四实者。阳也。指下寻之不绝举之有余。曰实主伏阳在内。脾虚不食。四体
劳倦。
实者。阳土也。何为阳土。谓土中有火也。指下寻之不绝。沉而有力也。举
之有余。浮而有力也。浮而有力为阳胜。沉而有力为伏阳在内。脉浮沉
俱有力。而谓脾虚者何也。阴阳和则脾胃安。而脉道和缓。今伏阳在内。
是阳火炼土。坚燥而乏生化之源。脾胃因之而虚矣。四体属脾。脾虚不
食。四体因之而劳倦矣。
按脉经云。实脉大而长微强。按之隐指 然。一曰沉浮皆得。
实脉寻之举有余。伏阳蒸内致脾虚。食少只因生胃壅。调和汤药始痊除。
实脉者。寻之举之。皆有力也。今脾胃之所以虚者。因伏阳蒸内之所致
耳。脾胃和则能磨谷而易饥。脾胃虚则食不消。食不消则胃口壅滞。胃
口壅滞。则脉道因之而实矣。若以辛温之药治之。则反助其阳邪。若以
寒凉之药治之。则伤其脾胃。若以峻补之药治之。则脾胃。愈滞。而食愈
少。若以克削之剂治之。则脾胃重虚。而食不化。然则我将如之何哉。亦
惟调和其汤药。如经所云。损其脾者。调其饮食。适其寒温。药则如补中
汤大健脾丸之类治之其疾始能痊除而愈也。
按经云。实紧胃中有寒。若不能食。时时下利者难治。
实脉关前胸热盛。
实脉。阳脉也。寸口。阳位也。所以候胸中者。今阳部而见阳脉。宜乎其胸
中热盛也。
按脉经云。寸口脉实。即生热。在脾肺。呕逆气塞虚即生寒。在脾胃食不
消化。有热即宜服竹叶汤葛根汤。有寒即宜服茱萸丸。生姜汤。
当关切痛中焦恁。
当关而见实脉。则饮食停滞中焦。而腹痛之证作矣。
按脉经云。关上实即痛。虚即胀满。又云。关脉实。胃中痛。宜脉栀子汤。茱
萸乌头丸。针胃管补之。
尺脉如绳应指来。腹胀小便都不禁。
池氏曰。尺脉实。主心经实热。传于小肠。致小腹胀满疼痛。而小便淋沥
也。云岐子曰。左尺主脉沉水。客脉实火。火水相合。水能胜火。治之以干
姜附子汤。右尺主脉相火。客脉实火。二火相合。致令腹胀。而小便不禁。
治之以大承气汤。据云岐子之说如此。谓是两尺脉实耶。谓是各尺脉
实耶。若云两尺俱实。则姜附汤与承气汤。寒热各异。若云各尺脉实。则
腹胀小便不禁。其说未必皆同。云岐子之说非也。刊误又谓其小便不
禁。为传写之误。而改为腹胀小便淋。不思其说更非。特未临其证消息
之耳。诀所谓小便不禁者。非虚寒而膀胱不固也。乃火极而兼水化也。
肾主门户之司。相火有余。则薄所不胜。而司户失守。故小便不禁。非小
便不禁也。乃欲便则痛。而不能不便。则反淋沥自出。所谓热淋者是也。
戴氏不自体认。而反以脉诀为非。可耻甚矣。
按脉经云。尺脉实。小腹痛。小便不禁。宜服当归汤。加大黄一两。以利大
便。针关元补之。止小便。又云。尺中实即小便难。少腹牢痛。虚即闭涩。
四实脉，属于阳脉。手指轻取（举）时感觉有余力，重按（寻）时脉搏连续不断且有力。这种脉象主病为伏藏之阳气在内，导致脾虚不能进食，四肢倦怠乏力。
实脉，对应五行中的阳土。什么是阳土？是指土中蕴含火气。手指重按时脉搏连续不断且沉而有力；手指轻取时感觉有余且浮而有力。浮而有力代表阳盛，沉而有力代表伏阳在内。既然脉象在浮取和沉取时都显得有力，为什么却说这是脾虚呢？因为阴阳调和则脾胃安宁，脉道表现为和缓。如今伏阳在内，如同阳火煎熬脾土，使脾土变得坚硬干燥，缺乏生化之源，从而导致脾胃虚弱。四肢归属于脾，脾虚导致食欲不振，进而引起四肢倦怠。
根据《脉经》记载：实脉脉形大而长，略微强劲，重按时指下充实有力。另一种说法是浮取和沉取都能触及。
实脉在重取和轻取时都有力，这是因为伏阳在内蒸腾，导致脾虚。食欲减少只是因为胃气壅滞。只有经过汤药的调和调理，疾病才能痊愈。
实脉，无论是重取还是轻取，都感觉有力。现在脾胃之所以虚弱，是因为伏阳在内蒸腾所致。脾胃功能正常就能消化谷物并容易感到饥饿；脾胃虚弱则食物无法消化。食物不消化会导致胃口壅滞，胃口壅滞则脉道因此变得实大。如果用辛温的药物来治疗，反而会助长阳邪；如果用寒凉的药物来治疗，则会损伤脾胃；如果用峻猛的补药来治疗，会使脾胃更加壅滞，食物摄入更少；如果用攻伐消导的药剂来治疗，会使脾胃再次虚弱，食物更加无法消化。那么我该怎么办呢？也只能通过调和汤药的方法，正如经典所说：“损伤了脾脏，要调节饮食，适应寒温。”药物可选用补中益气汤、大健脾丸之类的方剂治疗，这样疾病才能痊愈。
根据经典记载：实紧脉表示胃中有寒，如果无法进食，并且经常腹泻，则难以治疗。
实脉出现在寸部（关前），主胸中热盛。
实脉是阳脉，寸口部位属阳位，所以用来诊察胸中的情况。如今在阳的部位出现了阳脉，胸中热盛是理所当然的。
根据《脉经》记载：寸口脉实，就会产生热证，病变在脾肺，出现呕吐逆气、气机堵塞；若脉虚则产生寒证，病变在脾胃，食物不能消化。有热证适宜服用竹叶石膏汤或葛根汤；有寒证适宜服用吴茱萸丸或生姜汤。
实脉出现在关部，主中焦疼痛。
当在关部见到实脉时，说明饮食停滞在中焦，腹痛的症状就会发作。
根据《脉经》记载：关上脉实则疼痛，脉虚则胀满。又说：关脉实，胃中疼痛，适宜服用栀子汤或茱萸乌头丸，针刺胃管穴并用补法。
尺脉像绳子一样应指而来，主腹胀和小便失禁。
池氏说：尺脉实，主心经实热，传变到小肠，导致小腹胀满疼痛，以及小便淋漓不尽。云岐子说：左尺脉主肾水，若客脉见实火，水火相合，水能胜火，治疗应用干姜附子汤。右尺脉主命门相火，若客脉见实火，两火相合，导致腹胀和小便失禁，治疗应用大承气汤。依据云岐子的说法如此，是说两尺脉都实吗？还是说左右尺脉各自实？如果说两尺脉俱实，那么干姜附子汤与大承气汤，一寒一热截然不同。如果说左右尺脉分别实，那么腹胀和小便失禁的说法未必都相同。云岐子的说法是错误的。《刊误》又认为“小便不禁”是传写错误，改为“腹胀小便淋”，我认为这种想法更不对，只是没有亲自临证仔细推敲罢了。歌诀所说的“小便不禁”，并不是因为虚寒导致膀胱不固，而是因为火极盛兼有水化之象。肾主管门户开阖，相火有余，则侵犯其所不胜之气，导致司户失职，所以出现小便不禁。这并不是真正的小便失禁，而是想排尿时疼痛，却不得不排，反而淋漓自出，这就是所谓的“热淋”。戴氏不亲自体察验证，反而指责脉诀有误，真是可耻。
根据《脉经》记载：尺脉实，小腹痛，小便不禁，适宜服用当归汤，加大黄一两，以通利大便。针刺关元穴并用补法，以止小便。又说：尺中脉实则小便困难，少腹坚硬疼痛；脉虚则闭涩不通。
Four "Shi" (Excess) pulses belong to Yang. When lifting the fingers (Ju), there is a sense of surplus; when pressing down (Xun), the pulse is continuous and forceful. This pulse indicates latent Yang within, leading to Spleen deficiency with anorexia, and fatigue/lassitude of the four limbs.
The Shi pulse corresponds to Yang Earth in the Five Elements. What is Yang Earth? It refers to Fire contained within Earth. When pressing down, the pulse is continuous, deep, and forceful; when lifting, it feels surging, floating, and forceful. Floating and forceful indicates Yang excess; deep and forceful indicates latent Yang within. Since the pulse is forceful in both floating and deep positions, why is it said to be Spleen deficiency? When Yin and Yang are harmonious, the Spleen and Stomach are at peace, and the pulse pathway is gentle and moderate. Now, with latent Yang within, it is like Yang fire roasting the Earth, making it hard and dry, lacking the source of transformation and generation, thereby causing Spleen and Stomach deficiency. The four limbs belong to the Spleen; Spleen deficiency leads to poor appetite, which in turn causes lassitude of the four limbs.
According to the *Mai Jing* (Pulse Classic): The Shi pulse is large and long, slightly strong, and feels solid under heavy pressure. Another description states it can be felt in both floating and deep positions.
The Shi pulse is forceful in both pressing and lifting. Latent Yang steaming internally causes Spleen deficiency. Reduced food intake is solely due to Stomach Qi stagnation. Only through the harmonization of decoctions can the disease be cured.
The Shi pulse is forceful whether pressing or lifting. The reason for current Spleen and Stomach deficiency is caused by latent Yang steaming internally. When Spleen and Stomach are harmonious, they can grind grain and induce hunger easily; when deficient, food cannot be digested. Undigested food leads to Stomach gate stagnation; Stomach gate stagnation causes the pulse pathway to become Excess. If treated with acrid-warm herbs, it will inadvertently assist the Yang pathogen. If treated with cold-cool herbs, it will damage the Spleen and Stomach. If treated with drastic tonifying herbs, the Spleen and Stomach will become more stagnant, and food intake will decrease further. If treated with purgative/dissipating agents, the Spleen and Stomach will suffer double deficiency, and food will not transform. So what should I do? One must only harmonize the decoction, as stated in the classics: "If the Spleen is damaged, regulate its diet and adapt to cold and warmth." Herbs such as Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) or Dajianpi Wan (Great Spleen-Tonifying Pill) can be used to treat it, so that the disease may recover.
According to the classics: A Shi-Jin (Excess-Tight) pulse indicates Cold in the Stomach. If one cannot eat and experiences frequent diarrhea, it is difficult to treat.
A Shi pulse at the Cun position (front of the Guan) indicates intense heat in the chest.
The Shi pulse is a Yang pulse, and the Cun Kou position is a Yang location, used to observe the chest. Since a Yang pulse appears in a Yang position, intense heat in the chest is expected.
According to the *Mai Jing*: A Shi pulse at the Cun Kou generates Heat, affecting the Spleen and Lungs, causing vomiting, counterflow Qi, and Qi blockage. A Xu (Deficiency) pulse generates Cold, affecting the Spleen and Stomach, causing indigestion. For Heat patterns, Zhuye Tang (Bamboo Leaf Decoction) or Gegen Tang (Kudzu Decoction) are suitable. For Cold patterns, Zhuyu Wan (Evodia Pill) or Shengjiang Tang (Fresh Ginger Decoction) are suitable.
When the pulse is at the Guan position and painful, it indicates middle jiao stagnation.
When a Shi pulse is seen at the Guan position, it indicates food stagnation in the middle jiao, leading to abdominal pain.
According to the *Mai Jing*: A Shi pulse at the Guan indicates pain; a Xu pulse indicates fullness and distension. It also states: A Shi pulse at the Guan indicates Stomach pain, suitable for Zhizi Tang (Gardenia Decoction) or Zhuyu Wutou Wan (Evodia and Aconite Pill), and needling Weiguan with tonification.
The Chi pulse comes like a rope against the finger, indicating abdominal distension and urinary incontinence.
Chi Shi says: A Shi pulse at the Chi position primarily indicates Excess Heat in the Heart Meridian transmitting to the Small Intestine, causing lower abdominal distension, pain, and dribbling urination. Yun Qizi says: The left Chi governs Kidney Water; if the guest pulse shows Excess Fire, Water and Fire combine, and Water overcomes Fire, treated with Ganjiang Fuzi Tang (Dried Ginger and Prepared Aconite Decoction). The right Chi governs Ministerial Fire; if the guest pulse shows Excess Fire, two Fires combine, causing abdominal distension and urinary incontinence, treated with Dachengqi Tang (Major Order the Qi Decoction). Based on Yun Qizi's statement, does he mean both Chi pulses are Excess, or each Chi pulse is Excess respectively? If both Chi pulses are Excess, then Ganjiang Fuzi Tang and Dachengqi Tang have opposite cold and hot properties. If each Chi pulse is Excess respectively, then the statements about abdominal distension and urinary incontinence may not all be consistent. Yun Qizi's theory is incorrect. *Kanwu* (Corrections) further claims that "urinary incontinence" is a transcription error and changes it to "abdominal distension and dribbling urination." I think this idea is even more wrong, merely lacking clinical observation and careful consideration. The verse's mention of "urinary incontinence" does not refer to bladder insecurity due to Deficiency-Cold, but rather to Extreme Fire combining with Water transformation. The Kidney governs the opening and closing of the gates. If Ministerial Fire is excessive, it attacks what it cannot overcome, causing the gatekeeper to lose control, hence urinary incontinence. This is not true incontinence, but rather pain upon attempting to urinate, forcing release, resulting in dribbling discharge, known as "Heat Lin Syndrome." Dai Shi failed to verify this personally and instead blamed the Pulse Rhyme, which is shameful.
According to the *Mai Jing*: A Shi pulse at the Chi position indicates lower abdominal pain and urinary incontinence, suitable for Danggui Tang (Angelica Decoction) with added 1 liang of Dahuang (Rhubarb Root) to promote bowel movement. Needling Guanyuan with tonification stops urination. It also states: A Shi pulse at the Chi indicates difficulty in urination and firm pain in the lower abdomen; a Xu pulse indicates retention and obstruction.