肩前 ，上结缺盆，（并太阴脉行，故在 也。肩端之骨名肩 ，是则后骨之前，即肩前 也。）
下络胸里，散贯贲，合贲下，下抵季肋。（贲，谓膈也。筋虽不入脏腑，仍散于膈也。平按∶合贲
下《甲乙》作合胁下。下抵季肋《灵枢》作抵季胁。）其病当所过者支转筋痛，其成息贲者，胁
急吐血。治在燔针劫刺，以知为数，以痛为输，（息，谓喘息。肺之积，名息贲，在右胁下，大如
杯，久不愈，令人洒淅振寒热、喘咳、发肺痈也。平按∶其成息贲者《灵枢》、《甲乙》作甚成
息贲。）名曰仲冬痹。（十二月手之少阴，七月足之少阴，十一月手之太阴，八月足之太阴，十
月手心主厥阴，九月足厥阴，筋于此时感气为病，名为仲冬痹也。十二经脉，足之三阴三阳，配
十二月，手之三阴三阳，配甲乙等数，与此十二经筋不同，良以阴阳之气，成物无方故耳。）
手心主之筋，起于中指，与太阴之筋并行，结于肘内廉，上臂阴，结掖下，下散前后侠胁；
其支者，入掖，下散胸中，结于贲，（结于膈也。平按∶与太阴之筋并行《甲乙》作与太阳之经并
行。贲《灵枢》、《甲乙》均作臂。）其病当所过者支转筋，及胸痛息贲。治在燔针劫刺，以知
为数，以痛为输，名曰孟冬痹。（当此筋所过之处为痹，即是所行之筋为病也。平按∶转筋下《灵
枢》有前字，《甲乙》有痛手心主前五字。）
手少阴之筋，起于小指之内侧，结于兑骨，上结肘内廉，上入掖，交太阴，伏乳里，结于胸
中，循贲，（兑骨，谓掌后当小指下尖骨也。交手太阴已，伏于乳房之里，然后结于胸也。平按∶
《灵枢》、《甲乙》伏乳作挟乳，循贲作循臂。）下系于齐。其病内急，心承伏梁，下为肘纲。
其病当所过者则支转筋，筋痛。治在燔针劫刺，以知为数，以痛为输。其成伏梁唾脓血者，死不
治。（心之积，名曰伏梁，起齐上，如臂，上至心下。其筋循膈下齐，在此痛下，故曰承也。人肘
屈伸，以此筋为纲维，故曰肘纲也。平按∶唾《甲乙》作吐。）经筋之病，寒则筋急，热则施纵不
收，阴萎不用也。（凡十二经筋，寒则急，热则纵，不用之也。平按∶寒则下《灵枢》有反折二字，
《甲乙》同。）阳急则反折，阴急则俯不伸。（人背为阳，腹为阴。故在阳之筋急者，反折也；
在阴之筋急，则俯而不伸也。）淬刺者，刺寒急，热则筋纵，毋用燔针。（淬，千内反，谓烧针刺
之也。问曰∶热病皆有行灸，筋热为病，何以不用火针？答曰∶皮肉受于热病，脉通而易，故须
行灸；筋自受病，通之为难，寒热自在于筋，病以痛为输，不根据余输也。平按∶纵下《灵枢》、
《甲乙》有不收二字。针下《甲乙》有急刺二字。）名曰季冬痹。（经筋之病下，总论十二经筋；
此之一句，属手少阴筋也。）
足之阳明，手之太阳，筋急则口目为辟，目 急不能卒视，治皆如上方。（检手太阳有耳中
鸣、引颔、目瞑之言，无口目辟，亦可引颔即口目辟也。皆用前方寒急淬刺也。平按∶辟《灵枢》
作，《甲乙》作僻。 上《灵枢》无目字。）
The sinews at the front of the shoulder (the anterior aspect of the shoulder joint) ascend and knot at the Quepen (Large Intestine 15, "Clavicle Basin") acupoint. (Here, it runs parallel with the vessels of the Hand-Taiyin Lung Meridian, hence located here. The bone at the end of the shoulder is named Jianyu (Large Intestine 15), which refers to the position anterior to the posterior bone, i.e., the front of the shoulder.) Descending, it connects with the interior of the chest, spreads through the diaphragm (Ge, referring to the diaphragm; although sinews do not enter the Zang-Fu organs directly, they still spread around the diaphragm), converges below the diaphragm, and descends to reach the hypochondriac region (Ji Lei). (Ping An: *Jia Yi Jing* reads "converges below the hypochondrium" for "converges below Ge". *Ling Shu* reads "reaches the hypochondrium" for "descends to reach Ji Lei".) The pathological manifestations include supportiveness, spasms, and pain along the path of the sinews. If it develops into Xiben (Diaphragmatic Accumulation, a lung accumulation disease characterized by wheezing, located under the right hypochondrium, size of a cup, causing chills, fever, cough, asthma, and potentially lung abscess if chronic), there will be hypochondriac stiffness and hematemesis. This condition is called Zhongdong Bi (Mid-Winter Bi Syndrome). (In the twelfth month, the Hand-Shaoyin Heart Meridian governs; in the seventh month, the Foot-Shaoyin Kidney Meridian governs; in the eleventh month, the Hand-Taiyin Lung Meridian governs; in the eighth month, the Foot-Taiyin Spleen Meridian governs; in the tenth month, the Hand-Jueyin Pericardium Meridian governs; in the ninth month, the Foot-Jueyin Liver Meridian governs. When sinews contract pathogens during these times, the disease is named Zhongdong Bi. The twelve regular meridians' foot Yin-Yang meridians correspond to the twelve months, and hand Yin-Yang meridians correspond to the Heavenly Stems Jia-Yi, etc., which differs from the twelve sinew meridians, likely because the Qi of Yin and Yang generates things without fixed patterns.)
The sinews of the Hand-Jueyin Pericardium Meridian originate from the middle finger, run parallel with the sinews of the Hand-Taiyin Lung Meridian, knot at the medial aspect of the elbow, ascend along the medial aspect of the upper arm, knot at the axilla, and descend to spread anteriorly and posteriorly flanking the hypochondrium. Its branch enters the axilla, descends to spread within the chest, and knots at the diaphragm (Ping An: *Jia Yi Jing* reads "runs parallel with the Taiyang vessel" for "parallel with Taiyin sinews"; *Ling Shu* and *Jia Yi Jing* read "arm" for "Ge"). Pathological manifestations include supportiveness, spasms, chest pain, and Xiben along the path of the sinews. Treatment involves burning needle (Fanzhen) rapid puncture (Jieci), using the improvement of symptoms as the criterion for stopping, and using the painful point as the acupoint (Shu). This condition is called Mengdong Bi (Early Winter Bi Syndrome). (Bi syndrome at the location passed by this sinew indicates pathology of the running sinew. Ping An: *Ling Shu* adds "anterior" after "spasm"; *Jia Yi Jing* adds five characters "pain Hand Jueyin anterior" after "spasm".)
The sinews of the Hand-Shaoyin Heart Meridian originate from the medial side of the little finger, knot at the Dougu (Wrist Sesamoid Bone), ascend and knot at the medial aspect of the elbow, ascend into the axilla, intersect with the Hand-Taiyin, lie deep within the breast tissue, knot in the chest, follow the diaphragm, and descend to tie at the umbilicus. (Dougu refers to the sharp bone behind the palm corresponding to the little finger. After intersecting with Hand-Taiyin, it lies deep within the breast tissue before knotting in the chest. Ping An: *Ling Shu* and *Jia Yi Jing* read "clasp breast" for "lie deep in breast", and "follow arm" for "follow diaphragm".) Pathological manifestations include internal stiffness, Fulian (Trunk Beam, an heart accumulation disease starting above the umbilicus like an arm, extending to below the heart) supporting the heart, and forming the Zhougang (Elbow Gang) below. Along the path of the sinews, there is supportiveness, spasms, and sinew pain. Treatment involves burning needle rapid puncture, using symptom improvement as the criterion, and the painful point as the acupoint. If it develops into Fulian with expectoration of pus and blood, it is incurable. (Ping An: *Jia Yi Jing* reads "vomit" for "expectorate".) Sinew diseases caused by cold result in sinew stiffness; those caused by heat result in sinew laxity and inability to retract, leading to impotence and dysfunction. (For all twelve sinew meridians, cold causes stiffness, heat causes laxity, leading to loss of function. Ping An: *Ling Shu* adds "reverse folding" after "cold".) Yang-side stiffness causes reverse bending (opisthotonos); Yin-side stiffness causes forward flexion with inability to extend. (The back is Yang, the abdomen is Yin. Thus, stiffness in Yang sinews causes reverse bending; stiffness in Yin sinews causes forward flexion with inability to extend.) Quenci (Quenching needle/Red-hot needle) is used for cold-induced stiffness; for heat-induced sinew laxity, burning needles should not be used. (Qu means qiàn, referring to red-hot needle insertion. Question: Heat diseases often use moxibustion; why not use fire needles for heat-induced sinew disease? Answer: For skin and flesh affected by heat, meridians are open and easy to penetrate, so moxibustion is needed; for sinews themselves, unblocking is difficult. Cold and heat reside in the sinews; treatment uses the painful point as the acupoint, not other points. Ping An: *Ling Shu* and *Jia Yi Jing* add "unable to retract" after "laxity"; *Jia Yi Jing* adds "rapid puncture" after "needle under".) This condition is called Jidong Bi (Late Winter Bi Syndrome). (This sentence belongs to the Hand-Shaoyin sinew after the general discussion of the twelve sinew meridians.)
When the sinews of the Foot-Yangming Stomach Meridian and the Hand-Taiyang Small Intestine Meridian are stiff, the mouth and eyes deviate to one side (Pi), and the eyes are stiff, preventing sudden vision. Treatment follows the methods described above. (Checking the Hand-Taiyang meridian, there are mentions of tinnitus, jaw traction, and eye closure, but no mention of deviation; it can be inferred that jaw traction implies deviation. All use the aforementioned cold-stiffness quenching needle method. Ping An: *Ling Shu* reads "Pi" for "Bì"; *Jia Yi Jing* also reads "Pi". *Ling Shu* lacks the character "eye" before "Bì".)