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。
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.