have an inadequate understanding of it. I myself rarely used it in the past. Over the years I have seen many patients with cough, tried numerous formulas with unremarkable results, and for a very long time felt a genuine dread whenever a cough case walked through the door. I could never seem to grasp the essence of this condition or find a clear therapeutic thread — until recently, when a series of chance encounters led to inexplicable cures. After re-reading the classics several times, something finally clicked.

The description of Mai Men Dong Tang in the Essentials from the Golden Cabinet (Jin Gui Yao Lue), in the chapter on Lung Withering, Lung Abscess, Cough, and Rebellious Qi, is remarkably simple:

“When there is severe upward rebellion of qi and discomfort in the throat, the formula that stops the rebellion and sends qi downward is Mai Men Dong Tang.”

The analysis is actually quite straightforward. If you encounter a cough with throat discomfort — especially the kind that seems to rise from deep within the lungs — Mai Men Dong Tang can be used. The pattern differentiation is that simple: just look for those symptoms. Yet modern scholars insist on framing Mai Men Dong Tang as a treatment for “deficient fire flaring upward” or “yin deficiency of the lung and stomach,” piling on a bewildering array of additional symptoms that muddy the waters. They create the impression that it can only be used when there is heat — and specifically, deficient heat.

Actually, I first heard about the clinical use of Mai Men Dong Tang from Gao Guojian. He told me about a teacher at Kuangjie Traditional Chinese Medicine Hospital who treated an elderly patient with a severe cough whose main symptom was copious expectoration of sticky phlegm. The conventional approach would have been to fortify the spleen and transform phlegm — perhaps using Er Chen Tang (Two-Old Decoction) — and certainly one would avoid a rich, cloying formula like Mai Men Dong Tang. But this teacher not only used it, he used a remarkably large dose of Ophiopogon (Mai Dong) — 80 grams. The patient recovered quickly after taking it.

Later, when my grandfather was hospitalized with pulmonary fibrosis, he continued to expectorate sticky phlegm after discharge. He described it as white, stringy, and extremely profuse — every cough produced more. I recalled that case and decided to try Mai Men Dong Tang with a heavy dose of Mai Dong. Sure enough, the phlegm diminished rapidly and the cough subsided. The effect was remarkable.

For the past three months, I myself have been coughing — a harsh, barking cough, sonorous despite being non-productive, accompanied by sneezing and a runny nose. When I coughed, I could distinctly feel resonance deep in my lungs, as if the cough were being pushed up from within. In the early stage there was throat itching, which later disappeared. Even mild irritation or excessive talking would trigger it. At its worst, I would wake up coughing in the middle of the night, wheezing, unable to lie flat. Over three months I tried many medicines. Compound Licorice Tablets worked best; Tong Xuan Li Fei Wan was second. Formulas like Xiao Qing Long Tang, Jin Fei Cao San, Er Chen Tang, Ling Gui Zhu Gan Tang, Chai Hu Gui Zhi Tang, Gui Zhi Jia Hou Po Xing Zi Tang, Su Zi Jiang Qi Tang, Zhi Sou San, and Yang Yin Qing Fei Tang — none of them helped. Yesterday, under Zhao Shitong’s guidance, I tried Mai Men Dong Tang. The result was extraordinary — I did not cough at all during the night and woke up feeling quite comfortable. It was truly like striking a drum and hearing an immediate echo. Today I did some further research and summarized the cough presentations for which Mai Men Dong Tang is particularly suited:

1. Copious white sticky phlegm, or a dry cough with no expectoration but a sensation of phlegm in the throat; tendency to clear the throat after coughing.

2. Tongue body generally pale or pale red, with cracks; pulse slippery-weak or soft-feeble.

3. The cough feels deep, as if pushed up from the lungs; excessive coughing may even produce a sensation of nausea.

4. Cough with shortness of breath, especially worse at night; in severe cases, the patient cannot lie flat.

Analyzing the formula, the general picture is fire in the lungs — or lurking cold — in any case, both fire and cold coexisting, causing the Metal of the Lung to lose its moisture. In actual clinical practice, one must follow Zhang Zhongjing’s dosages. Mai Dong is undeniably used in large amounts — no less than 30 g, and I would recommend starting at a minimum of 45 g. Some have calculated that the ratio of Mai Dong to Ban Xia and Dang Shen is approximately 8:1. In my experience, reducing the Mai Dong dose significantly diminishes the effect.

These are my recent reflections.

麦门冬汤在教科书中并没有作为一个非常重要的方剂进行教授，导致许多医家对此方认识不足，我自己以前也不是很常用。这些年见过许多咳嗽的患者，用了许多方子效果都不明显，在非常长的一段时间内让我对咳嗽感到很惧怕，总感觉认识不到此病的本质，也抓不到治疗的思路，直到最近机缘巧合莫名其妙治好了几个，重新看了几遍书，终于有所感悟。

《金匮要略·肺痿肺痈咳嗽上气病脉证并治》对麦门冬汤的描述很简单，”大逆上气，咽喉不利，止逆下气者，麦门冬汤主之。”

这分析起来其实也是比较简单的，如果碰到咳嗽，嗓子不舒服，尤其是从肺里咳出来的那种，就可以用麦门冬汤。这个辩证法是相当简单的，只要看这几个症状就行了。可是，现代的学者们非要把麦门冬汤解释成虚火上炎、肺胃阴虚证，然后搞出来一堆莫名其妙的症状，扰乱了试听，总感觉一定要有热，还是虚热的情况下才能用它。

其实我第一次听说麦门冬汤的使用是高国建告诉我的，他说宽街中医院的一名老师，诊治一位高龄咳嗽患者，主要症状是咳吐大量黏痰，通常方法是要健脾化痰的，估计会用二陈汤之类，尤其是不能用像麦门冬汤这种滋腻方药。但是这位老师不仅用了，而且麦冬的用量还特别大，80克，患者吃下去很快就好了。

后来，爷爷肺纤维化住院，出院后一直吐黏痰，他的描述就是吐出来的都是白的拉丝的黏痰，特别多，咳嗽就要吐，后来我想起来这个例子，尝试用了麦门冬汤，重剂麦冬，吃下去之后果然很快痰就少了，咳嗽也少了，疗效神奇。

最近这三个月我也咳嗽，连声呛咳，无痰声重，喷嚏流涕，咳时明显感到肺内有共振，感觉是从肺里顶出来的咳。前期曾经喉痒，后面就没有了，稍微受点刺激或者说多了话就会咳嗽，严重时半夜咳醒，气喘，无法平躺。三个多月吃过很多药，感觉复方甘草片最管用，通宣理肺丸其次，像是小青龙汤、金沸草散、二陈汤、苓桂朮甘汤、柴胡桂枝汤、桂枝加厚朴杏子汤、苏子降气汤、止嗽散、养阴清肺汤等等都不管用，昨天在赵世同的指点下用了一下麦门冬汤，效果奇佳，一夜未咳，早上也很舒适，这真是效如桴鼓。今天我又查了一下，总结出麦门冬汤适宜的咳嗽症状如下：

1、有大量白色黏痰的或干咳无痰但感觉喉间有痰的，咳完爱清嗓子

2、一般舌质淡或淡红，有裂纹，脉象虚滑或濡弱

3、咳嗽的感觉比较深，从肺中顶出，咳多了甚至有呕吐感

4、咳嗽气急，尤其夜晚加重，严重的不得平卧

分析方剂，大体是肺中有火，或有伏寒，总之是有火又有寒，导致肺金不润，临床真正使用时，一定要遵守张仲景的剂量，麦冬无疑是大量的，不会少于30g，推荐最少应该45g起步，有人测算过，麦冬与半夏党参的比例大约是8：1，个人感觉麦冬少了效果不佳。

以上便是最近的体会。