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。
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).