Abstract: To investigate whether the onset of acute gouty arthritis is influenced by the theory of five evolutive phases and six climatic factors and how syndrome differentiation and treatment can be conducted based on this theory， a retrospective study was designed. Clinical data were collected from 892 patients diagnosed with acute gouty arthritis from the Department of Rheumatology， the First Affiliated Hospital of Henan University of Chinese Medicine， from January 20， 2014， to January 20， 2024. Descriptive statistical analysis and the Chi-square test were employed to examine the incidence differences of the disease under various conditions of annual evolutive phase， principal evolutive phase， principal qi and guest qi. The results showed that periods with high disease incidence corresponded to the overabundant fire of annual evolutive phase， the overabundant fire of principal evolutive phase， and the Taiyin damp earth as principal qi； While periods with low incidence included the overabundant earth of annual evolutive phase， the deficient fire of principal evolutive phase， and the Yangming dry metal as principal qi. Significant differences were observed in the incidence of acute gouty arthritis among different periods governed by five evolutive phases and six climatic factors. The fluctuation of disease incidence may be correlated with pathogenic fire and dampness. Therefore， the pathogenic fire and dampness should be prioritized in clinical intervention， and herbs for clearing heat and eliminating dampness should be prescribed correspondingly.