实则举按皆强，举指逼逼。凡弦洪紧滑，皆属实类。不似紧脉之迸急不和，滑脉之往来流利，
洪脉之来盛去衰也。（语出张璐。又濒湖体状诗曰∶浮沉皆得大而长，应指无虚 强；热蕴三焦成壮火，通
肠发汗始安康。相类诗曰∶实脉浮沉有力强，紧如弹索动无常；须知牢脉帮筋骨，实大微弦更带长。）
实为中外壅满之象。其在外感而见脉实而浮，则有头痛、发热、恶寒、鼻塞、头肿、肢体疼痛、痈毒等症可察；
脉实而沉，则有腹满硬痛等症可察。内伤脉实洪滑，则有诸火，潮热、 瘕、血瘀、痰饮、腹痛、喘逆等症可
察；脉实沉弦，则有诸寒壅滞等症可察。更以气血诸实等症兼观，则病情在我，而无可遁之病矣。但脉云
实，尚有何虚；既有虚象，便不云实。总在医人诊其脉气果实不实耳。（实脉有寒实热实之分。但今人止知病有
热实，而不知有寒实，殊为可惜。景岳云∶火邪实者，洪滑有力，为诸实热等症；寒邪实者，沉弦有力，为诸
痛滞等症。又曰∶实脉有真假，真实者易知，假实者易误，故必问其所因，而兼察形症，方是高手。）
虚则豁然浮大而软，按之不振，如寻鸡羽，久按根底不乏不散。凡芤濡迟涩，皆属虚类。不似芤脉
之豁然中空，按之渐出；涩脉之软弱无力，举指即来；散脉之散漫无根，重按久按，绝不可得也。（语出张璐。又
濒湖体状相类诗曰∶举之迟大按之松，脉状无涯类谷空；莫把芤虚为一例，芤来迟大如慈葱。）虚为气血空虚
之候。故浮而虚者为气衰，沉而虚者为火微，虚而迟者为虚寒，虚而数者为水涸，虚而涩者为血亏，虚而弦者
为土衰木盛，虚而尺中微细小为亡血失精，虚而大者为气虚不敛。要皆分别施治，无有差错，斯为之善。然总
不可用吐用下，以致益见其虚矣。（仲景云∶脉虚者不可吐，腹满脉虚复厥者不可下，脉阴阳俱虚热不止者死。）
实脉的特征是轻取（举）和重按（按）都感觉强劲有力，指下感觉充实饱满。凡是弦脉、洪脉、紧脉、滑脉，都属于实脉的同类。它们不像紧脉那样迸发急促而不调和，不像滑脉那样往来流利，也不像洪脉那样来势盛大而去势衰弱。（这段话出自张璐。另外李时珍在《濒湖脉学》的体状诗中说：浮取和沉取都能感到脉象大而长，指下没有虚弱感而显得强劲；这是热邪蕴结在三焦形成壮火，通过通利肠道和发汗的方法才能使身体安康。在相类诗中说道：实脉无论浮取还是沉取都有力且强劲，紧脉像弹动的绳索一样变动无常；必须知道牢脉是紧贴筋骨搏动，实脉则是大而且略微带弦并显得长。）实脉是体内内外壅塞充满的征象。如果在外感病中出现脉实而浮，就可以观察到头痛、发热、恶寒、鼻塞、头肿、肢体疼痛、痈毒等症状；如果脉实而沉，就可以观察到腹部胀满硬痛等症状。在内伤病中脉象实而洪滑，就可以观察到各种火证、潮热、癥瘕积聚、血瘀、痰饮、腹痛、气喘上逆等症状；如果脉实而沉弦，就可以观察到各种寒邪壅滞等症状。再结合气血诸实等病症综合观察，那么病情就在掌握之中，没有可以隐瞒的疾病了。但是既然说脉象是实，就不存在虚；既然有虚的征象，就不会说是实。这完全取决于医生诊断其脉气究竟是实还是不实罢了。（实脉有寒实和热实之分。但如今的人只知道病有热实，而不知道有寒实，这非常可惜。张景岳说：火邪导致的实证，脉象洪滑有力，对应各种实热等病症；寒邪导致的实证，脉象沉弦有力，对应各种痛症和阻滞等病症。他又说：实脉有真假之分，真实的实脉容易识别，虚假的实脉容易误诊，所以必须询问发病原因，并结合形体症状进行考察，这才是高明的医生。）
虚脉的特征是豁然浮大且柔软，重按时无力振奋，就像摸鸡羽毛一样，久按时根部不匮乏也不散乱。凡是芤脉、濡脉、迟脉、涩脉，都属于虚脉的同类。它们不像芤脉那样豁然中空，重按时感觉逐渐出现；不像涩脉那样软弱无力，轻取即来；也不像散脉那样散漫无根，重按久按时完全找不到。（这段话出自张璐。另外李时珍在《濒湖脉学》的体状相类诗中说：轻取时感觉迟大，重按时松软，脉象无边际类似谷空；不要把芤脉和虚脉混为一谈，芤脉来时迟大如同慈葱。）虚脉是气血空虚的表现。所以浮取而虚的是气衰，沉取而虚的是火微，虚而迟的是虚寒，虚而数的是阴液枯竭，虚而涩的是血亏，虚而弦的是脾土衰弱肝木偏盛，虚而尺部微弱细小的是失血或失精，虚而大的是气虚不能收敛。这些都需要分别施治，才能没有差错，这才算是善于诊治。然而总体上不可使用催吐或泻下的方法，以免使虚证更加严重。（张仲景说：脉虚的人不可用吐法，腹部胀满且脉虚又四肢厥冷的人不可用下法，脉象寸关尺三部都虚且发热不止的人是死证。）
The characteristic of the **Shi Mai (Real Pulse, 实脉)** is that both light pressure (**Ju**, 举) and heavy pressure (**An**, 按) feel strong and forceful, with a sense of fullness under the fingers. The **Xian Mai (Wiry Pulse, 弦脉)**, **Hong Mai (Surging Pulse, 洪脉)**, **Jin Mai (Tight Pulse, 紧脉)**, and **Hua Mai (Slippery Pulse, 滑脉)** all belong to the category of Real pulses. They do not resemble the Jin Mai which is bursting and urgent without harmony, nor the Hua Mai which flows smoothly back and forth, nor the Hong Mai which comes vigorously and departs weakly. (This passage is from Zhang Lu. Additionally, Li Shizhen states in the *Binhu Maixue* poem on pulse characteristics: "Obtained as large and long in both floating and deep positions; no emptiness felt under the finger, only strength; Heat accumulated in the Triple Burner forms vigorous fire, unblocking the intestines and inducing sweating brings health." In the poem on similar pulses: "The Real pulse is powerful and strong in both floating and deep positions; the Tight pulse moves unpredictably like a plucked string; one must know that the Firm pulse presses against the bones and sinews, while the Real pulse is large, slightly wiry, and longer.") The Real pulse is a sign of internal and external congestion and fullness. If seen in exterior diseases where the pulse is Real and Floating, symptoms such as headache, fever, aversion to cold, nasal congestion, head swelling, limb pain, and carbuncles/toxins can be observed; if the pulse is Real and Deep, symptoms such as abdominal fullness, hardness, and pain can be observed. In interior diseases, if the pulse is Real, Surging, and Slippery, various Fire syndromes, tidal fever, masses (*Zha*), blood stasis, phlegm-fluid retention, abdominal pain, and wheezing/counterflow qi can be observed; if the pulse is Real, Deep, and Wiry, various Cold stagnation syndromes can be observed. By observing these along with other Qi and Blood excess syndromes, the disease condition is within grasp, leaving no room for concealment. However, if the pulse is said to be Real, there is no Deficiency; if there are Deficient signs, it is not called Real. This entirely depends on the physician determining whether the pulse energy is truly Real or not. (The Real pulse has distinctions between Cold-Real and Heat-Real. But nowadays people only know of Heat-Real and are unaware of Cold-Real, which is regrettable. Zhang Jingyue says: "For Real syndromes caused by Fire pathogens, the pulse is Surging, Slippery, and forceful, corresponding to various Heat-Real syndromes; for Real syndromes caused by Cold pathogens, the pulse is Deep, Wiry, and forceful, corresponding to various Pain and Stagnation syndromes." He also says: "The Real pulse has true and false types; the true Real is easy to identify, but the false Real is easily misdiagnosed. Therefore, one must inquire about the cause and simultaneously examine physical signs and symptoms, which is the mark of a skilled physician.")
The characteristic of the **Xu Mai (Deficient Pulse, 虚脉)** is that it appears suddenly large and soft when lightly pressed, and fails to rebound or feel firm upon heavy pressure, feeling like searching for a chicken feather; after prolonged pressing, the root is neither lacking nor scattered. The **Kou Mai (Bamboo-slash Pulse, 芤脉)**, **Ru Mai (Soggy Pulse, 濡脉)**, **Chi Mai (Slow Pulse, 迟脉)**, and **Se Mai (Choppy Pulse, 涩脉)** all belong to the category of Deficient pulses. They do not resemble the Kou Mai which is suddenly hollow in the center and feels gradually emerging upon pressure; nor the Se Mai which is weak and powerless, appearing immediately upon light pressure; nor the San Mai (Scattered Pulse, 散脉) which is scattered without a root, completely undetectable upon heavy and prolonged pressure. (This passage is from Zhang Lu. Additionally, Li Shizhen states in the *Binhu Maixue* poems on characteristics and similarities: "Lightly pressed it is slow and large, heavily pressed it is loose; the pulse shape has no boundary, resembling an empty grain sack; do not treat the Bamboo-slash and Deficient pulses as the same type; the Bamboo-slash comes slow and large like a green onion.") The Deficient pulse is a manifestation of Qi and Blood deficiency. Therefore, if Floating and Deficient, it indicates Qi decline; if Deep and Deficient, it indicates weak Fire; if Deficient and Slow, it indicates Deficient-Cold; if Deficient and Rapid, it indicates exhaustion of Yin fluids; if Deficient and Choppy, it indicates Blood deficit; if Deficient and Wiry, it indicates Spleen Earth deficiency and Liver Wood excess; if Deficient with a faint, small, and thin sensation at the Chi position, it indicates loss of Blood or Essence; if Deficient and Large, it indicates Qi deficiency failing to consolidate. All these require differentiated treatment to avoid errors, which constitutes good medical practice. However, generally, emetic and purgative methods should not be used, lest they exacerbate the Deficiency. (Zhang Zhongjing says: "Those with a Deficient pulse cannot undergo emesis; those with abdominal fullness, a Deficient pulse, and recurrent cold limbs cannot undergo purgation; those with Deficient pulses in all three positions (Yin and Yang) with continuous fever are in a critical/deadly state.")