体象 实脉有力，长大而坚；应指 ，三候皆然。
主病 血实脉实，火热壅结。左寸心劳，舌强气涌。右寸肺病，呕逆咽疼。左关见实，肝
火胁痛。右关见实，中满气疼。左尺见实，便闭腹疼。右尺见实，相火亢逆。
兼脉 实而且紧，寒积稽留。实而且滑，痰凝为祟。
【按】实之为义，邪气盛满，坚劲有余之象也。既大矣而且兼长，
既长大矣而且有力，既长大有力矣，而且浮中沉三候皆然，则诸阳之象，
莫不毕备焉。见此脉者，必有大邪大热，大积大聚，故王叔和《脉经》云∶
“实脉浮沉皆得，脉大而长微弦，应指 然。”又曰∶“血实脉实。”又曰∶
“脉实者，水谷为病。”又曰∶“气来实强，是谓太过。”由是测之，则但主实
热，不主虚寒，较若列眉矣。故叔和有尺实则小便难之说。乃伪诀谬以
尺实为小便不禁，奈何与叔和适相反耶！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；盖紧脉弦急如切绳，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；以症合之，以理察之，便昭然于
心目之间，而不可混淆矣。
又按∶张洁古惑于伪诀实主虚寒之说，而遂以姜、附施治，此甚不可为训也。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，其不立毙者几希矣。以洁古之智，当必是兼紧之治无疑耳。
【体象】实脉的特征是脉搏有力，形态长大且坚实；手指按压时，浮、中、沉三候都呈现这种状态。
【主病】血分实证见实脉，多因火热邪气壅结所致。左寸部出现实脉，提示心经劳损，症状为舌体僵硬、气逆上涌。右寸部出现实脉，提示肺脏病变，症状为呕吐、呃逆、咽喉疼痛。左关部出现实脉，提示肝火旺盛，症状为胁肋部疼痛。右关部出现实脉，提示中焦胀满、气机疼痛。左尺部出现实脉，提示二便闭塞、腹部疼痛。右尺部出现实脉，提示相火亢盛上逆。
【兼脉】实脉兼见紧脉，提示寒邪积滞停留体内。实脉兼见滑脉，提示痰浊凝结为患。
【按语】所谓“实”的含义，是指邪气盛满，呈现出坚硬强劲、有余的状态。既然脉形已经宏大而且兼有长象，既然既宏大又长而且有力，既然既宏大、长又有力量，而且在浮、中、沉三候都如此表现，那么各种阳脉的特征就没有不全具备的了。诊察到这种脉象的人，必定患有大邪、大热、大积、大聚之证，所以王叔和在《脉经》中说：“实脉在浮取和沉取都能触及，脉象大而长且略微带弦，手指按压时感觉充实有力。”又说：“血分实证可见实脉。”又说：“脉象实的，是水谷饮食致病。”又说：“脉气来势坚实强劲，这叫做‘太过’。”由此推测，实脉主要主实热证，而不主虚寒证，这就如同眉毛一样清晰明了了。所以王叔和有尺脉实则小便困难的论述。然而伪托的诀文中错误地将尺脉实解释为小便失禁，这与王叔和的观点恰恰相反！又妄称如果脉象像绳子一样应指而来，那是紧脉的形状，而不是实脉的形象。紧脉与实脉，虽然相似但实际上相差甚远；因为紧脉弦急如切绳，左右弹击人手，而实脉则是既大又长，三候都有力。紧脉是因为热被寒邪束缚，所以其形象绷急而不宽舒；实脉是因为邪气被火邪逼迫，所以其形象坚硬满实而不柔和；结合症状，从道理上考察，就心中明白、眼中清晰了，不可混淆。
又按：张洁古被伪诀中“实脉主虚寒”的说法所迷惑，于是使用干姜、附子进行治疗，这非常不值得作为典范。如果是实脉兼见紧脉，或许还相当对应；如果不是紧脉的象，却对大热之人施用大温热的药剂，不立即死亡的几率极小了。以张洁古的智慧，应当一定是针对兼见紧脉的情况治疗，毫无疑问。
[Physical Characteristics] The characteristics of a Full pulse (Shi Mai) are that it is forceful, long and large in shape, and firm; upon finger pressure, the Floating (Fu), Middle (Zhong), and Deep (Chen) positions all exhibit this state.
[Etiology and Pathogenesis] A Blood Excess condition presenting with a Full pulse is mostly caused by the accumulation and knotting of Fire-Heat pathogenic factors. If a Full pulse appears at the Left Cun position, it indicates Heart exhaustion, with symptoms of tongue stiffness and surging Qi. If a Full pulse appears at the Right Cun position, it indicates Lung disease, with symptoms of vomiting, belching or hiccups, and throat pain. If a Full pulse appears at the Left Guan position, it indicates Liver Fire, with symptoms of hypochondriac pain. If a Full pulse appears at the Right Guan position, it indicates middle-jiao fullness and Qi-related pain. If a Full pulse appears at the Left Chi position, it indicates constipation and abdominal pain. If a Full pulse appears at the Right Chi position, it indicates hyperactivity and counterflow of Ministerial Fire (Xiang Huo).
[Combined Pulses] A Full pulse combined with a Tight pulse (Jin Mai) indicates stagnation of Cold accumulation within the body. A Full pulse combined with a Slippery pulse (Hua Mai) indicates pathology caused by phlegm coagulation.
[Commentary] The meaning of "Full" refers to the state where pathogenic factors are abundant and overflowing, presenting an image of firmness, strength, and excess. Since the pulse shape is already large and long, since it is both large and long and forceful, and since it exhibits these qualities in the Floating, Middle, and Deep positions, all characteristics of Yang pulses are fully present. Those who observe this pulse must suffer from major pathogens, major heat, major accumulations, and major masses. Therefore, Wang Shuhe stated in *Mai Jing* (Pulse Classic): "A Full pulse can be felt in both floating and deep palpations; the pulse is large, long, and slightly wiry, feeling solid and forceful under the fingers." He also said: "In cases of Blood Excess, the pulse is Full." He further stated: "When the pulse is Full, it is due to disorders of water and grain [diet]." He also said: "When the Qi comes forth solid and strong, this is called 'Excess' (Tai Guo)." From this, we can deduce that the Full pulse primarily indicates Excess-Heat conditions, not Deficiency-Cold conditions; this distinction is as clear as seeing one's eyebrows. Thus, Wang Shuhe held the view that a Full pulse at the Chi position leads to difficulty in urination. However, spurious formulas erroneously interpret a Full pulse at the Chi position as urinary incontinence, which is exactly opposite to Wang Shuhe's view! They also falsely claim that if the pulse feels like a rope responding to the finger, it is the form of a Tight pulse, not the image of a Full pulse. Although the Tight pulse and the Full pulse are similar, they are actually vastly different; the Tight pulse is wiry and urgent like a cut rope, rebounding against the hand left and right, whereas the Full pulse is both large and long, and forceful in all three positions. The Tight pulse occurs when Heat is constrained by Cold, so its image is tense and unrelaxed; the Full pulse occurs when pathogenic factors are driven by Fire, so its image is hard and full rather than soft and harmonious. By correlating with symptoms and examining through reason, the distinction becomes clear in mind and eye, and should not be confused.
[Further Commentary] Zhang Jiegu was misled by the spurious formula claiming that the Full pulse indicates Deficiency-Cold, and consequently used Gan Jiang (Dried Ginger) and Fu Zi (Prepared Aconite Root) for treatment; this is highly inadvisable as a model. If the Full pulse is combined with a Tight pulse, such treatment might be appropriate; but if there is no Tight pulse image, applying strongly warming agents to a person with major Heat will rarely fail to cause immediate death. Given Zhang Jiegu's wisdom, he undoubtedly treated cases where the Full pulse was combined with a Tight pulse.