实脉浮沉皆得脉大而长，微弦，应指 然， ，紧实貌。《脉诀》言∶如绳应指来
，乃
能康。又曰∶实脉浮沉有力强，紧如弹索转无常，须知牢脉掣筋骨，实大微弦更带长。
主病 实脉为阳火郁盛，发狂谵语，吐频频，为阳毒，或伤食大便不通，或气痛。寸实
主面
实，曰脉实者，水谷为病。曰气来实强，是为大过。《脉诀》言尺实，小便不禁，与脉尺实
，小腹痛，小便难之证相反。洁古不知其谬，以为虚寒用姜、附，愈误矣。
长脉不大不小，迢迢若如循长竿末梢为平，如引绳，如循长竿，曰病。又曰∶长有三部
之长
治
量，实牢弦紧，皆兼长脉。
主病 长脉迢迢大小匀，反常为病似牵绳，若非阳毒癫痫病，即是阳明热势深，大都长
主有余之病。
洪脉指下极大，来盛去衰。洪脉在卦为离，在时为夏，在人为心。《素问》谓之大，亦
。滑氏曰∶来盛去衰，如钩之曲，上复而下，应血脉来去之象，象万物敷布下垂之状。詹氏
如环珠者非也。《脉诀》云∶季夏宜之，秋季冬季发汗通阳，俱非洪脉所宜，盖谬也。李氏
曰∶脉来洪盛去还衰，满指涌涌应夏时，若在春秋冬月分，升阳散火莫狐疑。又曰∶洪脉来
时拍拍然，去衰来盛似波澜，欲知实脉参差处，举按弦长 坚。
主病 脉洪阳盛血应虚，相火炎炎热病居，胀满胃翻须早治，阴虚泄痢可愁如，寸洪心
焦炎，肺脉洪时金不堪，肝火内虚关内察，肾虚阴火尺中看。又曰∶洪主阳盛阴虚之病，泄
痢失血久嗽者，忌之。经曰∶形瘦脉大，多气者死。又曰∶大则病进。
实脉：无论浮取还是沉取，都能感觉到脉搏形态大而长，略微带弦象，手指按上去感觉坚实有力、紧实的样子。《脉诀》中说：“像绳子一样应指而来”，这样才能恢复健康。又说：“实脉在浮取和沉取时都显得有力且强劲，紧得像弹动的绳索一样变化无常；要知道牢脉是牵拉筋骨的感觉，而实脉则是大、微弦且更长。”
主病：实脉属于阳火郁结旺盛，表现为发狂、说胡话（谵语）、频繁呕吐，属于阳毒证；或者是伤食导致大便不通，或者是气滞疼痛。寸部出现实脉，主面部病症。经文说：“脉实者，是水谷之邪为病。”又说：“脉气来势强实，这是太过之象。”《脉诀》说尺部实脉会导致小便失禁，这与“尺部实脉伴有小腹痛、小便困难”的证候相反。洁古（张元素）不知道这是谬误，认为属于虚寒证而使用干姜、附子，反而更加误治了。
长脉：脉象不大不小，悠长顺畅，如果像顺着长竹竿的末梢触摸那样柔和，属于平脉（正常脉象）；如果像拉着绳子，或者像顺着长竹竿触摸那样僵硬，则属于病脉。又说：长脉涵盖三部（寸、关、尺）的量度，实脉、牢脉、弦脉、紧脉，都兼有长脉的特征。
主病：长脉悠长且大小均匀，反常时像拉着绳子一样紧张。如果不是阳毒或癫痫病，就是阳明经热势深重。大体上，长脉主要主有余之病（实证）。
洪脉：手指下感觉脉形极大，来时气势旺盛，去时气势衰减。洪脉在八卦中对应离卦，在季节中对应夏季，在人体脏腑中对应心脏。《素问》称之为“大”。滑寿（滑氏）说：“来盛去衰，像钩子的弯曲形状，向上复向下，符合血脉来去的景象，也象征万物舒展分布下垂的状态。”詹氏说像环珠滚动是不对的。《脉诀》说季夏（长夏）适宜洪脉，秋季冬季应当发汗通阳，这些都不是洪脉所适宜的，都是谬误。李氏说：“脉来洪盛而去时衰减，满指涌动应合夏时的特征；如果在春秋冬三个月份出现，应当升阳散火，不要犹豫。”又说：“洪脉来时拍拍然有声，去时衰减来时旺盛像波澜起伏；想知道实脉与洪脉的区别之处，在于举按之间是否弦长且坚硬。”
主病：脉洪表示阳气盛而血相对虚，相火炎炎，多见于热病；腹胀满、胃气上逆必须尽早治疗；阴虚导致的泄痢令人担忧。寸部洪脉主心火焦炎；肺脉洪时说明金气不堪受克；肝火内虚需在关部察知；肾虚阴火需在尺部查看。又说：洪脉主阳盛阴虚之病，对于泄痢、失血、久咳的患者，忌见洪脉。经文说：“形体消瘦而脉大，多气者死。”又说：“脉大表示病情进展。”
Real Pulse: Whether superficial or deep, the pulse is felt to be large and long, slightly wiry, and feels firm and tight under the fingers. The *Mai Jue* (Pulse Classic) states: "Coming like a rope responding to the touch," which indicates recovery. It also says: "The Real pulse is strong and powerful in both superficial and deep positions, tight like a snapping cord changing constantly; one must know that the Firm pulse pulls at the sinews and bones, whereas the Real pulse is large, slightly wiry, and longer."
Indications: The Real pulse indicates excessive stagnation of Yang fire, manifesting as madness, delirious speech, frequent vomiting, representing Yang toxicity; or it indicates food retention with constipation, or Qi stagnation pain. A Real pulse at the Cun (inch) position indicates facial disorders. The classics state: "When the pulse is Real, water and grain pathogens are the cause." It also states: "When the Qi comes strong and solid, this is an excess condition." The *Mai Jue* claims that a Real pulse at the Chi (cubit) position causes urinary incontinence, which contradicts the syndrome of Chi position Real pulse accompanied by lower abdominal pain and difficult urination. Jiegu (Zhang Yuansu) failed to recognize this error, mistakenly treating it as deficiency-cold using Sheng Jiang (Prepared Ginger) and Fu Zi (Aconite Root), thereby worsening the condition.
Long Pulse: The pulse is neither too large nor too small, stretching smoothly and far. If it feels like tracing the tip of a long bamboo pole, it is a normal pulse (Ping Mai); if it feels like pulling a taut rope or tracing a rigid long pole, it is a pathological pulse. Furthermore, the Long pulse encompasses the extent of all three positions (Cun, Guan, Chi). Real, Firm, Wiry, and Tight pulses all accompany the Long quality.
Indications: The Long pulse is smooth and uniform in size; when abnormal, it feels tense like a pulled rope. Unless it is Yang toxicity or epilepsy, it indicates deep heat in the Yangming channel. Generally, the Long pulse primarily indicates excess conditions.
Surging Pulse: Under the fingers, the pulse appears extremely large, coming with vigorous force and departing with declining force. In the Bagua (Eight Trigrams), the Surging pulse corresponds to Li; in seasons, it corresponds to Summer; in the human body, it corresponds to the Heart. The *Su Wen* refers to it as "Large." Hua Shou (Hua Shi) stated: "Coming vigorously and departing weakly, curved like a hook, rising then falling, reflecting the movement of blood vessels, resembling the shape of all things spreading out and hanging down." Zhan Shi incorrectly described it as rolling like beads. The *Mai Jue* claimed that the Surging pulse is suitable for Late Summer, and that sweating to unblock Yang is appropriate in Autumn and Winter; these are errors. Li Shi stated: "When the pulse comes surging and goes declining, filling the fingers with a rushing sensation corresponding to Summer; if appearing in Spring, Autumn, or Winter months, one should raise Yang and scatter fire without hesitation." He also said: "The Surging pulse arrives with a slapping sound, departing weakly but arriving strongly like waves; to distinguish it from the Real pulse, observe whether it is wiry, long, and hard upon lifting and pressing."
Indications: A Surging pulse indicates excessive Yang and deficient Blood, with Ministerial Fire blazing, commonly found in heat diseases; abdominal distension and stomach reversal require early treatment; deficiency-Yin diarrhea and dysentery are worrying. A Surging pulse at the Cun position indicates scorching Heart fire; a Surging Lung pulse indicates the Metal element cannot withstand the attack; Liver fire internal deficiency should be examined at the Guan position; Kidney deficiency with Yin fire should be viewed at the Chi position. It is further stated: The Surging pulse indicates diseases of Yang excess and Yin deficiency; it is contraindicated for patients with diarrhea, dysentery, hemorrhage, or chronic cough. The classics state: "Emaciated form with a large pulse and excessive Qi indicates death." It also states: "A large pulse indicates disease progression."