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。）
肩前（指肩关节前方部位），向上结聚于缺盆穴，（此处与手太阴肺经的脉气并行，所以位于此处。肩端的骨头称为肩髃，这就是后骨之前的位置，即肩前部位。）向下联络胸中内部，散布贯穿膈肌，汇合于膈肌下方，向下抵达季肋部。（贲，指的是膈肌。筋虽然不直接进入脏腑，但仍散布在膈肌周围。平按：《甲乙经》中“合贲下”写作“合胁下”。《灵枢》中“下抵季肋”写作“抵季胁”。）其病症表现为筋经过的地方出现支撑感、转筋和疼痛，如果发展成息贲病，则会出现胁部拘急和吐血。（息，指喘息。这是肺的积病，名叫息贲，位于右胁下，大小如杯，久治不愈，会导致人体洒淅恶寒发热、气喘咳嗽，甚至引发肺痈。平按：《灵枢》和《甲乙经》中“其成息贲者”写作“甚成息贲”。）这种病名叫仲冬痹。（十二月是手少阴心经主令，七月是足少阴肾经主令，十一月是手太阴肺经主令，八月是足太阴脾经主令，十月是手厥阴心包经主令，九月是足厥阴肝经主令。筋在这些时候感受邪气而发病，称为仲冬痹。十二经脉中，足的三阴三阳配属十二月，手的三阴三阳配属天干甲乙等数，这与十二经筋不同，大概是因为阴阳之气化生万物没有固定规律的原因。）
手厥阴心包络之筋，起于中指，与手太阴肺经之筋并行，结聚于肘内侧，沿上臂内侧上行，结聚于腋下，向下散布于前后两侧夹持胁肋；其分支进入腋下，向下散布于胸中，结聚于膈肌，（结聚于膈肌处。平按：《甲乙经》中“与太阴之筋并行”写作“与太阳之经并行”。《灵枢》和《甲乙经》中“贲”均写作“臂”。）其病症表现为筋经过的地方出现支撑感、转筋，以及胸痛和息贲。治疗采用燔针劫刺法，以病情好转为度，以痛点作为腧穴，这种病名叫孟冬痹。（当此筋经过之处发生痹证，就是所行经的筋发生病变。平按：《灵枢》中“转筋”下有“前”字，《甲乙经》中有“痛手心主前”五个字。）
手少阴心经之筋，起于小指内侧，结聚于腕部豆骨（兑骨），向上结聚于肘内侧，向上进入腋下，与手太阴肺经之筋相交，伏行于乳房内部，结聚于胸中，沿膈肌下行，向下系于脐部。（兑骨，指的是手掌后方对应小指下方的尖骨。交手太阴之后，伏行于乳房之内，然后结聚于胸中。平按：《灵枢》和《甲乙经》中“伏乳”写作“挟乳”，“循贲”写作“循臂”。）其病症表现为体内拘急，心脏部位有伏梁积聚，下部形成肘纲。其病症表现为筋经过的地方出现支撑感、转筋和筋痛。治疗采用燔针劫刺法，以病情好转为度，以痛点作为腧穴。如果发展成伏梁并咳唾脓血的，属于不治之症。（心的积病，名叫伏梁，起于脐上，如手臂粗细，向上至心下。此筋沿膈肌下行至脐，在此处疼痛向下牵引，所以叫“承”。人屈伸肘部，以此筋为纲维，所以叫“肘纲”。平按：《甲乙经》中“唾”写作“吐”。）经筋的病变，受寒则筋脉拘急，受热则筋脉弛纵不收，导致阳痿不用。（凡是十二经筋，受寒则拘急，受热则弛纵，导致功能丧失。平按：《灵枢》中“寒则”下有“反折”二字，《甲乙经》同。）阳气侧筋急则身体向后反折，阴气侧筋急则身体向前俯曲不能伸展。（人的背部属阳，腹部属阴。所以在阳侧的筋急，表现为反折；在阴侧的筋急，表现为俯身而不能伸展。）淬刺法，用于针刺寒性拘急，热性则筋脉弛纵，不要用燔针。（淬，音qiàn，指烧红的针刺入。问：热病都有用灸法的，筋受热致病，为什么不用火针？答：皮肉受于热病，脉络通畅容易渗透，所以需要施灸；筋自身受病，疏通比较困难，寒热邪气自在于筋，治病以痛点为腧穴，不依据其他腧穴。平按：《灵枢》和《甲乙经》中“纵”下有“不收”二字。《甲乙经》中“针下”有“急刺”二字。）这种病名叫季冬痹。（在论述完经筋之病后，总论十二经筋；这一句属于手少阴心经之筋。）
足阳明胃经和手太阳小肠经的筋发生拘急时，口眼会向一侧歪斜，眼睛拘急不能突然视物，治疗都按照上述方法。（检查手太阳经有耳中鸣、牵引下颌、目瞑的描述，没有口眼歪斜的说法，也可以理解为牵引下颌即为口眼歪斜。都使用前述的寒急淬刺法。平按：《灵枢》中“辟”写作“僻”，《甲乙经》也作“僻”。《灵枢》中“辟”字上没有“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".)