What are "Tzinim Pachim"?
Bava Metzi'a 107b: They are chills and fevers 1 .
Rashi: Tzinim are like "veli'Tzninim b'Tzideichem" (Bamidbar 33:55), "u'Va'u Alayich Hotzen" (Yechezkel 23:24). It is an expression of troops and robbers. Tzinim Pachim are hidden in crooked paths. I.e. afflictions are prepared for [an Ikesh].
R. Yonah: They are thorns and stumbling blocks.
What is "Derech Ikesh"?
R. Yonah: Sometimes one abandons the straight path, and he goes in a crooked, unpaved path to shorten his way. In the crooked path he finds thorns and stumbling blocks.
Refer to 17:20:1:2.
Malbim: The straight path for the Nefesh is the middle path. The Derech that leans from the middle to the extreme of excess or deficiency, it is crooked; it departs from straightness.
What do we learn from "Tzinim Pachim b'Derech Ikesh [Shomer Nafsho Yirchak Mehem]"?
Bava Metzi'a 107b: Whatever befalls one is decreed by Heaven, except for chills and fevers (they are due to lack of caution).
R. Yonah: Because people do not go on the crooked path, thorns arise and no one removes stumbling blocks. He will be stricken via the stumbling blocks or thorns.
Malbim: The verse gives a Mashal from nature. Medium air is healthy for the body. If it is too hot it burns the blood; red, dryness and fire overpower. This is Pachim - burning coals. On the side of deficiency, coldness overpowers; this constricts the blood. Tzinim is illness from excess cold. Both of them kill the body. The same applies to conduct of the Nefashos. On the extreme of excess, fire burns it. On the extreme of deficiency, cold and slackening freeze him.
How does Shomer Nafsho distance from them?
Rashi: He straightens his deeds; he will be saved from them.
R. Yonah: He goes on the straight path, and distances from the thorns and stumbling blocks on the crooked path. He gets to his destination without any harm. This Mashal teaches about "Ekev Anavah Yir'as Hashem Osher v'Chavod v'Chayim" (4). Worldly success comes from going on the straight path, aside from the true advantage that the Nefesh gets from it - he guards and is saved from sin. Yir'as Hashem that comes from humility is the foundation of guarding from every sin. One who seeks honor and wealth, he will seek to get them quickly amidst pride and robbery, he will find damage and stumbling blocks for his body in this world, and for his Nefesh in the world to come.
Malbim: He distances from the extremes, and goes in the middle path.