体象 实脉有力，长大而坚；应指 ，三候皆然。
实为邪盛有余之象，既大而且兼长，既长大而且有力，既长大有力而且浮中沉三候皆然，则诸阳之
象，莫不毕备。
主病 血实脉实，火热壅结。左寸实者，舌强气壅，口疮咽痛。实在左关，肝火胁痛。左尺得实，
便秘腹疼。右寸实者，呕逆咽痛，喘嗽气壅。实在右关，伏阳蒸内，中满气滞。右尺得实，脐痛便
难，相火亢逆。
脉实必有大邪、大热、大积、大聚。故《脉经》云∶“血实脉实。”又曰∶“气来实强，是谓太过。”由是测之，皆主
实热。其所主病，大约与数脉相类，而实则过之，以其蕴蓄之深也。
按《素问·大奇论》曰∶“肝满、肾满、肺满皆实，即为肿。”如肝雍两 满，卧则惊，不得小便；肾雍 下至
少腹满，胫有大小，髀 大跛，易偏枯；肺之雍喘而两 满之类。皆实脉也。实主邪气有余，易于体象，所
以叔和有“尺实则小便难”之说。乃伪诀谬以尺实为“小便不禁”，何适相反。又妄谓“如绳应指来”，
则是紧脉之形，而非实脉之象矣。夫紧脉之与实脉，虽相类而实相悬。但紧脉弦急如切绳，而左右弹
人手；实脉则且大且长，三候皆有力也。紧脉者，热为寒束，故其象绷急而不宽舒；实脉者，邪为火迫，故
其象坚满而不和柔。以证合之，以理察之，便昭昭于心目之间。又按张洁古惑于伪诀实主虚寒之说，
而遂以姜附施治，此甚不可为训。或实脉而兼紧者，庶乎相当；苟非紧象，而大温之剂施于大热之人，
其不立毙者几希！以洁古之智，当必是兼紧之治法无疑耳。夫阴阳对偶，不可稍偏。阳气过旺，不戢有
自焚之虞。今世宗丹溪者，以为阳常有余，喜用寒凉，乃致杀人如麻，恬不之怪。又有有激之论，为刘朱
之言不息，则轩岐之泽不彰，三吴两浙，翕然成风，以姜附为茶饭，其流毒更不可言。执一舍一，祸害相
寻，可胜叹哉！
【体象】实脉的形态特征是脉搏有力，脉体宽大且长，质地坚实；在手指按压的浮、中、沉三种力度下，均呈现这种状态。
实脉是邪气亢盛、正气未衰的表现。它既宽大又长，既长大又有力量，且在浮取、中取、沉取三候中皆如此，因此各种阳脉的特征无不具备。
【主病】血分实证可见实脉，多由火热之邪壅结所致。左寸部出现实脉，表现为舌体僵硬、气机壅滞、口舌生疮、咽喉疼痛。实脉出现在左关部，提示肝火旺盛导致的胁肋疼痛。左尺部出现实脉，表现为便秘和腹部疼痛。右寸部出现实脉，表现为呕吐逆气、咽喉疼痛、气喘咳嗽、气机壅滞。实脉出现在右关部，提示伏匿之火在内蒸灼，导致胸脘痞满、气机阻滞。右尺部出现实脉，表现为脐部疼痛、排便困难、相火亢逆上冲。
脉象实大必然对应着大邪、大热、大积、大聚等病症。所以《脉经》说：“血实则脉实。”又说：“脉气来势实而强，这叫做‘太过’。”由此推测，这些情况都主实热证。其所主的病症，大致与数脉相似，但实脉比数脉更甚，这是因为邪气蕴蓄深厚的缘故。
按《素问·大奇论》记载：“肝满、肾满、肺满若表现为实证，就会发生肿胀。”例如肝气雍滞，两胁胀满，睡眠时易受惊扰，小便不通；肾气雍滞，向下至少腹胀满，小腿粗细不一，大腿粗大且行走跛行，容易患偏枯（半身不遂）；肺气雍滞则气喘且两胁胀满之类。这些都是实脉的表现。实脉主邪气有余，易于辨识其体象，所以王叔和有“尺脉实则小便难”的说法。然而伪托的《脉诀》错误地将尺脉实解释为“小便失禁”，这与事实完全相反。又妄称脉象“如绳索般应指而来”，这是紧脉的形态，而非实脉的象。紧脉与实脉，虽然相似但实际上相差甚远。紧脉弦急如同切绳，左右弹击手指；实脉则是既大又长，三候都有力。紧脉是因为热被寒邪束缚，所以其象绷急而不宽舒；实脉是因为邪气被火邪逼迫，所以其象坚满而不柔和。结合症状验证，从医理分析，便能在心中清晰地分辨出来。另外，张洁古被伪《脉诀》中“实脉主虚寒”的说法所迷惑，于是使用干姜、附子进行治疗，这非常不可作为典范。如果是实脉兼见紧象，或许还比较恰当；如果不是紧象，却对大热之人施用大温补的药物，不立即死亡的几率极小！以张洁古的智慧，应当一定是针对兼有紧象的情况才采用此治法，毫无疑问。阴阳是对立的，不能稍有偏向。阳气过旺，如果不加以遏制，就有自焚的危险。当今世间的丹溪学派信徒，认为“阳常有余”，喜欢使用寒凉药物，以致杀人无数，却安然不觉奇怪。又有激进的言论，认为如果刘朱（刘完素、朱震亨）的学说不停止，那么黄帝岐伯的恩泽就不能彰显，江浙一带，众人纷纷效仿成风，把干姜、附子当作茶饭一样随意使用，其流毒更是不可言说。执着于一点而舍弃整体，祸害接连不断，怎能不令人叹息呢！
[Body Manifestation] The morphological characteristics of the Shi (Full) pulse are forceful, wide and long, and firm; this state is present under all three degrees of pressure: floating (Fu), middle (Zhong), and deep (Chen).
The Shi pulse is a manifestation of excess pathogenic factors and sufficient healthy qi. It is both wide and long, both large and forceful, and consistent across the floating, middle, and deep levels. Therefore, it embodies all the characteristics of Yang pulses.
[Indications for Disease] A Full pulse in the blood level indicates excess, typically caused by the congestion and knotting of Fire-Heat. A Full pulse at the Left Cun position indicates stiffness of the tongue, Qi stagnation, mouth ulcers, and sore throat. A Full pulse at the Left Guan position indicates hypochondriac pain due to Liver Fire. A Full pulse at the Left Chi position indicates constipation and abdominal pain. A Full pulse at the Right Cun position indicates vomiting and regurgitation, sore throat, wheezing and coughing, and Qi stagnation. A Full pulse at the Right Guan position indicates latent Fire steaming internally, leading to chest and epigastric fullness and Qi stagnation. A Full pulse at the Right Chi position indicates umbilical pain, difficulty in defecation, and hyperactivity of Ministerial Fire ascending.
A Full pulse must correspond to major pathogens, major heat, major accumulations, or major masses. Thus, the *Mai Jing* (Pulse Classic) states: "When blood is excess, the pulse is Full." It also says: "When the Qi comes strong and solid, this is called 'Excess' (Tai Guo)." From this, we can deduce that these conditions all indicate Excess-Heat syndromes. The diseases indicated are roughly similar to those of the Shu (Rapid) pulse, but the Full pulse is more severe because the pathogenic factors are deeply accumulated.
According to the *Su Wen · Da Qi Lun*: "If Gan (Liver), Shen (Kidney), and Fei (Lung) are full and manifest as Excess, swelling will occur." For example, if Gan Qi is congested, there is fullness in both hypochondria, fright during sleep, and inability to urinate; if Shen Qi is congested, there is fullness from below down to the lower abdomen, calves of unequal size, enlarged thighs with limping gait, and susceptibility to hemiplegia (Pian Gu); if Fei Qi is congested, there is wheezing and fullness in both hypochondria, etc. These are all manifestations of the Full pulse. The Full pulse indicates excess pathogenic factors and is easy to identify by its body manifestation. Therefore, Wang Shuhe stated, "Full pulse at the Chi position indicates difficulty in urination." However, the spurious *Mai Jue* erroneously interprets Full pulse at the Chi position as "incontinence of urine," which is completely opposite to reality. It also falsely claims the pulse feels "like a rope pressing against the finger"; this is the shape of the Jin (Taut) pulse, not the Shi (Full) pulse. Although the Jin and Shi pulses are similar, they are actually vastly different. The Jin pulse is wiry and urgent like a cut rope, rebounding left and right against the fingers; the Shi pulse is both large and long, with force at all three levels. The Jin pulse occurs when Heat is constrained by Cold, so its manifestation is tense and unrelaxed; the Shi pulse occurs when Pathogens are driven by Fire, so its manifestation is firm and full without softness. By correlating with symptoms and analyzing through theory, the distinction becomes clear in one's mind. Furthermore, Zhang Jiegu was confused by the spurious *Mai Jue*'s claim that "Full pulse indicates Deficiency-Cold," and consequently used Ginger (Sheng Jiang) and Prepared Aconite (Zhi Fu Zi) for treatment. This should not be set as a model. If the Full pulse is accompanied by a Taut quality, this approach might be appropriate; but if there is no Taut quality, applying strongly warming agents to a person with major Heat would likely result in immediate death! Given Zhang Jiegu's wisdom, he undoubtedly intended this treatment only for cases where the pulse was Full and Taut. Yin and Yang are opposites and cannot be biased. If Yang Qi is excessively vigorous and not restrained, there is a danger of self-immolation. Today, followers of Danxi believe that "Yang is often in excess" and favor cold-cooling herbs, resulting in countless deaths while remaining unconcerned. There are also radical arguments stating that if the theories of Liu (Wansu) and Zhu (Zhenheng) do not cease, the benevolence of Xuanyuan (Huangdi) and Qibo will not be manifested. In the regions of Sanwu and Liangzhe, this has become a widespread trend, with people treating Ginger and Aconite as common food. The toxic consequences are indescribable. Clinging to one aspect while abandoning another leads to continuous disasters; how can one not sigh at this?