Authors: Wang Zhangsheng ，Song Yuqing ，Han Kaiyue ，Sun Guifang ，Guzailinur Silimu ，Fan Yaohua
1. Fudan University Affiliated Shanghai Fifth People’s Hospital, Fudan University Community
Health Research Center, Minhang District, Shanghai, China;
2. Department of Traditional Chinese Medicine, Maqiao Community Health Service Center,
Minhang District, Shanghai, China;
3. Department of Cardiovascular Diseases, Zepu County People’s Hospital, Kashgar Prefecture,
Xinjiang Uygur Autonomous Region, Zepu County, Kashgar Prefecture,
Xinjiang Uygur Autonomous Region;
4. Henan Wuyun Liuqi Medical Center, Henan Province, China
Corresponding Author: Fan Yaohua
Abstract
To investigate the distribution characteristics and differences in Five Movements and Six Qi attributes associated with the birth dates and onset dates of patients with atrial fibrillation (AF).
Methods: From January 2009 to March 2021, a total of 1,922,693 electrocardiograms (ECGs) obtained during physical examinations or hospital visits at community hospitals in Minhang District, Shanghai, were collected through the MUSE system. Information on birth dates and onset dates of atrial fibrillation was extracted, and the distribution characteristics of the Five Movements and Six Qi were calculated. Descriptive statistics and the chi-square tests were performed.
Results: After excluding repeated examinations and ECGs with incomplete information, 20,448 ECGs showing atrial fibrillation were included in the final analysis. Regarding birth-date Five Movements and Six Qi attributes, the most frequent characteristics were excessive Soil movement in annual movement, excessive Water movement in host movement, insufficient Metal movement in guest movement, Taiyang Cold-Water in host qi, Minor Yin Ruling-Fire in guest qi, and Minor Yin Ruling-Fire in the corresponding Sitian qi. Regarding onset-date attributes, the most frequent characteristics were excessive Wood movement in annual movement, insufficient Fire movement in host movement, excessive Soil movement in guest movement, Minor Yang Minister-Fire in host qi, Jueyin Wind-Wood in guest qi, and Jueyin Wind-Wood in the corresponding Sitian qi. Fire qi and Water qi were the most common heavenly-stem attributes on onset days. In qi interaction analysis, accommodation and heavenly penalty (Tianxing, 天刑) were the most frequent forms of yunqi transformation. Analysis of qi correspondence showed that “same-year convergence” (Tong Sui Hui, 同歲會) and “heavenly-day conformity” (Tong Tian Fu, 同天符) were the most common patterns. Differences in the above distributions were statistically significant except for birth-date guest qi and birth-date Sitian qi (P < 0.05).
Conclusion: The Five Movements and Six Qi attributes of both birth dates and onset dates in patients with atrial fibrillation show distinct distribution patterns, suggesting that time-related yunqi characteristics may contribute to AF susceptibility.
Keywords: Five Movements and Six Qi (Yunqi); atrial fibrillation; temporal risk factors
1. Introduction
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias, and its incidence continues to increase with population aging in China. According to data from a large-scale epidemiological survey conducted in China, approximately 4.87 million individuals suffer from AF.¹ In the past, AF was generally regarded as a benign arrhythmia. However, studies conducted over the past two decades have demonstrated that AF is an independent risk factor for stroke and is associated with high disability and mortality rates. AF also plays an important role in the progression of congestive heart failure. Therefore, the prevention and treatment of AF have become important topics in clinical practice and medical research.
Currently, no universally accepted international classification standard for AF exists. Based on clinical manifestations, AF is generally classified as first-detected, paroxysmal, persistent, or permanent to guide clinical management. The management of AF focuses on addressing its underlying causes. However, because the etiology of AF is complex and diagnostic uncertainty often exists, identifying common etiological and triggering factors is of great clinical significance.
The traditional Chinese medical theory of Five Movements and Six Qi is an ancient theoretical system used to study climatic variations and their influence on human physiological activities.² It correlates natural climatic phenomena with human biological activities and integrates climate-related variations with disease occurrence, therapeutic principles, and preventive health strategies. Analyzing the pathogenesis of AF within the framework of Five Movements and Six Qi theory may provide new perspectives for the prevention and intervention of AF.
This study analyzed AF cases in Minhang District, Shanghai, over a continuous 12-year period to investigate the relationship between congenital yunqi characteristics and onset-related yunqi factors, with the aim of providing reference data for identifying populations and time periods susceptible to AF.
2. Materials and Methods
2.1. Data sources
The data for this study were obtained from patients diagnosed with atrial fibrillation in the MUSE electrocardiographic database in Minhang District, Shanghai, between January 2009 and March 2021. Exclusion criteria included patients without birth-date records and those born on solar-term transition days.
2.2 Data processing
2.2.1 The celestial stems and terrestrial branches corresponding to each patient’s birth year were extracted from the medical records. The ten celestial stems are Jia, Yi, Bing, Ding, Wu, Ji, Geng, Xin, Ren, and Gui. The twelve terrestrial branches are Zi, Chou, Yin, Mao, Chen, Si, Wu, Wei, Shen, You, Xu, and Hai.
2.2.2 Determination of the annual movement (Suiyun, 歲運) based on birth year. The patients were classified into Five Movements according to the celestial stems of the birth year, namely, Jia–Ji (Soil), Yi–Geng (Metal), Bing–Xin (Water), Ding–Ren (Wood), and Wu–Gui (Fire). Each year’s Five Movement attribute is categorized as either excessive (Taiguo) or insufficient (Buji). Accordingly, ten types of annual movement attributes were identified: excessive wood, insufficient fire, insufficient soil, excessive metal, excessive water, insufficient wood, excessive fire, excessive soil, insufficient metal, and insufficient water.
2.2.3 Determination of Five-Movement attributes of the birth date:
The Five Movements are divided into Host Movement (Zhuyun, 主運) and Guest Movement (Keyun, 客運). The Host Movement divides the year into five sequential phases: Wood Season, Fire Season, Soil Season, Metal Season and Water Season. These five seasons correspond to the five movements. The Guest Movement is also divided into five seasonal phases according to the same Wood, Fire, Soil, Metal and Water sequence. However, the order of the Guest Movement is not fixed. It is determined by the annual yunqi configuration.
2.2.4 Determination of Six-Qi attributes of the birth date
The Six Qi consist of the Host Qi and the Guest Qi. The Host Qi is divided into six steps, and each step corresponds to four solar terms. The initial qi begins on the day of Major Cold (Da han,大寒) and is called “Jueyin Wind-Wood”(Jueyin Fengmu,厥陰風木). The second qi is called “Shaoyin Imperial Fire” (Shaoyin Junhuo,少陰君火 ). The third qi is called “Minor Yang, Ministerial Fire” (Shaoyang Xianghuo, 少陽相火). The fourth qi is called “Major Yin, Taiyin Dampness-Earth” (Taiyin Shitu,太陰濕土). The fifth step is called “Yangming Dryness-Metal” (Yangming Zaojin,陽明燥金). The final qi is called “Taiyang, Cold Water” (Taiyang Hanshui,太陽寒水). Each step governs approximately 60 days, and only three of these steps correspond to the heavenly qi. The Guest Qi is also divided into six steps, but its sequence varies from year to year and is determined by the annual heavenly configuration. Detailed calculation methods can be found in the relevant monographs3-5.
2.2.5 Statistical Methods
After data processing according to the above procedures, a database of patients with atrial fibrillation was established. SPSS 25.0 was used for statistical analysis. Descriptive statistics were applied to examine the distribution of the birth dates and onset dates of patients with atrial fibrillation across different yunqi periods and across different Host Qi and Guest Qi phases. The chi-square test was used to evaluate differences in these distributions. P < 0.05 was considered statistically significant.
2.3 Ethics Statement
This study was approved by the Ethics Committee of Shanghai Fifth People’s Hospital. Because the study involved retrospective analysis of anonymized data, the requirement for obtaining informed consent was waived by the committee. All procedures complied with the principles of the Declaration of Helsinki.
3. Results
3.1 ECG Screening and Subject Selection
A total of 1,922,693 ECG records were obtained from the MUSE electrocardiographic database. After excluding 1,882,266 non-AF ECG records, 17,914 duplicate examinations from the same individuals, 415 records without birth-date information, 893 records with birth dates occurring on solar-term transition days, and 757 records with invalid birth-date information, 20,448 subjects were ultimately included in the analysis.
3.2 Five-Movement and Six-Qi Attributes of Birth Dates in Patients with AF
The distribution of birth-year annual movements differed significantly among categories, with excessive Soil and insufficient Fire being the most common patterns, whereas excessive Fire and insufficient Soil were the least common (χ² = 24.00, P < 0.01).
In the birth-date Host Movement analysis, excessive Water and insufficient Water were the most frequent patterns (χ² = 297.9, P < 0.01).
In the birth-date Guest Movement analysis, insufficient Metal and excessive Water were the most common patterns (χ² = 26.04, P < 0.01).
In the birth-date Host Qi analysis, Taiyang Cold-Water and Jueyin Wind-Wood were the most frequent patterns (χ² = 319.5, P < 0.01), as shown in Figure 1.
Figure 1 Five Motions and six qi attributes at birth
3.3 Five-Movement and Six-Qi Attributes of Onset Dates in Patients with AF
In the onset-day Host Movement analysis, insufficient Fire and excessive Soil were the most common patterns (χ² = 734.3, P < 0.01).
In the onset-day Guest Movement analysis, excessive Soil and insufficient Fire were the most common patterns (χ² = 158.1, P < 0.01).
In the onset-day Host Qi analysis, Shaoyang Ministerial Fire and Shaoyin Imperial Fire were the most frequent patterns (χ² = 439.1, P < 0.01).
In the onset-year Sitian Qi analysis, Taiyang Cold-Water and Jueyin Wind-Wood were the most common patterns (χ² = 1821, P < 0.01), as shown in Figure 2.
Figure 2 Five Motions and six qi attributes of onset day
3.4 Distribution of Daily Heavenly Stem and Terrestrial Branch Attributes
Chi-square analysis of the distribution of daily Heavenly Stem and Terrestrial Branch attributes on AF onset dates showed significant differences across the ten-category classification system (χ² = 205.8, P < 0.01).
Under the Five-Element classification system, AF onset occurred more frequently on Fire- and Water-dominant days (χ² = 170.5, P < 0.01), as shown in Figure 3.
Figure 3 Daily heavenly stems and earthly branches
3.5 Combined Analysis of Five-Movement and Six-Qi Attributes
Due to the COVID-19 pandemic, the number of AF-related ECG records collected in 2020 and 2021 decreased considerably. Therefore, onset-year annual movements were excluded from the combined analysis.
Joint analysis of five birth-related attributes, including birth-year Annual Movement, birth-date Host Movement, birth-date Guest Movement, birth-date Host Qi, and birth-date Guest Qi, revealed significant differences in distribution patterns. The most frequent combination pattern is shown in Table 1, whereas the least frequent combination pattern is also presented in Table 1.
Joint analysis of five onset-related attributes, including birth-date Host Movement, onset-date Host Movement, birth-date Host Qi, onset-date Host Qi, and onset-year Sitian Qi, also showed significant differences in distribution patterns. Two combined patterns exhibited the highest frequencies, as presented in Table 2.
Table 1. Birth Five-Movements and Six-Qi Types Associated with Susceptibility or Protection Against Atrial Fibrillation
| Constitution Type | Cases (in descending order) |
| Excessive Wood – Excessive Wood – Excessive Wood – Jueyin, Jueyin Wind-Wood – Shaoyin Imperial Fire | 212 |
| Insufficient Fire – Excessive Water – Insufficient Wood – Taiyang, Cold Water – Shaoyin Imperial Fire | 196 |
| Insufficient Wood – Insufficient Wood – Insufficient Wood – Jueyin, Jueyin Wind-Wood – Yangming Dryness-Metal | 195 |
| Excessive Earth – Excessive Water – Excessive Fire – Taiyang, Cold Water – Major Yin, Taiyin Dampness-Earth | 184 |
| …… | …… |
| Excessive Water – Excessive Wood – Excessive Water – Shaoyin Imperial Fire – Major Yin, Taiyin Dampness-Earth | 10 |
| Excessive Fire – Insufficient Wood – Excessive Fire – Shaoyin Imperial Fire – Yangming Dryness-Metal | 10 |
| Insufficient Water – Insufficient Wood – Insufficient Water – Shaoyin Imperial Fire – Taiyang, Cold Water | 10 |
| Excessive Earth – Excessive Wood – Excessive Earth – Shaoyin Imperial Fire – Jueyin, Jueyin Wind-Wood | 7 |
Table 2. Combined Birth–Onset Five-Movements and Six-Qi Types Associated With Atrial Fibrillation Susceptibility
| Constitution Type | Cases (in descending order) |
| Excessive Water – Insufficient Fire – Taiyang Cold-Water – Shaoyin Imperial Fire – Taiyang Cold-Water | 57 |
| Excessive Wood – Excessive Earth – Jueyin, Jueyin Wind-Wood – Major Yin, Taiyin Dampness-Earth – Taiyang Cold-Water | 57 |
| Insufficient Water – Insufficient Fire – Taiyang Cold-Water – Shaoyin Imperial Fire – Taiyang Cold-Water | 56 |
| Excessive Water – Excessive Fire – Taiyang, Cold Water – Shaoyin Imperial Fire – Jueyin, Jueyin Wind-Wood | 54 |
| Insufficient Wood – Excessive Earth – Jueyin, Jueyin Wind-Wood – Minor Yang, Ministerial Fire – Taiyang, Cold Water | 53 |
| Excessive Wood – Excessive Earth – Jueyin, Jueyin Wind-Wood – Minor Yang, Ministerial Fire – Taiyang, Cold Water | 53 |
4. Discussion
The Yellow Emperor’s Canon of Medicine states that “Human beings are born from the Qi of Heaven and Earth and are shaped by the laws of the four seasons.” Human life is a product of natural cyclical changes, and temporal factors play an important role in the formation of innate constitution as well as in the occurrence and progression of acquired diseases. The theory of Five Movements and Six Qi provides a time-based framework for interpreting cyclical natural changes and their influence on physiological and pathological processes. The chapter Plain Conversation – Discussion on the Association of Zang-Qi with the Four Seasons describes the temporal patterns of stability, improvement, aggravation, and death in the diseases of the five zang organs. For example, it states heart disease heals in late summer; if it does not heal in late summer, it will worsen in winter; if it does not result in death in winter, it will stabilize in spring and improve in summer. Patients should avoid hot-natured food and warm clothing. Heart disease improves in the days of Wu and Ji; if not, it worsens in the days of Ren and Gui; if not fatal in Ren and Gui, it becomes stable in Jia and Yi and improves in Bing and Ding. Symptoms improve at noon, worsen at midnight, and calm at dawn. Because the heart is Yang within Yang and corresponds to Fire in the Five Elements, it is particularly vulnerable to Cold influences.
Professor Zhou Ciqing3 noted that “Yin deficiency with inability to contain Yang is the primary mechanism of atrial fibrillation… resulting in irregular, rapid, or finch-pecking pulse.” The terminal Qi “Taiyang, Cold Water” occurs from approximately November 20 to January 20, when ambient temperature is lowest and Yang-Qi weakest. During this period, the body is especially susceptible to Cold-Water pathogenic influences. Sudden temperature drops can increase sympathetic tone and elevate catecholamine levels, triggering tachycardia, increased premature beats, and potentially atrial fibrillation.
In this study, we analyzed the distribution characteristics of birthday and onset date yunqi attributes of patients with atrial fibrillation for 12 consecutive years and found that the difference in attribute distribution was statistically significant (P < 0.05). We found that when “controlling heaven” qi is “Jueyin, wind-wood”, atrial fibrillation is easy to develop. The years when “Jueyin, wind-wood” controlling heaven is Guisi and Jihai. [In the years of] Guisi (the same with Year-Convergence), Jueyin [dominates the heavens] and Shaoyang [is in the Spring]. [Since Wugui is a year of Fire-Motion and Gui symbolizes the year of Yin, the Motion is] Shaozhi. [When Fire-Motion is insufficient,] the Cold-Qi [of Water that restricts Fire is in domination] and the Rainy-Qi [of Soil that is generated by Fire retaliates. During this year, the dominating Qi and the retaliating Qi are] the same. [In these two years, ] the Motion is heat, [the dominating Qi is] cold [and the retaliating Qi is] rain7. [In the years of] Jihai, Jueyin [dominates the heavens] and Shaoyang [is in the Spring]. [Since Jiaji is a year of Soil-Motion and Ji symbolizes the year of Yin, the Motion is] Shaogong. [When Soil-Motion is insufficient,] the Wind-Qi [of Wood is in domination and] the Clear-Qi [of Metal that is generated by Soil] retaliates. [During this year, the dominating Qi and the retaliating Qi are] the same. [Because Soil-Motion is insufficient, it is conquered by Wood-Qi that dominates the heavens. So, Wood has taken the advantage of Soil transformation and becomes predominant. That is why it is] the same with [Wood-Motion]. [In this year, ] the Motion is rain, [the dominating Qi is] wind [and the retaliating Qi is] clear8. So, in the years of Guisi and Jihai, the dominating Qi and the retaliating Qi are the same, which is not conducive to heart fire.
With respect to annual movement at birth, individuals born in years of excessive Soil-Movement were most susceptible to atrial fibrillation. Onset years included Jichou, Renchen, and Xinchou. Because Renchen Earth contains Gui-Water, and Water restrains Fire, Renchen Earth consequently suppresses Heart-Fire. As stated in the Major Discussion on the Changes of Qi-Convergence, “When Soil-Movement is excessive, Rain-Qi and Dampness prevail.” In such years, climatic characteristics include high humidity and increased precipitation. Previous research has shown correlations between relative humidity and the incidence of heart disease.9 Therefore, the acquired onset of atrial fibrillation can also be influenced by Dampness. This suggests that individuals born in Jia years (characterized by excessive Soil-Movement) should likewise take precautions for AF prevention.
We also found that atrial fibrillation onset occurred more frequently on days dominated by Fire-Qi or Water-Qi. Since the heart corresponds to Fire in the Five Elements, excessive Fire-Qi or excessive Water-Qi can respectively lead to hyperfunction or hypofunction of Heart-Qi, thereby increasing susceptibility to arrhythmogenesis.
The theory of Five Movements and Six Qi has profound significance for disease prevention and treatment in both ancient and modern contexts and represents a valuable legacy of traditional Chinese medicine. With the integration of big-data analytics, the application of yun-qi theory in disease prediction has become an important direction in the modernization of traditional Chinese medicine2. Continued development and empirical validation of this theoretical system may help traditional Chinese medicine move beyond empirical practice into a more structured theoretical discipline, contributing to improved scientific rigor and refinement of its foundational medical framework10.
Grants
Health Commission of Xinjiang Uygur Autonomous Region under Grant “Tianshan Talents Training Program”(TSYC202301B133); Health Commission of Xinjiang Uygur Autonomous Region under Grant “medical science and technology of young talent project”(WJWY-202344). High-Level Specialist Physician Training Program under the Medical-Education-Research Integrated Health Service System in Minhang District (2024MZYS22)
References
1. HU, S., Report on Cardiovascular Health and Diseases in China 2021: an Updated Summary. Chinese Circulation Journal 2022, 37 (6), 553-578.
2. Tian, H., Basic knowledge of astronomical calendar for five elements and six qi, Shanxi Science and Technology Press: Taiyuan, 2016.
3. Zou, Y., Twelve Lectures on Introduction and Enhancementof Five Elements and Six Qi. First edition ed.; People’s Medical Publishing House: Beijing, 2017.
4. Xu, Y., Yunqi Shang. China Traditional Chinese Medicine Press: Beijing, 2016.
5. Paul, U. U., Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. UNIVERSITY OF CALIFORNIA PRESS: 2003.
6. Shan, S., Re-revised Clinical Evidence of Ancient and Modern TCM Doctors(Palpitation Volume). China Medical Science and Technology Press: Beijing, 2017.
7. Yellow Emperor’s Canon of Medicine • Plain Conversation. Xi’an World Publishing Corporation: Xi’an, 2005; Vol. 21, p 949.
8. Yellow Emperor’s Canon of Medicine • Plain Conversation. Xi’an World Publishing Corporation: Xi’an, 2005; Vol. 21, p 951.
9. Tang, Q.; Ma, S.; Liu, H.; Gao, S.; He, J., Correlation between coronary heart disease and six Qi and meteorology in Beijing. Chinese Journal of Traditional Chinese Medicine 2012, 27 (6), 1564-1566.
10. Yang, W., Bai, W., Research on Five Yun and Six Qi [M]. China Press of Traditional Chinese Medicine:Beijing, 2020
About the author:
Wang Zhangsheng, Deputy Chief Physician, Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University. Medical Doctor, Fudan University; Member of the 11th Batch of Xinjiang-Aiding Medical Professionals.Visiting Scholar of Yale University School of Medicine; Clinical Research Scholar (GCSRT) of Harvard University School of Medicine.
Research Interests: Evidence-based medicine, construction and maintenance of disease-specific databases, improvement of medical devices (stethoscope, four-diagnosis apparatus), medical ethics, modernization of traditional Chinese medicine theory.se medicine beyond empirical practice into a more structured theoretical discipline.
基於五運六氣理論對心房顫動患者時間危險因素的分析
作者：王張生1，宋雨晴1，韓凱月1，孫桂芳2，古再麗努爾•斯力木3，範耀華4
Wang Zhangsheng1，Song Yuqing1，Han Kaiyue1，Sun Guifang2，Guzailinur Silimu3，Fan Yaohua4
1.復旦大學附屬上海市第五人民醫院，復旦大學社區健康研究中心，上海市，
2.上海市閔行區馬橋社區衛生服務中心，上海市，
3.新疆維吾爾自治區喀什地區澤普縣人民醫院，新疆，
4.河南五運六氣醫藥中心，河南省
通訊作者：範耀華
摘要
目的：研究心房顫動患者五運六氣屬性分佈特點及差異。方法：對上海市閔行區MUSE系統2009年至2021年第一季度各社區醫院體檢及就診檢查的 1,922,693 份心電圖匯總其生日及房顫發病日資訊，計算五運六氣屬性分佈特點，並進行描述性統計、卡方檢驗。結果：去除重複檢查及資訊不完整者，最終20448份房顫心電圖納入分析。出生五運六氣要素最常見的依次是：中運土運太過，主運水運太過，客運金運不及，主氣太陽寒水，客氣少陰君火，實際司天少陰君火。發病五運六氣要素最常見的依次是：中運木運太過，主運火運不及，客運土運太過，主氣少陽相火，客氣厥陰風木，實際司天厥陰風木，發病日干支火氣勝及水氣勝最常見。發病運氣異化中順化及天刑最常見。運氣相合分析發現發病時間的同歲會、同天符最常見。以上分佈除出生客氣及出生實際司天外，其差異均具有統計學意義（P < 0.05）。
結論：房顫患者的先天稟賦及發作與五運六氣屬性有較多關聯性。
關鍵詞：五運六氣；心房顫動；危險因素
1. 引言
心房顫動(房顫)是臨床常見心律失常之一，隨著我國老齡化社會的發展，其發病率逐年升高。我國大規模房顫流行病學調查資料顯示，我國房顫人群487萬[1]。以往房顫多被看作是一種良性心律失常，然而近20年來的研究結果表明，房顫是腦卒中的獨立危險因素，具有較高的致殘率及致死率；同時也是充血性心力衰竭發展過程中的一個重要促進因素。因此，房顫的治療成為了臨床上關注和研究的重要課題。目前房顫的分類國際上並沒有統一的標準，根據臨床上房顫的發作特點，大致可分為初髮型、陣發性、持續性和永久性房顫，以用來指導臨床治療工作。房顫治療的重點在於去除病因，但由於房顫的病因複雜，同時在病因診斷中存在一定的診斷誤區，因此探索房顫的常見病因、誘發因素就顯得非常重要。中醫五運六氣理論是中國古代研究天時氣候變化規律及天時氣候變化規律對人體生命影響的一門科學。它將自然氣候現象與生物的生命現象聯繫起來，將自然氣候變化與人體發病規律、用藥規律以及養生防治規律統一起來。結合五運六氣理論來研究分析房顫發病規律，可以為房顫的預防提供有效的防治方案。本研究通過對上海市閔行區連續12年房顫患者進行研究分析，探討房顫患者先天運氣稟賦以及發病運氣要素之間的關係，為房顫易感人群及易感時段提供預防參考。
2、資料與方法
2.1.資料來源：本研究資料來源於上海市閔行區2009年至2021年3月MUSE系統診斷為心房顫動的患者。剔除標準：交節當天出生者；無具體生日記錄者。
2.2.資料處理
2.2.1 記錄病歷中患者出生年的天干地支十天干，即甲、乙、丙、丁、戊、己、庚、辛、壬、癸。十二地支，即子、醜、寅、卯、辰、巳、午、未、申、酉、戌、亥。
2.2.2 出生年歲運屬性轉化 根據患者出生年的天干劃分歲運五行屬性。根據十天干，劃分五運，即甲己-土運、乙庚-金運、丙辛-水運、戊癸-火運、丁壬-木運。奇數年為歲運太過，偶數年為歲運不及。據此，將其劃分為木運太過、火運不及、土運太過、金運不及、水運太過、木運不及、火運太過、土運不及、金運太過、水運不及10種歲運屬性。
2.2.3 出生日期五運屬性轉化 五運分為主運和客運，主運把一年均分為五個季節，即木季、火季、土季、金季、水季。客運也分五季，也是按照木火土金水來劃分，但順序不是固定的，初運要根據歲運來定。
2.2.4 出生日期六氣屬性轉化
六氣分為主氣和客氣，主氣分為六步，每步主四個節氣。初氣起自大寒日，二氣起自春分日，至小滿正屬司天三氣主之，四氣起自大暑，五氣起自秋分，至小雪之終氣方屬在泉所司。每一氣各主六十日有奇，以知司天惟主三氣也。然六氣中則又有主氣、客氣之分。主氣者，初氣屬風木，二氣屬君火，三氣屬相火，四氣屬濕土，五氣屬燥金，六氣屬寒水，以相生為序，一定而不移者，故謂之主。客氣亦有六，但隨每年司天之氣遷轉而無定，故謂之客。推算具體方法可參見相關專著[2]。
2.2.5 統計學方法利用上述方法對材料處理後，建立心房顫動患者資料庫。運用SPSS25 進行數據統計分析。運用描述性統計觀察心房顫動患者生日及發病日在不同歲運、主氣、客氣時段的分佈情況。並對其分佈的差異性進行卡方檢驗。以P<0.05為差異有統計學意義。
2.3 倫理聲明
本研究已通過倫理委員會審批，因研究為回顧性匿名數據分析，倫理委員會豁免了研究對象簽署知情同意書的要求。所有研究過程均符合《赫爾辛基宣言》的要求。
3、結果
3.1 MUSE心電圖資料庫共計1922693張心電圖，去除1882266張非房顫心電圖，17914張同一個體重複檢查者，415張生日不明者，893張交節當天生日者，757張生日有誤者，最終20448例受試者納入分析。
3.2 心房顫動患者出生日期五運六氣屬性分佈
心房顫動患者出生時的中運分佈依次為土運太過>火運不及>……>火運太過>土運不及，差異有統計學意義（χ2=24.00，P<0.01）。出生主運水運太過及水運不及者房顫高發（χ2= 297.9，P<0.01）。出生客運金運不及、水運太過者房顫高發（χ2=26.04，P<0.01）。出生主氣太陽寒水、厥陰風木者房顫高發（χ2=319.5，P<0.01），見圖1。
圖1 出生時間五運六氣特徵分佈
3.3 心房顫動患者發病日期五運六氣屬性分佈
患者發病時的主運常見的為火運不及、土運太過，分佈差異有統計學意義（χ2=734.3， P<0.01）。心房顫動患者發病時的客運常見為土運太過、火運不及，分佈差異有統計學意義（χ2=158.1，P<0.01）。發病時的主氣常見為少陽相火、少陰君火，分佈差異有統計學意義（χ2=439.1，P<0.01）。發病年司天常見為太陽寒水、厥陰風木，分佈差異有統計學意義（χ2=1821，P<0.01），見圖2。
圖2 發病日五運六氣特徵分佈
3.4 日干支分佈 心房顫動患者發病時的日干支分佈經卡方檢驗，按十分類，分佈差異有統計學意義（χ2=205.8， P<0.01）， 按五行五分類，火氣勝及水氣勝兩天房顫發病率較高，分佈差異有統計學意義（χ2=170.5，P<0.01），見圖3。
圖3 發病日干支屬性分佈
3.5五運六氣各要素的聯合分析
因疫情關係，2020年-2021年房顫心電圖數量有相當程度減少。故本研究只針對出生日期以及除發病中運之外的發病日期進行五運六氣各要素的聯合分析。聯合出生中運、出生主運、出生客運、出生主氣、出生客氣五要素，統計分析發現太木-太木-太木-厥陰風木-少陰君火型最高發，太土-太木-太土-少陰君火-厥陰風木則最低發(見表1)。聯合出生主運、發病主運、出生主氣、發病主氣、發病司天五要素，統計分析發現太水-少火-太陽寒水-少陰君火-太陽寒水以及太木-太土-厥陰風木-太陰濕土-太陽寒水型最高發(見表2)。
表1 房顫易感及有保護作用的出生五運六氣類型
| 體質類型 | 例數（降序排列） |
| 太木太木太木厥陰風木少陰君火 | 212 |
| 少火太水少木太陽寒水少陰君火 | 196 |
| 少木少木少木厥陰風木陽明燥金 | 195 |
| 太土太水太火太陽寒水太陰濕土 | 184 |
| …… | …… |
| 太水太木太水少陰君火太陰濕土 | 10 |
| 太火少木太火少陰君火陽明燥金 | 10 |
| 少水少木少水少陰君火太陽寒水 | 10 |
| 太土太木太土少陰君火厥陰風木 | 7 |
表2 房顫易感的出生聯合發病五運六氣類型
| 體質類型 | 例數（降序排列） |
| 太水少火太陽寒水少陰君火太陽寒水 | 57 |
| 太木太土厥陰風木太陰濕土太陽寒水 | 57 |
| 少水少火太陽寒水少陰君火太陽寒水 | 56 |
| 太水太火太陽寒水少陰君火厥陰風木 | 54 |
| 少木太土厥陰風木少陽相火太陽寒水 | 53 |
| 太木太土厥陰風木少陽相火太陽寒水 | 53 |
4、討論
《素問·寶命全形論》記載:“人以天地之氣生，四時之法成”,人是自然變化之中的產物，時間因素對於先天稟賦形成和後天疾病發生發展具有重要意義，五運六氣學說即是從時間視角解讀自然週期性變化規律及對生命活動的影響。《素問·藏氣法時論》詳細描述了五臟之病在不同時間節段當中病情平穩、減輕、加重或病死的時緒規律。如“病在心，愈在長夏，長夏不愈，甚於冬，冬不死，持於春，起於夏，禁溫食熱衣。心病者，愈在戊己，戊己不愈，加於壬癸，壬癸不死，持於甲乙，起於丙丁。心病者，日中慧，夜半甚，平旦靜……”。心為陽中之陽，五行屬火，故最怕寒水之邪。周次清教授雲[3]：“陰虛不能斂陽是心房顫動的主要原因……會出現‘參伍不調’的促脈，或雀啄脈。快速性房顫……發作時脈見促象。”《素問·天元紀大論篇》雲：“厥陰之上，風氣主之；少陰之上，熱氣主之；太陰之上，濕氣主之；少陽之上，相火主之；陽明之上，燥氣主之；太陽之上，寒氣主之。所謂本也，是謂六元”。終之氣太陽寒水約為每年11月20日至次年1月20日，一年中氣溫最低，且陽氣最弱，人體易被寒水之邪侵襲。氣溫驟降會興奮交感神經，同時升高腎上腺素的水準，造成心率加快、早搏增多，嚴重可致心房顫動。
本研究通過對閔行區連續12年心房顫動患者的出生日期及發病日期運氣屬性分佈特點研究分析發現，屬性分佈差異具有統計學意義（P<0.05）。本研究發現厥陰風木司天房顫容易發病。厥陰風木司天年份為癸巳及己亥年。癸巳年，同歲會，厥陰風木司天，少陽相火在泉，歲運為少征。火運不及，則寒氣為勝氣，勝氣之後，則雨氣來複。如此歲運為熱，勝氣為寒，複氣為雨。己亥年，厥陰風木司天，少陽相火在泉，歲運為少宮。土運不及，則風氣為勝氣，勝氣之後，則清氣來複。此二年勝複之氣相同，均不利心火。
從歲運來看，出生年份在土運太過之年的人群最易罹患房顫，發病年份包含己醜、壬辰、辛醜。因為辰醜土中藏幹含有癸水，水克火，所以辰醜土晦火。此結果與張軒等[4] 研究結果類似。《素問·氣交變大論篇》雲：“歲土太過，雨濕流行”，在歲土太過之年，全年氣候變化以潮濕為特點，雨水偏多。太陽寒水司天的時段心房顫動發病率最高，與張曉芳研究[5]一致。有學者[6]通過對心臟發病與氣象因素之間的相關性研究發現，相對濕度與心臟發病具有相關性。可見，房顫在後天發病也會受到濕氣的影響。故出生在甲年（土運太過）的人群，同樣要注意對房顫的預防。
本研究還發現，心房顫動患者發病日的干支提示水氣勝及火氣勝兩天發病率較高，考慮心五行屬火，火日本氣致病，水日邪氣致病。
五運六氣理論無論古代與現代，對於疾病的預防與治療都有著重大的意義，是我們中醫學的珍貴寶藏。五運六氣大數據化，預測疾病已成為中西醫結合的重要手段與目的[7]。構建、完善並實證五運六氣理論，使得中醫學脫離經驗醫學的束縛，上升為真正的理論醫學，以打破中醫理論基礎體系不完善的瓶頸[8]。
基金
“天山英才”培養計畫醫藥衛生高層次人才培養專案（TSYC202301B133），自治區衛生健康青年醫學科技人才專項（WJWY-202344），閔行區醫教研協同型健康服務體系下高層次專科骨幹醫師培養專案（2024MZYS22）。
参考文献
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作 者 简 介 ：
王張生，復旦大學附屬上海市第五人民醫院心內科副主任醫師
復旦大學醫學博士，第十一批援疆人才
耶魯大學醫學院訪問學者、哈佛大學醫學院臨床科研學者(GCSRT)。研究興趣：循證醫學、專
病資料庫建設維護、醫療器械改進(聽診器、四診儀)、醫學倫理、中醫理論現代化。
