实脉浮沉皆得大而且长。应指 然不虚。经云。血实脉实。曰脉实者水谷为病。曰气
来实
强。是谓太过。盖实主火热有余之病。或发狂谵语。或阳毒便结。或咽 舌强。或脾热中满
。或腰肠壅痛。或平人实大。主有痢疾。宜先下之。或疮疽脉实。急下之。以邪气在里故也
。俱宜通肠发汗。亟解繁苛之火。不待再计矣。又有如实之脉。久病得此孤阳外脱。脉必先
见弦数滑实。故书云久病脉实者凶。其可疗以消伐之剂乎。更有沉寒内痼。脉道壅滞。而坚
牢如实。此又不得概用寒剂。但温以姜附之属可也。又有真阴大亏燎原。日炽脉见关格洪弦
若实法几穷矣。尚可清凉乎以上三症皆如实脉。非正实脉也。
长脉不大不小。迢迢自若。如循长竿末稍为平。如引绳。如循长竿为病。长有三部之长
。一
部之长。心脉长。神强气壮。肾脉长。蒂固根深。经云长则气治。短则气病长。主于肝短主
于肺。皆平脉也。反此则为有余之。病非阳毒癫痫。则阳明热深。若长而缓者百病皆愈。大
概虽主乎病。亦属轻浅之症。其有如长之脉。或鳏寡思色不遂。心肝两部则洪长而溢鱼际。
是皆七情为患。而非有病之脉也。或 疝而左尺偏长。是又宿疾留经。而非无病之脉也。或寒入经腑。六部细长不鼓。
此非投以
辛热
不能蠲除也。若细长而鼓。又须清解。灵变在人耳。看得长脉多有兼见。不得偏执为悉无病
。但病得此。终非死脉。老人两尺脉沉长滑实。寿可期颐。且征瓜瓞之盛。若短脉不及本位
。应指而回。不能满部。主病为内虚。为喘满气促。为胃气弱。为头腹疼。诸病见短难治。
为真气不足。是又与长为霄壤之判。
实脉在浮取和沉取时都能感觉到，脉体宽大且长。脉搏跳动有力，按之坚实而不空虚。医经中说：血分实证则脉象实。又说：脉象实，是因为水谷之邪为病；又说：脉气来势坚实强劲，这叫做“太过”。大概实脉主要主火热有余的病证。或者出现发狂、说胡话的症状；或者是阳毒导致的大便干结；或者是咽喉和舌头僵硬；或者是脾热导致的胸腹痞满；或者是腰部和肠道壅滞疼痛；或者是健康人出现实大的脉象，主有痢疾，应当先用攻下法治疗；或者是疮疡疽毒脉象实，应当急用攻下法，因为邪气在体内故也。这些情况都适宜通利肠道、发汗，急切地解除繁重的火热之邪，就不需要再作其他考虑了。又有类似实脉的脉象，久病之人出现这种脉象，是孤阳外脱的表现，脉象必定先见到弦、数、滑、实。所以医书说：久病而脉象实的预后凶险。这可以用消伐（攻逐）的药物来治疗吗？还有沉寒内伏固结，脉道壅滞不通，脉象坚硬牢固如同实脉。这种情况又不可以一概使用寒凉药物，只用温热的姜、附子之类的药物就可以了。又有真阴严重亏损，虚火燎原，日益炽盛，脉象出现在关部呈现格拒洪大、弦急，好像实脉一样，几乎无计可施了。还可以用清凉的方法治疗吗？以上三种情况都是类似实脉，而不是真正的实脉。
长脉不大不小，悠长自然。如果像顺着长竹竿的末梢那样柔和，是平脉（正常脉象）；如果像拉紧的绳子那样绷直，则是病脉。长脉有三部皆长的，也有单部长长的。心脉长，表示神强气壮；肾脉长，表示根基稳固。医经说：长则气机调畅，短则气机有病。长脉主肝，短脉主肺，这都是平脉。与此相反则为有余的病证。如果不是阳毒或癫痫，就是阳明热邪深重。如果长而缓和，各种疾病都会痊愈。大概虽然长脉主病，但也属于轻浅的病症。又有类似长脉的脉象，或者是鳏夫寡妇思慕色欲不得满足，导致心肝两部脉象洪大而长，甚至溢出于鱼际部位。这些都是七情致病，而不是有器质性病变的脉象。或者是疝气导致左尺脉偏长，这是宿疾留在经络中，也不是没有病的脉象。或者是寒邪侵入经络脏腑，六部脉象细长且不鼓指。这种情况不用辛热药物不能祛除。如果脉象细长但鼓指有力，又须用清解的方法。灵活变通在于医者本人罢了。诊察长脉时多有兼见脉象，不能片面地认为完全没有病。但只要得了这种脉象，终究不是死脉。老人两尺脉沉、长、滑、实，可以预期长寿，并且能见证子孙昌盛。至于短脉，不及本位，应指即回，不能充满寸口各部。主病为内虚，为喘促气急，为胃气虚弱，为头腹疼痛。各种疾病见到短脉都难治，这是因为真气不足。这又与长脉有着天壤之别。
Shi Mai (Excess Pulse) can be felt in both floating and deep positions; it is large and long. It feels firm against the finger without being empty. The classics state: "When blood is excessive, the pulse is excess." It is said: "An excess pulse indicates disease caused by food and water [stagnation]." It is also said: "When the qi comes strong and solid, this is called 'excessive'." Generally, Shi Mai (Excess Pulse) primarily indicates diseases of excess heat and fire. Symptoms may include mania and delirium, or Yang Du (Yang Toxin) with constipation, or stiffness of the throat and tongue, or spleen heat with abdominal fullness, or congestion and pain in the waist and intestines. If a healthy person presents with a large and excess pulse, it indicates dysentery, and purgation should be used first. If an abscess or carbuncle presents with an excess pulse, urgent purgation is required because the pathogenic factor is in the interior. In all these cases, promoting bowel movement and sweating are suitable to urgently resolve the heavy fire pathogens, leaving no need for further deliberation. There is also a pulse resembling Shi Mai (Excess Pulse). In chronic illness, its appearance indicates the external collapse of isolated Yang. The pulse must first appear wiry, rapid, slippery, and excess. Therefore, medical texts state: "An excess pulse in chronic illness is ominous." Can it be treated with reducing and attacking agents? Furthermore, there is internal accumulation of severe cold causing stagnation in the pulse channels, resulting in a hard and firm pulse resembling Shi Mai (Excess Pulse). This condition cannot generally be treated with cold-natured medicines; only warm herbs such as Ginger (Zingiberis Rhizoma) and Aconite (Aconiti Lateralis Radix Praeparata) should be used. Additionally, when True Yin is severely depleted and deficiency fire blazes like a prairie fire, becoming increasingly intense, the pulse at the Guan position may show obstruction with a surging, large, wiry quality, appearing almost like an excess pulse, leaving few options. Can cooling methods still be applied? The above three conditions are all pulses resembling Shi Mai (Excess Pulse), not true Shi Mai (Excess Pulse).
Chang Mai (Long Pulse) is neither too large nor too small, extending leisurely and naturally. If it feels like tracing the tip of a long bamboo pole, it is a Ping Mai (Normal Pulse). If it feels like pulling a tight rope, it is a Bing Mai (Disease Pulse). Chang Mai (Long Pulse) can be long across all three positions or in one position. A long Heart Mai (Heart Pulse) indicates strong spirit and robust qi. A long Kidney Mai (Kidney Pulse) indicates a solid foundation and deep roots. The classics state: "Long indicates regulated qi; short indicates diseased qi." Chang Mai (Long Pulse) governs the Liver, while Duan Mai (Short Pulse) governs the Lung; both are considered Ping Mai (Normal Pulses). Deviating from this indicates an excess condition. Such conditions are either Yang Du (Yang Toxin) or epilepsy, or deep heat in the Yangming channel. If the pulse is long and moderate, various diseases will heal. Although Chang Mai (Long Pulse) generally indicates disease, it often belongs to mild and superficial conditions. There are also pulses resembling Chang Mai (Long Pulse). For example, in widowers or widows whose desires for sexual gratification are unfulfilled, the Heart and Liver positions may present with surging and long pulses overflowing into the Yuji area. These are all caused by emotional disturbances (Seven Emotions) rather than organic disease. Or, in cases of hernia, the left Chi position may be predominantly long, indicating a lingering old disease in the meridians, which is not a sign of health. If cold enters the meridians and fu organs, the six positions may present as thin and long without bulging under pressure. In such cases, acrid-warm herbs are necessary to dispel the pathogen. If the pulse is thin and long but bulges strongly, clearing and resolving methods are required. Flexibility lies with the practitioner. When examining Chang Mai (Long Pulse), combined pulses are common; one must not rigidly assume the absence of disease. However, if a patient has this pulse, it is ultimately not a death pulse. In the elderly, if the two Chi positions are deep, long, slippery, and excess, longevity can be expected, and flourishing descendants may be witnessed. Conversely, Duan Mai (Short Pulse) does not reach its proper position, retracts upon pressure, and fails to fill the entire cun-kou area. It indicates internal deficiency, panting and shortness of breath, weak stomach qi, headache and abdominal pain. Various diseases presenting with Duan Mai (Short Pulse) are difficult to treat due to insufficiency of True Qi. This stands in stark contrast to Chang Mai (Long Pulse).