diff --git a/apps/web-antd/src/components/loading/PrescriptionLoading.vue b/apps/web-antd/src/components/loading/PrescriptionLoading.vue
new file mode 100644
index 00000000..4996776f
--- /dev/null
+++ b/apps/web-antd/src/components/loading/PrescriptionLoading.vue
@@ -0,0 +1,714 @@
+<template>
+  <!--
+    AI 加载动画：处方=药丸；病历=病历本
+    type + text 由调用方传入；嵌入抽屉时默认不显示主题切换
+  -->
+  <div
+    ref="containerRef"
+    class="loading-wrapper"
+    :class="{ 'loading-wrapper--dark': isDark }"
+    :style="{ width: '100%', height: '100%' }"
+  >
+    <canvas ref="canvasRef" class="loading-canvas"></canvas>
+    <button
+      v-if="showToggle"
+      class="theme-toggle-btn"
+      :title="isDark ? '切换到亮色模式' : '切换到暗色模式'"
+      @click="toggleTheme"
+    >
+      <span class="theme-icon">
+        <svg
+          v-if="!isDark"
+          class="sun"
+          width="20"
+          height="20"
+          viewBox="0 0 24 24"
+          fill="none"
+          stroke="currentColor"
+          stroke-width="2"
+        >
+          <circle cx="12" cy="12" r="5" />
+          <line x1="12" y1="1" x2="12" y2="3" />
+          <line x1="12" y1="21" x2="12" y2="23" />
+          <line x1="4.22" y1="4.22" x2="5.64" y2="5.64" />
+          <line x1="18.36" y1="18.36" x2="19.78" y2="19.78" />
+          <line x1="1" y1="12" x2="3" y2="12" />
+          <line x1="21" y1="12" x2="23" y2="12" />
+          <line x1="4.22" y1="19.78" x2="5.64" y2="18.36" />
+        </svg>
+        <svg
+          v-else
+          class="moon"
+          width="20"
+          height="20"
+          viewBox="0 0 24 24"
+          fill="none"
+          stroke="currentColor"
+          stroke-width="2"
+        >
+          <path d="M21 12.79A9 9 0 1 1 11.21 3 7 7 0 0 0 21 12.79z" />
+        </svg>
+      </span>
+<!--      <span class="theme-label">{{ isDark ? '亮色' : '暗色' }}</span>-->
+    </button>
+  </div>
+</template>
+
+<script setup lang="ts">
+/**
+ * AI 生成加载动画
+ * - type=prescription：中心画胶囊药丸
+ * - type=medical_record：中心画病历本
+ * - text：底部文案（可动态传）
+ */
+import { computed, nextTick, onMounted, onUnmounted, ref, watch } from 'vue';
+
+export type AiLoadingType = 'prescription' | 'medical_record';
+
+const props = withDefaults(
+  defineProps<{
+    /** 动画类型：处方 / 病历 */
+    type?: AiLoadingType;
+    /** 底部文案 */
+    text?: string;
+    /** 是否显示主题切换（嵌入业务抽屉建议关闭） */
+    showToggle?: boolean;
+  }>(),
+  {
+    type: 'prescription',
+    text: '',
+    showToggle: false,
+  },
+);
+
+/** 未传文案时按 type 给默认值 */
+const displayText = computed(() => {
+  const t = String(props.text || '').trim();
+  if (t) return t;
+  return props.type === 'medical_record'
+    ? 'AI正在生成病历'
+    : 'AI正在生成处方';
+});
+
+const containerRef = ref<HTMLDivElement | null>(null);
+const canvasRef = ref<HTMLCanvasElement | null>(null);
+const isDark = ref(false);
+/** 画布循环里读取最新文案/类型，避免闭包过期 */
+const liveText = ref(displayText.value);
+const liveType = ref<AiLoadingType>(props.type);
+
+watch(
+  displayText,
+  (v) => {
+    liveText.value = v;
+  },
+  { immediate: true },
+);
+watch(
+  () => props.type,
+  (v) => {
+    liveType.value = v || 'prescription';
+  },
+  { immediate: true },
+);
+
+function detectAppDark(): boolean {
+  return (
+    document.documentElement.classList.contains('dark') ||
+    document.documentElement.getAttribute('data-theme') === 'dark' ||
+    document.documentElement.getAttribute('class')?.includes('dark') === true
+  );
+}
+
+function syncThemeFromApp() {
+  if (localStorage.getItem('prescription-loading-theme')) {
+    isDark.value = localStorage.getItem('prescription-loading-theme') === 'dark';
+    return;
+  }
+  isDark.value = detectAppDark();
+}
+
+function toggleTheme() {
+  isDark.value = !isDark.value;
+  localStorage.setItem(
+    'prescription-loading-theme',
+    isDark.value ? 'dark' : 'light',
+  );
+  resetParticles?.();
+}
+
+interface Particle {
+  x: number;
+  y: number;
+  vx: number;
+  vy: number;
+  life: number;
+  maxLife: number;
+  size: number;
+  color: { r: number; g: number; b: number };
+  type: 'circle' | 'cross';
+}
+
+interface ThemeColors {
+  textColor: string;
+  ringColor: string;
+  glowInner: string;
+  glowMiddle: string;
+  glowOuter: string;
+  particleBright: number;
+  iconShadow: string;
+}
+
+let animationId = 0;
+let resetParticles: (() => void) | null = null;
+let themeObserver: MutationObserver | null = null;
+let resizeObserver: ResizeObserver | null = null;
+let removeWindowResize: (() => void) | null = null;
+
+onMounted(async () => {
+  await nextTick();
+  syncThemeFromApp();
+  if (!containerRef.value || !canvasRef.value) return;
+
+  const canvas = canvasRef.value;
+  const ctx = canvas.getContext('2d');
+  if (!ctx) return;
+  const container = containerRef.value;
+
+  const dpr = Math.min(window.devicePixelRatio || 1, 2);
+  let cssWidth = 0;
+  let cssHeight = 0;
+  let prevW = 0;
+  let prevH = 0;
+  let startTime: number | null = null;
+  let lastTime: number | null = null;
+  let particles: Particle[] = [];
+  const MAX_PARTICLES = 28;
+
+  resetParticles = () => {
+    particles = [];
+  };
+
+  function updateSize() {
+    const rect = container.getBoundingClientRect();
+    cssWidth = rect.width || 300;
+    cssHeight = rect.height || 280;
+    const pw = Math.round(cssWidth * dpr);
+    const ph = Math.round(cssHeight * dpr);
+    if (canvas.width !== pw || canvas.height !== ph) {
+      canvas.width = pw;
+      canvas.height = ph;
+      if (
+        prevW &&
+        (Math.abs(cssWidth - prevW) > 2 || Math.abs(cssHeight - prevH) > 2)
+      ) {
+        particles = [];
+      }
+      prevW = cssWidth;
+      prevH = cssHeight;
+    }
+  }
+
+  function createParticle(cx: number, cy: number, s: number): Particle {
+    const angle = Math.random() * Math.PI * 2;
+    const distance = s * (0.15 + Math.random() * 0.45);
+    const speed = s * (0.03 + Math.random() * 0.08);
+    const colors = [
+      { r: 61, g: 214, b: 208 },
+      { r: 74, g: 195, b: 190 },
+      { r: 93, g: 173, b: 226 },
+      { r: 46, g: 180, b: 170 },
+      { r: 100, g: 200, b: 215 },
+    ];
+    const color = colors[Math.floor(Math.random() * colors.length)]!;
+    return {
+      x: cx + Math.cos(angle) * distance,
+      y: cy + Math.sin(angle) * distance,
+      vx: Math.cos(angle) * speed,
+      vy: Math.sin(angle) * speed,
+      life: 1,
+      maxLife: 1.8 + Math.random() * 2.5,
+      size: 1.2 + Math.random() * 2.8,
+      color,
+      type: Math.random() < 0.25 ? 'cross' : 'circle',
+    };
+  }
+
+  function updateParticles(dt: number, cx: number, cy: number, s: number) {
+    for (let i = particles.length - 1; i >= 0; i--) {
+      const p = particles[i]!;
+      p.life -= dt / p.maxLife;
+      p.x += p.vx * dt;
+      p.y += p.vy * dt;
+      p.vx *= 0.997;
+      p.vy *= 0.997;
+      if (p.life <= 0) particles.splice(i, 1);
+    }
+    while (particles.length < MAX_PARTICLES) {
+      const p = createParticle(cx, cy, s);
+      const ang = Math.random() * Math.PI * 2;
+      p.x = cx + Math.cos(ang) * s * 0.12 * Math.random();
+      p.y = cy + Math.sin(ang) * s * 0.12 * Math.random();
+      particles.push(p);
+    }
+  }
+
+  function drawParticle(
+    c: CanvasRenderingContext2D,
+    p: Particle,
+    bright: number,
+  ) {
+    const alpha = p.life;
+    const { r, g, b } = p.color;
+    const size = p.size * (0.7 + 0.3 * p.life);
+    const br = Math.min(255, Math.round(r * bright));
+    const bg = Math.min(255, Math.round(g * bright));
+    const bb = Math.min(255, Math.round(b * bright));
+    c.save();
+    c.globalAlpha = alpha;
+    if (p.type === 'cross') {
+      const len = size * 1.8;
+      const w = size * 0.55;
+      c.strokeStyle = `rgba(${br},${bg},${bb},${alpha})`;
+      c.lineWidth = w;
+      c.lineCap = 'round';
+      c.beginPath();
+      c.moveTo(p.x - len, p.y);
+      c.lineTo(p.x + len, p.y);
+      c.stroke();
+      c.beginPath();
+      c.moveTo(p.x, p.y - len);
+      c.lineTo(p.x, p.y + len);
+      c.stroke();
+      c.fillStyle = `rgba(255,255,255,${alpha * 0.9})`;
+      c.beginPath();
+      c.arc(p.x, p.y, size * 0.35, 0, Math.PI * 2);
+      c.fill();
+    } else {
+      c.shadowColor = `rgba(${br},${bg},${bb},${alpha * 0.7})`;
+      c.shadowBlur = size * 2.5;
+      c.fillStyle = `rgba(${br},${bg},${bb},${alpha})`;
+      c.beginPath();
+      c.arc(p.x, p.y, size, 0, Math.PI * 2);
+      c.fill();
+      c.shadowBlur = 0;
+      c.fillStyle = `rgba(255,255,255,${alpha * 0.6})`;
+      c.beginPath();
+      c.arc(p.x, p.y, size * 0.4, 0, Math.PI * 2);
+      c.fill();
+    }
+    c.restore();
+  }
+
+  /** 处方药丸（处方） */
+  function drawPill(
+    c: CanvasRenderingContext2D,
+    px: number,
+    py: number,
+    pw: number,
+    ph: number,
+    floatOff: number,
+    pulse: number,
+    shadowCol: string,
+  ) {
+    c.save();
+    const cx = px + pw / 2;
+    const cy = py + ph / 2;
+    const hw = (pw / 2) * pulse;
+    const hh = (ph / 2) * pulse;
+    const adjY = cy + floatOff;
+    const dx = cx - hw;
+    const dy = adjY - hh;
+    const dw = hw * 2;
+    const dh = hh * 2;
+    const rad = hh;
+    const path = new Path2D();
+    path.roundRect(dx, dy, dw, dh, rad);
+
+    c.shadowColor = shadowCol;
+    c.shadowBlur = hh * 0.7;
+    c.shadowOffsetY = hh * 0.25;
+    c.fillStyle = '#ffffff';
+    c.fill(path);
+    c.shadowColor = 'transparent';
+    c.shadowBlur = 0;
+    c.shadowOffsetY = 0;
+
+    c.save();
+    c.clip(path);
+    const leftGrad = c.createLinearGradient(dx, 0, dx + dw * 0.5, 0);
+    leftGrad.addColorStop(0, '#FDFBF7');
+    leftGrad.addColorStop(0.7, '#F5F1EA');
+    leftGrad.addColorStop(1, '#EDE8DF');
+    c.fillStyle = leftGrad;
+    c.fillRect(dx, dy, dw * 0.5, dh);
+
+    const rightGrad = c.createLinearGradient(dx + dw * 0.5, 0, dx + dw, 0);
+    rightGrad.addColorStop(0, '#5DD9D1');
+    rightGrad.addColorStop(0.5, '#3DD6D0');
+    rightGrad.addColorStop(1, '#2CB8B0');
+    c.fillStyle = rightGrad;
+    c.fillRect(dx + dw * 0.5, dy, dw * 0.5, dh);
+
+    c.strokeStyle = 'rgba(180,180,180,0.5)';
+    c.lineWidth = Math.max(0.6, hh * 0.06);
+    c.beginPath();
+    c.moveTo(dx + dw * 0.5, dy + 1);
+    c.lineTo(dx + dw * 0.5, dy + dh - 1);
+    c.stroke();
+
+    const hy = dy + dh * 0.15;
+    const hh2 = dh * 0.38;
+    const hp = new Path2D();
+    hp.roundRect(dx + dw * 0.06, hy, dw * 0.88, hh2, hh2 / 2);
+    c.fillStyle = 'rgba(255,255,255,0.45)';
+    c.fill(hp);
+    c.restore();
+
+    c.strokeStyle = 'rgba(200,200,200,0.5)';
+    c.lineWidth = Math.max(0.8, hh * 0.08);
+    c.stroke(path);
+    c.restore();
+  }
+
+  /** 病历本（病历） */
+  function drawMedicalRecord(
+    c: CanvasRenderingContext2D,
+    cx: number,
+    cy: number,
+    scale: number,
+    floatOff: number,
+    pulse: number,
+    shadowCol: string,
+  ) {
+    c.save();
+    const w = scale * 0.28 * pulse;
+    const h = scale * 0.34 * pulse;
+    const x = cx - w / 2;
+    const y = cy - h / 2 + floatOff;
+    const r = Math.max(4, scale * 0.018);
+    const path = new Path2D();
+    path.roundRect(x, y, w, h, r);
+
+    c.shadowColor = shadowCol;
+    c.shadowBlur = scale * 0.035;
+    c.shadowOffsetY = scale * 0.012;
+    c.fillStyle = '#ffffff';
+    c.fill(path);
+    c.shadowColor = 'transparent';
+    c.shadowBlur = 0;
+    c.shadowOffsetY = 0;
+
+    // 左侧装订条
+    c.fillStyle = '#3DD6D0';
+    c.fillRect(x, y + r * 0.2, w * 0.12, h - r * 0.4);
+
+    // 横线（像病历行）
+    c.strokeStyle = 'rgba(61,214,208,0.35)';
+    c.lineWidth = Math.max(1, scale * 0.004);
+    for (let i = 0; i < 4; i++) {
+      const ly = y + h * (0.32 + i * 0.14);
+      c.beginPath();
+      c.moveTo(x + w * 0.22, ly);
+      c.lineTo(x + w * 0.88, ly);
+      c.stroke();
+    }
+    // 顶部标题条
+    c.fillStyle = 'rgba(61,214,208,0.2)';
+    c.beginPath();
+    c.roundRect(x + w * 0.22, y + h * 0.12, w * 0.5, h * 0.08, 2);
+    c.fill();
+
+    c.strokeStyle = 'rgba(180,200,200,0.55)';
+    c.lineWidth = Math.max(0.8, scale * 0.005);
+    c.stroke(path);
+    c.restore();
+  }
+
+  function drawCross(
+    c: CanvasRenderingContext2D,
+    x: number,
+    y: number,
+    size: number,
+    alpha: number,
+    rot: number,
+  ) {
+    c.save();
+    c.translate(x, y);
+    c.rotate(rot);
+    c.globalAlpha = alpha;
+    const len = size;
+    const w = size * 0.3;
+    c.strokeStyle = '#3DD6D0';
+    c.lineWidth = w;
+    c.lineCap = 'round';
+    c.beginPath();
+    c.moveTo(-len, 0);
+    c.lineTo(len, 0);
+    c.stroke();
+    c.beginPath();
+    c.moveTo(0, -len);
+    c.lineTo(0, len);
+    c.stroke();
+    c.fillStyle = '#ffffff';
+    c.beginPath();
+    c.arc(0, 0, size * 0.25, 0, Math.PI * 2);
+    c.fill();
+    c.restore();
+  }
+
+  function getTheme(): ThemeColors {
+    const dark = isDark.value;
+    return {
+      textColor: dark ? '#d1d5db' : '#4a5568',
+      ringColor: dark ? 'rgba(255,255,255,0.25)' : 'rgba(180,195,200,0.45)',
+      glowInner: dark ? 'rgba(61,214,208,0.15)' : 'rgba(61,214,208,0.13)',
+      glowMiddle: dark ? 'rgba(61,214,208,0.05)' : 'rgba(61,214,208,0.04)',
+      glowOuter: 'rgba(61,214,208,0)',
+      particleBright: dark ? 1.4 : 1.0,
+      iconShadow: dark ? 'rgba(0,0,0,0.4)' : 'rgba(0,0,0,0.12)',
+    };
+  }
+
+  function draw(timestamp: number) {
+    updateSize();
+    if (cssWidth <= 0 || cssHeight <= 0) {
+      animationId = requestAnimationFrame(draw);
+      return;
+    }
+    if (startTime === null) {
+      startTime = timestamp;
+      lastTime = timestamp;
+    }
+    const elapsed = (timestamp - startTime) / 1000;
+    let dt = (timestamp - (lastTime ?? timestamp)) / 1000;
+    if (dt <= 0) dt = 0.016;
+    if (dt > 0.2) dt = 0.2;
+    lastTime = timestamp;
+
+    ctx.clearRect(0, 0, canvas.width, canvas.height);
+    ctx.save();
+    ctx.scale(dpr, dpr);
+
+    const cx = cssWidth / 2;
+    const cy = cssHeight / 2 - cssHeight * 0.04;
+    const scale = Math.min(cssWidth, cssHeight);
+    const orbitR = scale * 0.26;
+    const fontSize = Math.max(12, scale * 0.055);
+    const textY = cy + orbitR + fontSize * 2.4;
+    const text = liveText.value;
+    const animType = liveType.value;
+
+    const dashOff = elapsed * scale * 0.025;
+    const arcRot = elapsed * 3.5;
+    const arcLen = (100 * Math.PI) / 180;
+    const floatOff = Math.sin(elapsed * 2.5) * scale * 0.025;
+    const pulseS = 1 + Math.sin(elapsed * 3.7) * 0.04;
+    const textAlpha = 0.55 + 0.45 * Math.sin(elapsed * 1.6);
+    const theme = getTheme();
+
+    const grad = ctx.createRadialGradient(
+      cx,
+      cy,
+      orbitR * 0.15,
+      cx,
+      cy,
+      orbitR * 1.6,
+    );
+    grad.addColorStop(0, theme.glowInner);
+    grad.addColorStop(0.5, theme.glowMiddle);
+    grad.addColorStop(1, theme.glowOuter);
+    ctx.fillStyle = grad;
+    ctx.fillRect(0, 0, cssWidth, cssHeight);
+
+    ctx.save();
+    ctx.setLineDash([scale * 0.018, scale * 0.04]);
+    ctx.lineDashOffset = -dashOff;
+    ctx.strokeStyle = theme.ringColor;
+    ctx.lineWidth = Math.max(1, scale * 0.006);
+    ctx.beginPath();
+    ctx.arc(cx, cy, orbitR, 0, Math.PI * 2);
+    ctx.stroke();
+    ctx.setLineDash([]);
+    ctx.restore();
+
+    const arcS = arcRot;
+    const arcE = arcRot + arcLen;
+    const fx = cx + orbitR * Math.cos(arcE);
+    const fy = cy + orbitR * Math.sin(arcE);
+    ctx.save();
+    ctx.shadowColor = 'rgba(61,214,208,0.8)';
+    ctx.shadowBlur = scale * 0.04;
+    ctx.strokeStyle = '#3DD6D0';
+    ctx.lineWidth = Math.max(2, scale * 0.014);
+    ctx.lineCap = 'round';
+    ctx.beginPath();
+    ctx.arc(cx, cy, orbitR, arcS, arcE);
+    ctx.stroke();
+    ctx.restore();
+
+    ctx.save();
+    ctx.shadowColor = 'rgba(255,255,255,0.9)';
+    ctx.shadowBlur = scale * 0.03;
+    ctx.fillStyle = '#ffffff';
+    ctx.beginPath();
+    ctx.arc(fx, fy, Math.max(2.5, scale * 0.014), 0, Math.PI * 2);
+    ctx.fill();
+    ctx.restore();
+
+    // 中心图标：按 type 切换
+    if (animType === 'medical_record') {
+      drawMedicalRecord(ctx, cx, cy, scale, floatOff, pulseS, theme.iconShadow);
+    } else {
+      const pillW = scale * 0.34;
+      const pillH = scale * 0.1;
+      drawPill(
+        ctx,
+        cx - pillW / 2,
+        cy - pillH / 2,
+        pillW,
+        pillH,
+        floatOff,
+        pulseS,
+        theme.iconShadow,
+      );
+    }
+
+    for (let i = 0; i < 3; i++) {
+      const ang = elapsed * 1.8 + (i * Math.PI * 2) / 3;
+      const crossOrbitR = orbitR * 1.02;
+      const rx = cx + crossOrbitR * Math.cos(ang);
+      const ry = cy + crossOrbitR * Math.sin(ang);
+      const rs = Math.max(4, scale * 0.022);
+      const ra = 0.4 + 0.35 * Math.sin(elapsed * 3.2 + i * 1.7);
+      drawCross(ctx, rx, ry, rs, ra, elapsed * 0.9 + i);
+    }
+
+    updateParticles(dt, cx, cy, scale);
+    for (const p of particles) {
+      drawParticle(ctx, p, theme.particleBright);
+    }
+
+    ctx.save();
+    ctx.globalAlpha = textAlpha;
+    ctx.fillStyle = theme.textColor;
+    ctx.font = `${fontSize}px "PingFang SC","Microsoft YaHei","Noto Sans SC","Helvetica Neue",sans-serif`;
+    ctx.textAlign = 'center';
+    ctx.textBaseline = 'middle';
+    ctx.shadowColor = 'rgba(61,214,208,0.25)';
+    ctx.shadowBlur = fontSize * 0.6;
+    ctx.fillText(text, cx, textY);
+    ctx.restore();
+
+    const charW = fontSize * 0.55;
+    const dotsStartX = cx + (text.length / 2) * charW + fontSize * 0.5;
+    const dotR = Math.max(2, fontSize * 0.16);
+    const dotSpacing = fontSize * 0.7;
+    for (let i = 0; i < 3; i++) {
+      const phase = (elapsed * 2.8 + i * 1.0) % 3;
+      let brightness = phase < 1 ? phase : phase < 2 ? 2 - phase : 0;
+      brightness = brightness * brightness * (3 - 2 * brightness);
+      const alpha = 0.2 + brightness * 0.75;
+      const dx = dotsStartX + i * dotSpacing * 2.2;
+      ctx.save();
+      ctx.shadowColor = `rgba(61,214,208,${alpha * 0.8})`;
+      ctx.shadowBlur = dotR * 3;
+      ctx.fillStyle = `rgba(61,214,208,${alpha})`;
+      ctx.beginPath();
+      ctx.arc(dx, textY, dotR, 0, Math.PI * 2);
+      ctx.fill();
+      ctx.restore();
+    }
+
+    ctx.restore();
+    animationId = requestAnimationFrame(draw);
+  }
+
+  updateSize();
+  animationId = requestAnimationFrame(draw);
+
+  if (window.ResizeObserver) {
+    resizeObserver = new ResizeObserver(() => updateSize());
+    resizeObserver.observe(container);
+  } else {
+    const onResize = () => updateSize();
+    window.addEventListener('resize', onResize);
+    removeWindowResize = () => window.removeEventListener('resize', onResize);
+  }
+
+  // 跟随应用 dark class（未手动锁定主题时）
+  themeObserver = new MutationObserver(() => {
+    if (!localStorage.getItem('prescription-loading-theme')) {
+      syncThemeFromApp();
+    }
+  });
+  themeObserver.observe(document.documentElement, {
+    attributes: true,
+    attributeFilter: ['class', 'data-theme'],
+  });
+});
+
+onUnmounted(() => {
+  cancelAnimationFrame(animationId);
+  resizeObserver?.disconnect();
+  resizeObserver = null;
+  removeWindowResize?.();
+  removeWindowResize = null;
+  themeObserver?.disconnect();
+  themeObserver = null;
+  resetParticles = null;
+});
+</script>
+
+<style scoped>
+.loading-wrapper {
+  position: relative;
+  width: 100%;
+  height: 100%;
+  min-height: 220px;
+  //background: #ffffff;
+  border-radius: 12px;
+  overflow: hidden;
+}
+.loading-wrapper--dark {
+  //background: #1e2227;
+}
+.loading-canvas {
+  display: block;
+  width: 100%;
+  height: 100%;
+}
+.theme-toggle-btn {
+  position: absolute;
+  top: 12px;
+  right: 12px;
+  z-index: 10;
+  display: flex;
+  align-items: center;
+  gap: 6px;
+  padding: 6px 14px;
+  background: rgba(255, 255, 255, 0.85);
+  border: 1px solid rgba(128, 128, 128, 0.3);
+  border-radius: 20px;
+  cursor: pointer;
+  font-size: 14px;
+  color: #4a5568;
+  backdrop-filter: blur(8px);
+  transition: all 0.25s;
+}
+.loading-wrapper--dark .theme-toggle-btn {
+  background: rgba(30, 34, 39, 0.9);
+  color: #d1d5db;
+}
+.theme-toggle-btn:hover {
+  border-color: #3dd6d0;
+  transform: scale(1.03);
+}
+.theme-icon {
+  display: flex;
+  align-items: center;
+  justify-content: center;
+  width: 20px;
+  height: 20px;
+}
+</style>
diff --git a/apps/web-antd/src/views/doctor/doctor-reception/api/index.ts b/apps/web-antd/src/views/doctor/doctor-reception/api/index.ts
index 97edd82c..54d0785f 100644
--- a/apps/web-antd/src/views/doctor/doctor-reception/api/index.ts
+++ b/apps/web-antd/src/views/doctor/doctor-reception/api/index.ts
@@ -428,3 +428,41 @@ export async function saveGranularCommonPrescriptionApi(data: {
     data,
   );
 }
+
+/** AI 给处方 */
+export async function aiGeneratePrescriptionApi(data: {
+  register_id: number;
+  store_id?: number;
+  prescription_type: number;
+  /** 前端确认过的主诉（可编辑） */
+  chief_complaint?: string;
+  /** 当前病历表单快照（可未保存），供 AI 综合参考 */
+  medical_record?: Record<string, any>;
+}) {
+  return requestClient.post<any>(`${prefix}ai-generate-prescription`, data);
+}
+
+/** 本挂号 AI 生成历史（轻量列表） */
+export async function aiListGenerationsApi(data: {
+  register_id: number;
+  scene?: string;
+  limit?: number;
+}) {
+  return requestClient.get<any>(`${prefix}ai-list-generations`, { params: data });
+}
+
+/** AI 生成详情（点选历史） */
+export async function aiGenerationDetailApi(data: { id: number }) {
+  return requestClient.get<any>(`${prefix}ai-generation-detail`, { params: data });
+}
+
+/** AI 处方药名模糊对照 */
+export async function aiMatchPrescriptionDrugsApi(data: {
+  generation_id?: number;
+  register_id?: number;
+  store_id?: number;
+  prescription_type?: number;
+  items?: Array<Record<string, any>>;
+}) {
+  return requestClient.post<any>(`${prefix}ai-match-prescription-drugs`, data);
+}
diff --git a/apps/web-antd/src/views/doctor/doctor-reception/components/AiPrescriptionDrawer.vue b/apps/web-antd/src/views/doctor/doctor-reception/components/AiPrescriptionDrawer.vue
new file mode 100644
index 00000000..4c122128
--- /dev/null
+++ b/apps/web-antd/src/views/doctor/doctor-reception/components/AiPrescriptionDrawer.vue
@@ -0,0 +1,710 @@
+<script lang="ts" setup>
+/**
+ * PC 接诊：AI 辅助出方
+ * 主抽屉：历史列表 + 详情对照 + 确认导入
+ * 二级弹窗：紧凑可编辑病历预览 → 生成处方（编辑同步回病历面板）
+ */
+import { computed, ref } from 'vue';
+
+import { useVbenDrawer, useVbenModal } from '@vben/common-ui';
+import { Button, Descriptions, Input, Switch, Tag, message } from 'ant-design-vue';
+
+import {
+  aiGeneratePrescriptionApi,
+  aiListGenerationsApi,
+  aiMatchPrescriptionDrugsApi,
+} from '../api';
+import PrescriptionLoading from '#/components/loading/PrescriptionLoading.vue';
+
+/** 二级弹窗通栏字段（Descriptions span=2） */
+const FULL_SPAN_KEYS = new Set([
+  'chief_complaint',
+  'present_illness',
+  'tcm_case',
+  'treatment_advice',
+  'doctor_order',
+  'auxiliary_exam',
+  'physical_exam',
+]);
+
+/** 二级弹窗可编辑的病历字段（主诉单独置顶） */
+const MR_EDIT_FIELDS: Array<{ key: string; label: string }> = [
+  { key: 'present_illness', label: '现病史' },
+  { key: 'tongue', label: '舌象' },
+  { key: 'pulse', label: '脉象' },
+  { key: 'tcm_case', label: '中医病案' },
+  { key: 'tcm_disease', label: '中医疾病' },
+  { key: 'tcm_syndrome', label: '中医证候' },
+  { key: 'tcm_method', label: '中医治法' },
+  { key: 'diagnosis', label: '临床诊断' },
+  { key: 'treatment_advice', label: '治疗意见' },
+  { key: 'doctor_order', label: '医嘱' },
+  { key: 'allergy_history', label: '过敏史' },
+  { key: 'past_history', label: '既往史' },
+  { key: 'family_history', label: '家族史' },
+  { key: 'epidemic_history', label: '流行病学史' },
+  { key: 'personal_history', label: '个人史' },
+  { key: 'menstrual_history', label: '月经史' },
+  { key: 'marital_history', label: '婚育史' },
+  { key: 'physical_exam', label: '体征检查' },
+  { key: 'auxiliary_exam', label: '辅助检查' },
+];
+
+const emit = defineEmits<{
+  (
+    e: 'import',
+    payload: {
+      rows: Array<Record<string, any>>;
+      dosage?: number;
+      day_dosage?: number;
+    },
+  ): void;
+  (e: 'search-drug', keyword: string): void;
+  /** 预览里改病历字段时回写父页病历面板 */
+  (e: 'sync-medical-record', payload: Record<string, any>): void;
+}>();
+
+const registerId = ref(0);
+const storeId = ref(0);
+const prescriptionType = ref(0);
+const patientName = ref('');
+const patientSex = ref(0);
+const patientAge = ref(0);
+const chiefComplaint = ref('');
+const medicalRecord = ref<Record<string, any>>({});
+const histLoading = ref(false);
+const generating = ref(false);
+const matchLoading = ref(false);
+const historyList = ref<any[]>([]);
+const activeId = ref(0);
+const matchedList = ref<any[]>([]);
+const unmatchedList = ref<any[]>([]);
+const conflictMessages = ref<string[]>([]);
+const rxDosage = ref(0);
+const rxDayDosage = ref(0);
+const rxReason = ref('');
+const rxBasis = ref('');
+const rxPrescriptionName = ref('');
+/** 二级弹窗：当前正在编辑的字段 key，空表示浏览态 */
+const editingKey = ref('');
+
+const sexLabel = computed(() => {
+  const s = Number(patientSex.value);
+  if (s === 1) return '男';
+  if (s === 2) return '女';
+  return '未知';
+});
+
+const typeLabel = computed(() => {
+  const t = Number(prescriptionType.value);
+  if (t === 1) return '中药';
+  if (t === 2) return '西（中成）药';
+  return `类型 ${t || '—'}`;
+});
+
+const isTcmRx = computed(() => Number(prescriptionType.value) === 1);
+
+/** 二级弹窗紧凑展示：有内容的字段 + 主诉 */
+const genPreviewRows = computed(() => {
+  const mr = medicalRecord.value || {};
+  const rows: Array<{ key: string; label: string; value: string }> = [
+    {
+      key: 'chief_complaint',
+      label: '主诉',
+      value: String(chiefComplaint.value || mr.chief_complaint || '').trim(),
+    },
+  ];
+  for (const f of MR_EDIT_FIELDS) {
+    const val = String(mr[f.key] ?? '').trim();
+    if (val) rows.push({ key: f.key, label: f.label, value: val });
+  }
+  return rows;
+});
+
+const [Drawer, drawerApi] = useVbenDrawer({
+  title: 'AI辅助出方',
+  class: 'w-[920px]',
+  // 按钮放内容区，关掉默认 footer，避免底部留白占高
+  footer: false,
+  showCancelButton: false,
+  showConfirmButton: false,
+  // 内容区改 flex 铺满，由内部滚动，避免双重裁切
+  contentClass: '!flex !flex-col !overflow-hidden',
+  onOpenChange(isOpen) {
+    if (!isOpen) {
+      resetState();
+      return;
+    }
+    const data = drawerApi.getData<{
+      registerId: number;
+      storeId?: number;
+      prescriptionType: number;
+      patientName?: string;
+      patientSex?: number;
+      patientAge?: number;
+      chiefComplaint?: string;
+      medicalRecord?: Record<string, any>;
+    }>();
+    registerId.value = Number(data?.registerId || 0);
+    storeId.value = Number(data?.storeId || 0);
+    prescriptionType.value = Number(data?.prescriptionType || 0);
+    patientName.value = String(data?.patientName || '');
+    patientSex.value = Number(data?.patientSex || 0);
+    patientAge.value = Number(data?.patientAge || 0);
+    chiefComplaint.value = String(data?.chiefComplaint || '');
+    medicalRecord.value =
+      data?.medicalRecord && typeof data.medicalRecord === 'object'
+        ? { ...data.medicalRecord }
+        : {};
+    resetPreview();
+    // 打开即进历史，并尽量选中第一条
+    void bootstrapHistory();
+  },
+});
+
+const [GenModal, genModalApi] = useVbenModal({
+  title: '生成处方',
+  class: 'w-[920px]',
+  confirmText: '开始生成',
+  cancelText: '取消',
+  // 校验失败不关；通过后立刻关弹窗，生成在抽屉内进行
+  onConfirm: async () => confirmGenerateAndClose(),
+});
+
+function resetPreview() {
+  matchedList.value = [];
+  unmatchedList.value = [];
+  conflictMessages.value = [];
+  rxDosage.value = 0;
+  rxDayDosage.value = 0;
+  rxReason.value = '';
+  rxBasis.value = '';
+  rxPrescriptionName.value = '';
+  activeId.value = 0;
+  editingKey.value = '';
+}
+
+function resetState() {
+  generating.value = false;
+  matchLoading.value = false;
+  histLoading.value = false;
+  historyList.value = [];
+  medicalRecord.value = {};
+  chiefComplaint.value = '';
+  resetPreview();
+  genModalApi.close();
+}
+
+function formatTime(ts: number) {
+  const n = Number(ts || 0);
+  if (!n) return '—';
+  const d = new Date(n * 1000);
+  const pad = (x: number) => (x < 10 ? `0${x}` : `${x}`);
+  return `${pad(d.getMonth() + 1)}-${pad(d.getDate())} ${pad(d.getHours())}:${pad(d.getMinutes())}`;
+}
+
+function typeLabelOf(t: number | string) {
+  const n = Number(t || 0);
+  if (n === 1) return '中药';
+  if (n === 2) return '西药（中成药）';
+  return n ? `类型 ${n}` : '—';
+}
+
+function applyRxMeta(data: any) {
+  rxDosage.value = Number(data?.dosage || 0);
+  rxDayDosage.value = Number(data?.day_dosage || 0);
+  rxReason.value = String(data?.reason || '').trim();
+  rxBasis.value = String(data?.basis || '').trim();
+  rxPrescriptionName.value = String(data?.prescription_name || '').trim();
+}
+
+function applyConflict(conflict: any) {
+  const msgs = Array.isArray(conflict?.messages) ? conflict.messages : [];
+  conflictMessages.value = msgs
+    .map((m: any) => String(m || '').trim())
+    .filter(Boolean);
+}
+
+function applyMatch(match: any) {
+  const matched = Array.isArray(match?.matched) ? match.matched : [];
+  matchedList.value = matched.map((m: any) => ({
+    ...m,
+    _import: true,
+  }));
+  unmatchedList.value = Array.isArray(match?.unmatched) ? match.unmatched : [];
+}
+
+async function loadHistory() {
+  histLoading.value = true;
+  try {
+    const list = await aiListGenerationsApi({
+      register_id: registerId.value,
+      scene: 'prescription',
+      limit: 30,
+    });
+    historyList.value = Array.isArray(list) ? list : [];
+  } catch (e: any) {
+    historyList.value = [];
+    message.error(e?.message || e?.msg || '加载历史失败');
+  } finally {
+    histLoading.value = false;
+  }
+}
+
+/** 打开抽屉后加载历史；有则选最新，无则自动打开生成框 */
+async function bootstrapHistory() {
+  if (!registerId.value) return;
+  await loadHistory();
+  if (historyList.value.length) {
+    await onSelectHistory(historyList.value[0]);
+  } else {
+    openGenerateModal();
+  }
+}
+
+function openGenerateModal() {
+  if (!prescriptionType.value) {
+    message.warning('请先选择处方类型');
+    return;
+  }
+  editingKey.value = '';
+  genModalApi.open();
+}
+
+/**
+ * 点字段进入编辑；改完 blur 后同步病历
+ */
+function startEdit(key: string) {
+  editingKey.value = key;
+}
+
+function fieldValue(key: string) {
+  if (key === 'chief_complaint') return chiefComplaint.value;
+  return String(medicalRecord.value?.[key] ?? '');
+}
+
+function onFieldInput(key: string, val: string) {
+  if (key === 'chief_complaint') {
+    chiefComplaint.value = val;
+    medicalRecord.value = {
+      ...(medicalRecord.value || {}),
+      chief_complaint: val,
+    };
+  } else {
+    medicalRecord.value = {
+      ...(medicalRecord.value || {}),
+      [key]: val,
+    };
+  }
+  emit('sync-medical-record', { [key]: val });
+}
+
+function endEdit() {
+  editingKey.value = '';
+}
+
+/**
+ * 二级弹窗点「开始生成」：先关弹窗，回抽屉等待 AI
+ */
+async function confirmGenerateAndClose(): Promise<boolean> {
+  if (generating.value) return false;
+  const chief = String(chiefComplaint.value || '').trim();
+  if (!chief) {
+    message.warning('请先填写主诉后再生成');
+    return false;
+  }
+  if (!prescriptionType.value) {
+    message.warning('请先选择处方类型');
+    return false;
+  }
+  if (!registerId.value) {
+    message.warning('挂号无效');
+    return false;
+  }
+  // 先关模态，在抽屉内展示「AI 处理中」
+  genModalApi.close();
+  void runGenerateInDrawer(chief);
+  return true;
+}
+
+async function runGenerateInDrawer(chief: string) {
+  generating.value = true;
+  try {
+    const data = await aiGeneratePrescriptionApi({
+      register_id: registerId.value,
+      store_id: storeId.value || undefined,
+      prescription_type: prescriptionType.value,
+      chief_complaint: chief,
+      medical_record: {
+        ...(medicalRecord.value || {}),
+        chief_complaint: chief,
+      },
+    });
+    await loadHistory();
+    activeId.value = Number(data?.generation_id || 0);
+    applyMatch(data?.match || null);
+    applyConflict(data?.conflict || null);
+    applyRxMeta(data);
+    message.success('已生成，请确认导入');
+  } catch (e: any) {
+    message.error(e?.message || e?.msg || '生成失败');
+  } finally {
+    generating.value = false;
+  }
+}
+
+async function onSelectHistory(row: any) {
+  if (!row?.id) return;
+  activeId.value = Number(row.id);
+  matchLoading.value = true;
+  try {
+    const data = await aiMatchPrescriptionDrugsApi({
+      generation_id: Number(row.id),
+      register_id: registerId.value,
+      store_id: storeId.value || undefined,
+      prescription_type: Number(
+        prescriptionType.value || row.prescription_type || 0,
+      ),
+    });
+    applyMatch(data);
+    applyConflict(data?.conflict || null);
+    applyRxMeta({
+      ...data,
+      prescription_name:
+        data?.prescription_name || row?.name || row?.prescription_name || '',
+    });
+  } catch (e: any) {
+    matchedList.value = [];
+    unmatchedList.value = [];
+    conflictMessages.value = [];
+    message.error(e?.message || e?.msg || '对照失败');
+  } finally {
+    matchLoading.value = false;
+  }
+}
+
+function onConfirmImport() {
+  const drugs: any[] = [];
+  for (const m of matchedList.value) {
+    if (!m || m._import === false) continue;
+    const sid = Number(m.selected_drug_id || 0);
+    if (!sid) continue;
+    const picked = (m.candidates || []).find(
+      (c: any) => Number(c.drug_id) === sid,
+    );
+    if (!picked) continue;
+    drugs.push({
+      candidate: picked,
+      dose: m.dose || '',
+      unit: m.unit || '',
+      usage: m.usage || '',
+      ai_name: m.ai_name || '',
+    });
+  }
+  if (!drugs.length) {
+    message.warning('请先勾选已对照药品');
+    return;
+  }
+  emit('import', {
+    rows: drugs,
+    dosage: rxDosage.value || undefined,
+    day_dosage: rxDayDosage.value || undefined,
+  });
+  drawerApi.close();
+}
+
+defineExpose({
+  open(payload: {
+    registerId: number;
+    storeId?: number;
+    prescriptionType: number;
+    patientName?: string;
+    patientSex?: number;
+    patientAge?: number;
+    chiefComplaint?: string;
+    medicalRecord?: Record<string, any>;
+  }) {
+    drawerApi.setData(payload);
+    drawerApi.open();
+  },
+});
+</script>
+
+<template>
+  <Drawer>
+    <!-- 铺满抽屉内容区：头部/禁忌/按钮固定，中间历史+对照可滚动 -->
+    <div class="flex min-h-0 flex-1 flex-col gap-2 overflow-hidden text-foreground">
+      <div class="shrink-0 text-sm text-muted-foreground">
+        {{ patientName || '—' }} · {{ sexLabel }} · {{ patientAge || '—' }}岁 ·
+        {{ typeLabel }}
+      </div>
+      <div
+        v-if="conflictMessages.length"
+        class="shrink-0 rounded-lg border border-orange-500/35 bg-orange-500/10 px-3 py-2 text-xs"
+      >
+        <div class="mb-1 font-medium">配伍禁忌提示</div>
+        <div v-for="(line, i) in conflictMessages" :key="i" class="text-muted-foreground">
+          · {{ line }}
+        </div>
+      </div>
+      <div class="flex min-h-0 flex-1 gap-3 overflow-hidden">
+        <div class="w-44 shrink-0 overflow-y-auto border-r border-border pr-2">
+          <div class="mb-2 text-sm font-medium">历史记录</div>
+          <div v-if="histLoading" class="text-xs text-muted-foreground">加载中…</div>
+          <div v-else-if="!historyList.length" class="text-xs text-muted-foreground">
+            暂无记录，可点击下方「生成处方」
+          </div>
+          <div
+            v-for="row in historyList"
+            :key="row.id"
+            class="mb-1 cursor-pointer rounded-md px-2 py-1.5 text-xs transition-colors hover:bg-accent"
+            :class="{
+              'bg-primary/10 ring-1 ring-primary/20': activeId === Number(row.id),
+            }"
+            @click="onSelectHistory(row)"
+          >
+            <div class="truncate font-medium">
+              {{ row.name || row.prescription_name || `方案 #${row.id}` }}
+            </div>
+            <div class="mt-0.5 text-muted-foreground">
+              {{ row.prescription_type_label || typeLabelOf(row.prescription_type) }}
+              · {{ row.item_count || 0 }}味 · {{ formatTime(row.created_at) }}
+            </div>
+          </div>
+        </div>
+        <div class="min-h-0 min-w-0 flex-1 overflow-y-auto pl-1 pb-2">
+          <div
+            v-if="generating || matchLoading"
+            class="flex h-full min-h-[260px] items-center justify-center"
+          >
+            <PrescriptionLoading
+              type="prescription"
+              :text="
+                generating ? 'AI正在生成处方' : 'AI正在对照药品'
+              "
+              class="h-[280px] w-full max-w-[420px]"
+            />
+          </div>
+          <template v-else>
+            <div
+              v-if="!matchedList.length && !unmatchedList.length"
+              class="py-8 text-center text-muted-foreground"
+            >
+              请选择左侧历史，或点击「生成处方」
+            </div>
+            <template v-else>
+              <div class="mb-1.5 text-xs font-medium text-muted-foreground">
+                已对照（{{ matchedList.length }}）
+              </div>
+              <!-- 中药：一行多味网格；西药：仍用较完整卡片 -->
+              <div
+                v-if="isTcmRx"
+                class="grid grid-cols-2 gap-1.5 xl:grid-cols-3"
+              >
+                <div
+                  v-for="(m, mi) in matchedList"
+                  :key="mi"
+                  class="rounded border border-border bg-card px-1.5 py-1"
+                >
+                  <div class="flex items-start gap-1">
+                    <div class="min-w-0 flex-1">
+                      <div class="truncate text-xs font-medium">{{ m.ai_name }}</div>
+                      <div class="text-[11px] text-muted-foreground">
+                        {{ m.dose }}{{ m.unit }}{{ m.usage ? `·${m.usage}` : '' }}
+                      </div>
+                    </div>
+                    <Switch v-model:checked="m._import" size="small" />
+                  </div>
+                  <div class="mt-1 flex flex-wrap gap-0.5">
+                    <Tag
+                      v-for="c in m.candidates || []"
+                      :key="c.drug_id"
+                      class="cursor-pointer !m-0 !px-1 !text-[10px] !leading-4"
+                      :color="
+                        Number(m.selected_drug_id) === Number(c.drug_id)
+                          ? 'success'
+                          : undefined
+                      "
+                      @click="m.selected_drug_id = Number(c.drug_id)"
+                    >
+                      {{ c.drug_name }}
+                    </Tag>
+                  </div>
+                </div>
+              </div>
+              <div v-else class="space-y-2">
+                <div
+                  v-for="(m, mi) in matchedList"
+                  :key="mi"
+                  class="rounded-lg border border-border bg-card p-2.5"
+                >
+                  <div class="flex items-center gap-2">
+                    <span class="min-w-0 flex-1 truncate font-medium">{{ m.ai_name }}</span>
+                    <span class="text-xs text-muted-foreground">
+                      {{ m.dose }}{{ m.unit }}{{ m.usage ? `·${m.usage}` : '' }}
+                    </span>
+                    <Switch v-model:checked="m._import" size="small" />
+                  </div>
+                  <div class="mt-1 flex flex-wrap gap-1">
+                    <Tag
+                      v-for="c in m.candidates || []"
+                      :key="c.drug_id"
+                      class="cursor-pointer !m-0 !text-[11px]"
+                      :color="
+                        Number(m.selected_drug_id) === Number(c.drug_id)
+                          ? 'success'
+                          : undefined
+                      "
+                      @click="m.selected_drug_id = Number(c.drug_id)"
+                    >
+                      {{ c.drug_name }} ￥{{ Number(c.price || 0).toFixed(2) }}
+                    </Tag>
+                  </div>
+                </div>
+              </div>
+              <div
+                v-if="unmatchedList.length"
+                class="mb-1.5 mt-3 text-xs font-medium text-muted-foreground"
+              >
+                未对照（{{ unmatchedList.length }}）
+              </div>
+              <div
+                v-for="(u, ui) in unmatchedList"
+                :key="ui"
+                class="mb-1.5 rounded border border-orange-500/30 bg-orange-500/10 px-2 py-1.5 text-sm"
+              >
+                <div class="font-medium">{{ u.ai_name }}</div>
+                <Button
+                  type="link"
+                  size="small"
+                  class="!h-auto !px-0"
+                  @click="
+                    emit('search-drug', u.ai_name || '');
+                    drawerApi.close();
+                  "
+                >
+                  去手动搜索
+                </Button>
+              </div>
+              <!-- 药方摘要：Descriptions 双列展示名称/剂数/出方理由 -->
+              <Descriptions
+                v-if="
+                  rxPrescriptionName ||
+                  rxReason ||
+                  rxBasis ||
+                  rxDosage ||
+                  rxDayDosage
+                "
+                :column="2"
+                bordered
+                size="small"
+                class="ai-rx-meta-desc mt-3"
+                title="出方说明"
+              >
+                <Descriptions.Item label="药方名" :span="2">
+                  {{ rxPrescriptionName || '未命名药方' }}
+                </Descriptions.Item>
+                <Descriptions.Item label="推荐剂数">
+                  {{ rxDosage || '—' }}剂
+                </Descriptions.Item>
+                <Descriptions.Item label="每天几次">
+                  {{ rxDayDosage || '—' }}次
+                </Descriptions.Item>
+                <Descriptions.Item
+                  v-if="rxReason"
+                  label="为什么出这个方"
+                  :span="2"
+                >
+                  <div class="max-h-28 overflow-y-auto whitespace-pre-wrap leading-relaxed">
+                    {{ rxReason }}
+                  </div>
+                </Descriptions.Item>
+                <Descriptions.Item
+                  v-if="rxBasis"
+                  label="根据哪些"
+                  :span="2"
+                >
+                  <div class="max-h-28 overflow-y-auto whitespace-pre-wrap leading-relaxed">
+                    {{ rxBasis }}
+                  </div>
+                </Descriptions.Item>
+              </Descriptions>
+            </template>
+          </template>
+        </div>
+      </div>
+      <div class="flex shrink-0 justify-end gap-2 border-t border-border pt-3">
+        <Button @click="drawerApi.close()">关闭</Button>
+        <Button type="default" @click="openGenerateModal">生成处方</Button>
+        <Button
+          type="primary"
+          :disabled="generating || matchLoading || !matchedList.length"
+          @click="onConfirmImport"
+        >
+          确认导入
+        </Button>
+      </div>
+    </div>
+  </Drawer>
+
+  <!-- 二级：病历预览（可点改）+ 生成；Descriptions 双列 -->
+  <GenModal>
+    <div class="space-y-2 text-sm text-foreground">
+      <div class="text-xs text-muted-foreground">
+        {{ patientName || '—' }} · {{ sexLabel }} · {{ patientAge || '—' }}岁 ·
+        {{ typeLabel }} · 点击文字可编辑，将同步到病历
+      </div>
+      <div class="max-h-[58vh] overflow-y-auto">
+        <Descriptions
+          v-if="genPreviewRows.length"
+          :column="2"
+          bordered
+          size="small"
+          class="ai-rx-gen-desc"
+        >
+          <Descriptions.Item
+            v-for="row in genPreviewRows"
+            :key="row.key"
+            :label="row.label"
+            :span="FULL_SPAN_KEYS.has(row.key) ? 2 : 1"
+          >
+            <Input.TextArea
+              v-if="editingKey === row.key"
+              :value="fieldValue(row.key)"
+              :rows="row.key === 'chief_complaint' ? 3 : 2"
+              autofocus
+              @update:value="(v) => onFieldInput(row.key, String(v ?? ''))"
+              @blur="endEdit"
+            />
+            <div
+              v-else
+              class="max-h-24 cursor-text overflow-y-auto whitespace-pre-wrap leading-relaxed"
+              title="点击编辑"
+              @click="startEdit(row.key)"
+            >
+              {{ fieldValue(row.key) || '（空，点击填写）' }}
+            </div>
+          </Descriptions.Item>
+        </Descriptions>
+        <div
+          v-if="genPreviewRows.length <= 1"
+          class="px-2 py-3 text-center text-xs text-muted-foreground"
+        >
+          仅有主诉。建议先在病历区补充现病史、舌脉等，再生成。
+        </div>
+      </div>
+    </div>
+  </GenModal>
+</template>
+
+<style scoped>
+.ai-rx-gen-desc :deep(.ant-descriptions-item-label),
+.ai-rx-meta-desc :deep(.ant-descriptions-item-label) {
+  width: 110px;
+  white-space: nowrap;
+}
+.ai-rx-gen-desc :deep(.ant-descriptions-item-content),
+.ai-rx-meta-desc :deep(.ant-descriptions-item-content) {
+  font-size: 12px;
+}
+</style>
diff --git a/apps/web-antd/src/views/doctor/doctor-reception/index.vue b/apps/web-antd/src/views/doctor/doctor-reception/index.vue
index 85b7bc96..d4efeee5 100644
--- a/apps/web-antd/src/views/doctor/doctor-reception/index.vue
+++ b/apps/web-antd/src/views/doctor/doctor-reception/index.vue
@@ -14,6 +14,7 @@ import {
   MenuFoldOutlined,
   MenuUnfoldOutlined,
   PlusOutlined,
+  RobotOutlined,
   SaveOutlined,
   StopOutlined,
   SwapOutlined,
@@ -85,6 +86,7 @@ import RefusalOfTreatmentModal
   from "#/views/doctor/doctor-reception/components/RefusalOfTreatmentModal.vue";
 // 常用方选择弹窗组件
 import CommonPrescriptionModal from './components/CommonPrescriptionModal.vue';
+import AiPrescriptionDrawer from './components/AiPrescriptionDrawer.vue';
 // 确认模态框组件
 import ConfirmModal from './components/ConfirmModal.vue';
 // 信息提示模态框组件
@@ -1264,6 +1266,177 @@ function openCommonPrescriptionModal() {
   CommonPrescriptionModalApi.open();
 }
 
+const aiPrescriptionDrawerRef = ref<InstanceType<typeof AiPrescriptionDrawer> | null>(null);
+
+/** 打开 AI 给处方抽屉：先确认患者与主诉，再生成预览 */
+function openAiPrescriptionDrawer() {
+  if (guardSpecialPrescriptionCartEdit()) return;
+  const registerId = Number.parseInt(
+    localStorage.getItem(`doctorReception-id`) || '0',
+  );
+  if (!registerId) {
+    message.warning('请先选择患者');
+    return;
+  }
+  if (!activeCategory.value) {
+    message.warning('请先选择处方类型');
+    return;
+  }
+  const payload = medicalRecordPanelRef.value?.getPayload?.() || {};
+  aiPrescriptionDrawerRef.value?.open({
+    registerId,
+    storeId: Number(myStoreId.value || 0) || undefined,
+    prescriptionType: Number(activeCategory.value),
+    patientName: String(activePatient.value?.name || ''),
+    patientSex: Number(activePatient.value?.sex || 0),
+    patientAge: Number(activePatient.value?.age || 0),
+    chiefComplaint: String(payload.chief_complaint || ''),
+    // 带入当前病历表单（含未保存内容），出方时综合参考而非只看主诉
+    medicalRecord: { ...payload },
+  });
+}
+
+/**
+ * AI 出方预览里改病历字段时，回写到当前病历面板（不强制保存）
+ */
+function handleSyncAiMedicalRecord(partial: Record<string, any>) {
+  medicalRecordPanelRef.value?.patchFields?.(partial || {});
+}
+
+/**
+ * 将 AI 对照结果覆盖导入当前处方（非追加）
+ * 中药会同步剂数/每日次数，并按 usage 匹配先煎后下 way_id
+ */
+function handleImportAiPrescription(payload: {
+  rows?: any[];
+  dosage?: number;
+  day_dosage?: number;
+}) {
+  if (guardSpecialPrescriptionCartEdit()) return;
+  const list = Array.isArray(payload?.rows) ? payload.rows : [];
+  if (!list.length) {
+    message.warning('没有可导入的药品');
+    return;
+  }
+  const resolveWayId = (usage: string) => {
+    const u = String(usage || '').trim();
+    if (!u) return 0;
+    const found = (drugUseWay.value || []).find(
+      (w: any) =>
+        String(w.name || '') === u || String(w.name || '').includes(u),
+    );
+    return found ? Number(found.id || 0) : 0;
+  };
+  const doOverwrite = () => {
+    clearAppliedSpecialPrescription();
+    const next: any[] = [];
+    for (const row of list) {
+      const c = row?.candidate || {};
+      const drugId = Number(c.drug_id || 0);
+      if (!drugId) continue;
+      if (next.find((item: any) => Number(item.id) === drugId)) continue;
+      const doseNum = parseFloat(row.dose);
+      const qty = !Number.isNaN(doseNum) && doseNum > 0 ? doseNum : 1;
+      const drug = c.drug || {};
+      if (activeCategory.value === 1) {
+        const wayId = resolveWayId(row.usage || '');
+        next.push({
+          index_id: c.id || drugId,
+          id: drugId,
+          drug_name: c.drug_name || row.ai_name,
+          number: qty,
+          price: parseFloat(c.price) || 0,
+          way_id: wayId,
+          use_ways: drugUseWay.value.find((item: any) => item.id === wayId),
+          select_number: 1,
+          unit: c.unit || { id: 0, name: row.unit || 'g' },
+        });
+        continue;
+      }
+      if (activeCategory.value === 2) {
+        next.push({
+          index_id: c.id || drugId,
+          id: drugId,
+          drug_name: c.drug_name || drug.drug_name || row.ai_name,
+          number: qty,
+          select_number: qty,
+          price: parseFloat(c.price) || 0,
+          image: c.image || drug.image || '',
+          instruction: drug.instruction || '',
+          time_id: c.time_id || drug.time_id || 0,
+          type_id: c.type_id || drug.type_id || 0,
+          frequency_id: c.frequency_id || drug.frequency_id || 0,
+          unit_id: c.unit_id || drug.unit_id || 0,
+          use_num: drugTime.value.find(
+            (item) => item.id === (c.time_id || drug.time_id || 0),
+          ),
+          use_type: drugUseType.value.find(
+            (item) => item.id === (c.type_id || drug.type_id || 0),
+          ),
+          use_frequency: drugUseFrequency.value.find(
+            (item) => item.id === (c.frequency_id || drug.frequency_id || 0),
+          ),
+          unit:
+            c.unit ||
+            drugUnit.value.find(
+              (item) => item.id === (c.unit_id || drug.unit_id || 0),
+            ),
+          type: 2,
+        });
+        continue;
+      }
+      next.push({
+        index_id: c.id || drugId,
+        id: drugId,
+        drug_name: c.drug_name || row.ai_name,
+        number: 1,
+        select_number: 1,
+        price: parseFloat(c.price) || 0,
+        image: c.image || '',
+        type: activeCategory.value,
+      });
+    }
+    if (!next.length) {
+      message.warning('没有可导入的药品');
+      return;
+    }
+    currentDrugs.value = next;
+    if (activeCategory.value === 1) {
+      if (payload.dosage != null && Number(payload.dosage) > 0) {
+        dosage.value = Number(payload.dosage);
+      }
+      if (payload.day_dosage != null && Number(payload.day_dosage) > 0) {
+        dayDosage.value = Number(payload.day_dosage);
+      }
+    }
+    updateLocalStorage();
+    message.success(`已覆盖导入 ${next.length} 个药品`);
+  };
+  if (currentDrugs.value.length > 0) {
+    AntModal.confirm({
+      title: '覆盖当前处方',
+      content: '导入将清空并覆盖现有处方药品，是否继续？',
+      okText: '继续覆盖',
+      cancelText: '取消',
+      onOk: () => doOverwrite(),
+    });
+    return;
+  }
+  doOverwrite();
+}
+
+/** 未对照药名：提示手动搜索 */
+function handleAiSearchUnmatchedDrug(keyword: string) {
+  const key = String(keyword || '');
+  if (activeCategory.value === 2) {
+    openWesternModal();
+    return;
+  }
+  if (key) {
+    message.info(`请手动搜索：${key}`);
+  }
+}
+
 /**
  * 处理选择常用方
  * @param data 常用方数据，包含prescription和recipes
@@ -2947,6 +3120,15 @@ function onStoreSelectOpenChange(open: boolean) {
           <BookOutlined />
           选择常用方
         </Button>
+        <Button
+          v-if="!isSpecialPrescriptionCartLocked"
+          type="link"
+          size="small"
+          @click="openAiPrescriptionDrawer"
+        >
+          <RobotOutlined />
+          AI辅助出方
+        </Button>
         <Button
           v-if="canUseCommonPrescription"
           type="link"
@@ -3007,6 +3189,14 @@ function onStoreSelectOpenChange(open: boolean) {
           <HistoryOutlined />
           引用历史病历
         </Button>
+        <Button
+          type="link"
+          size="small"
+          @click="medicalRecordPanelRef?.aiGenerate?.()"
+        >
+          <RobotOutlined />
+          AI写病历
+        </Button>
         <Button
           type="link"
           size="small"
@@ -3745,6 +3935,7 @@ function onStoreSelectOpenChange(open: boolean) {
           :user-patient-id="Number(activePatient?.id || 0)"
           :patient-sex="Number(activePatient?.sex || 0)"
           :patient-age="Number(activePatient?.age || 0)"
+          :patient-name="String(activePatient?.name || '')"
           :show-toolbar="false"
         />
       </div>
@@ -3767,6 +3958,12 @@ function onStoreSelectOpenChange(open: boolean) {
     <PrescriptionDetailModal/>
     <!-- 常用方选择弹窗 -->
     <CommonPrescriptionModals/>
+    <AiPrescriptionDrawer
+      ref="aiPrescriptionDrawerRef"
+      @import="handleImportAiPrescription"
+      @search-drug="handleAiSearchUnmatchedDrug"
+      @sync-medical-record="handleSyncAiMedicalRecord"
+    />
     <!-- 确认添加药品弹窗 -->
     <ConfirmModalComponent />
     <PriceAdjustDrawer />
diff --git a/apps/web-antd/src/views/doctor/medical-record/MedicalRecordPanel.vue b/apps/web-antd/src/views/doctor/medical-record/MedicalRecordPanel.vue
index c0521f1a..e91b8d60 100644
--- a/apps/web-antd/src/views/doctor/medical-record/MedicalRecordPanel.vue
+++ b/apps/web-antd/src/views/doctor/medical-record/MedicalRecordPanel.vue
@@ -19,6 +19,7 @@ import {
 import {
   ClearOutlined,
   HistoryOutlined,
+  RobotOutlined,
   SaveOutlined,
 } from '@ant-design/icons-vue';
 
@@ -35,6 +36,7 @@ import EntryKeywordBubble, {
 import CommonDxOrderChips from './components/CommonDxOrderChips.vue';
 import PatientMedicalRecordDrawer from './components/PatientMedicalRecordDrawer.vue';
 import TextareaExpandModal from './components/TextareaExpandModal.vue';
+import AiMedicalRecordModal from './components/AiMedicalRecordModal.vue';
 import { emptyMedicalRecord, isHistoryFieldVisible } from './config/constants';
 import {
   clearMedicalRecordDraft,
@@ -62,6 +64,8 @@ const props = withDefaults(
     patientSex?: number;
     /** 就诊人年龄，用于婚育史显隐 */
     patientAge?: number;
+    /** 就诊人姓名（AI 写病历确认用） */
+    patientName?: string;
     /**
      * 是否在面板内展示操作工具栏
      * 接诊台/弹窗已把按钮提到一级 Tab 下吸顶工具栏时传 false
@@ -75,6 +79,7 @@ const props = withDefaults(
     storagePrefix: '',
     patientSex: 0,
     patientAge: 0,
+    patientName: '',
     showToolbar: true,
   },
 );
@@ -579,6 +584,54 @@ async function handleSave() {
   }
 }
 
+/**
+ * 打开 AI 写病历抽屉：先进历史；无历史自动打开生成框
+ */
+function handleAiGenerate() {
+  if (!props.registerId) {
+    message.warning('无挂号信息');
+    return;
+  }
+  aiMedicalRecordModalRef.value?.open({
+    registerId: props.registerId,
+    storeId: props.storeId || undefined,
+    patientName: props.patientName || '',
+    patientSex: Number(props.patientSex || 0),
+    patientAge: Number(props.patientAge || 0),
+    chiefComplaint: String(form.chief_complaint || ''),
+  });
+}
+
+/**
+ * 将 AI 预览结果导入病历表单（不自动保存）
+ */
+function handleImportAiMedicalRecord(payload: {
+  chief_complaint: string;
+  fields: Record<string, string>;
+}) {
+  const fields = payload?.fields || {};
+  Object.keys(fields).forEach((k) => {
+    if (k === 'chief_complaint' || k === 'name') return;
+    // 诊断与处方同源，走双向绑定而不是仅写 form
+    if (k === 'diagnosis') {
+      const dx = fields[k] == null ? '' : String(fields[k]);
+      form.diagnosis = dx;
+      emit('update:diagnosis', dx);
+      return;
+    }
+    if (Object.prototype.hasOwnProperty.call(form, k)) {
+      (form as any)[k] = fields[k] == null ? '' : String(fields[k]);
+    }
+  });
+  if (payload?.chief_complaint) {
+    form.chief_complaint = payload.chief_complaint;
+  }
+  persistLocalDraft();
+  message.success('已导入，请检查后保存');
+}
+
+const aiMedicalRecordModalRef = ref<InstanceType<typeof AiMedicalRecordModal> | null>(null);
+
 async function handleClear() {
   if (!props.registerId) return;
   await clearMedicalRecord({
@@ -637,6 +690,7 @@ defineExpose({
   loadRecord,
   applyCitedRecord,
   openCiteHistory: handleCiteHistory,
+  aiGenerate: handleAiGenerate,
   loading,
   getPayload: () => ({
     ...form,
@@ -644,6 +698,30 @@ defineExpose({
     diagnosis: diagnosisModel.value,
     doctor_order: medicalAdviceModel.value,
   }),
+  /**
+   * 外部局部回写病历字段（如 AI 出方预览里点改），同步表单与本地草稿，不自动落库
+   */
+  patchFields: (partial: Record<string, any>) => {
+    if (!partial || typeof partial !== 'object') return;
+    Object.keys(partial).forEach((k) => {
+      const raw = partial[k];
+      const val = raw == null ? '' : String(raw);
+      if (k === 'diagnosis') {
+        form.diagnosis = val;
+        emit('update:diagnosis', val);
+        return;
+      }
+      if (k === 'doctor_order' || k === 'medicalAdvice') {
+        form.doctor_order = val;
+        emit('update:medicalAdvice', val);
+        return;
+      }
+      if (Object.prototype.hasOwnProperty.call(form, k)) {
+        (form as any)[k] = val;
+      }
+    });
+    persistLocalDraft();
+  },
 });
 
 /** source：走中医三典气泡；默认 entry 走病历词条 */
@@ -692,6 +770,8 @@ const allNormalFields = [
   fieldBlock('personal_history', '个人史'),
   fieldBlock('allergy_history', '过敏史'),
   fieldBlock('treatment_advice', '治疗意见'),
+  // 诊断/医嘱与处方 Tab 同源双向同步（此前网格漏渲染导致病历侧「诊断」消失）
+  fieldBlock('diagnosis', '临床诊断'),
   fieldBlock('doctor_order', '医嘱'),
   fieldBlock('physical_exam', '体征检查'),
   fieldBlock('auxiliary_exam', '辅助检查'),
@@ -724,6 +804,10 @@ const visibleNormalFields = computed(() =>
         <HistoryOutlined />
         引用历史病历
       </Button>
+      <Button type="link" size="small" :loading="loading" @click="handleAiGenerate">
+        <RobotOutlined />
+        AI写病历
+      </Button>
       <Button
         type="link"
         size="small"
@@ -747,8 +831,25 @@ const visibleNormalFields = computed(() =>
       >
         <div class="mr-field-head mb-1">
           <span class="mr-field-label">{{ f.label }}</span>
+          <!-- 诊断/医嘱走处方同源气泡；其余走病历词条 -->
           <div
-            v-if="f.fieldCode === 'doctor_order'"
+            v-if="f.fieldCode === 'diagnosis'"
+            class="mr-field-search"
+            data-mr-module="diagnosis"
+            data-mr-role="search"
+          >
+            <EntryKeywordBubble
+              :ref="(el) => setSearchRef('diagnosis', el)"
+              source="diagnosis"
+              placeholder="诊断关键字"
+              compact
+              :show-common-in-bubble="showCommonInBubble"
+              @select="(item) => onEntryPick('diagnosis', item)"
+              @common-changed="commonChipsTick += 1"
+            />
+          </div>
+          <div
+            v-else-if="f.fieldCode === 'doctor_order'"
             class="mr-field-search"
             data-mr-module="doctor_order"
             data-mr-role="search"
@@ -848,7 +949,34 @@ const visibleNormalFields = computed(() =>
             />
           </span>
         </div>
-        <template v-if="f.fieldCode === 'doctor_order'">
+        <template v-if="f.fieldCode === 'diagnosis'">
+          <div data-mr-module="diagnosis" data-mr-role="textarea">
+            <Textarea
+              :ref="(el) => setTextareaRef('diagnosis', el)"
+              v-model:value="diagnosisModel"
+              :rows="2"
+              :readonly="diagnosisReadonly"
+              placeholder="临床诊断（与处方同步，双击放大）"
+              @dblclick="openDiagnosisExpand"
+            />
+          </div>
+          <CommonDxOrderChips
+            v-if="showCommonTags && !diagnosisReadonly"
+            :key="`dx_chips_${commonChipsTick}`"
+            source="diagnosis"
+            :field-value="diagnosisModel"
+            @select="
+              (text) =>
+                onEntryPick('diagnosis', {
+                  id: text,
+                  title: text,
+                  content: text,
+                  remark: '',
+                })
+            "
+          />
+        </template>
+        <template v-else-if="f.fieldCode === 'doctor_order'">
           <div data-mr-module="doctor_order" data-mr-role="textarea">
             <Textarea
               :ref="(el) => setTextareaRef('doctor_order', el)"
@@ -1075,6 +1203,10 @@ const visibleNormalFields = computed(() =>
 
     <ExpandModal />
     <CiteHistoryDrawer />
+    <AiMedicalRecordModal
+      ref="aiMedicalRecordModalRef"
+      @import="handleImportAiMedicalRecord"
+    />
   </div>
 </template>
 <style scoped>
diff --git a/apps/web-antd/src/views/doctor/medical-record/api/index.ts b/apps/web-antd/src/views/doctor/medical-record/api/index.ts
index 68ffe1e7..4593df9b 100644
--- a/apps/web-antd/src/views/doctor/medical-record/api/index.ts
+++ b/apps/web-antd/src/views/doctor/medical-record/api/index.ts
@@ -84,6 +84,33 @@ export async function getMedicalRecordListByPatient(data: {
   return requestClient.get<any>(`${prefix}list-by-patient`, { params: data });
 }
 
+/** AI 写病历（需先填主诉；返回草稿字段） */
+export async function aiGenerateMedicalRecord(data: {
+  register_id: number;
+  store_id?: number;
+  chief_complaint?: string;
+}) {
+  return requestClient.post<any>(`${prefix}ai-generate-medical-record`, data);
+}
+
+/** 本挂号 AI 生成历史（与接诊共用 doctor-reception 接口） */
+export async function aiListGenerations(data: {
+  register_id: number;
+  scene?: string;
+  limit?: number;
+}) {
+  return requestClient.get<any>('doctor-reception/ai-list-generations', {
+    params: data,
+  });
+}
+
+/** AI 生成详情（点选历史） */
+export async function aiGenerationDetail(data: { id: number }) {
+  return requestClient.get<any>('doctor-reception/ai-generation-detail', {
+    params: data,
+  });
+}
+
 /** Excel 解析后批量导入词条 */
 export async function importMedicalRecordEntry(data: {
   scope: 'public' | 'store';
diff --git a/apps/web-antd/src/views/doctor/medical-record/components/AiMedicalRecordModal.vue b/apps/web-antd/src/views/doctor/medical-record/components/AiMedicalRecordModal.vue
new file mode 100644
index 00000000..edd67c74
--- /dev/null
+++ b/apps/web-antd/src/views/doctor/medical-record/components/AiMedicalRecordModal.vue
@@ -0,0 +1,406 @@
+<script lang="ts" setup>
+/**
+ * PC：AI 写病历
+ * 主抽屉：生成历史 + 预览 + 确认导入
+ * 二级弹窗：确认主诉后点生成 → 关弹窗，回抽屉等待结果
+ * 无历史时打开抽屉后自动弹出生成框
+ */
+import { computed, ref } from 'vue';
+
+import { useVbenDrawer, useVbenModal } from '@vben/common-ui';
+import { Button, Descriptions, Input, message } from 'ant-design-vue';
+
+import {
+  aiGenerateMedicalRecord,
+  aiGenerationDetail,
+  aiListGenerations,
+} from '../api';
+import { MEDICAL_RECORD_FIELD_OPTIONS } from '../config/constants';
+import PrescriptionLoading from '#/components/loading/PrescriptionLoading.vue';
+
+/** Descriptions 通栏字段 */
+const FULL_SPAN_KEYS = new Set([
+  'present_illness',
+  'tcm_case',
+  'treatment_advice',
+  'auxiliary_exam',
+  'physical_exam',
+  'chief_complaint',
+]);
+/** 预览字段顺序（不含主诉） */
+const PREVIEW_FIELDS = [
+  { label: '现病史', value: 'present_illness' },
+  { label: '舌象', value: 'tongue' },
+  { label: '脉象', value: 'pulse' },
+  { label: '中医病案', value: 'tcm_case' },
+  { label: '中医证候', value: 'tcm_syndrome' },
+  { label: '中医疾病', value: 'tcm_disease' },
+  { label: '中医治法', value: 'tcm_method' },
+  { label: '临床诊断', value: 'diagnosis' },
+  { label: '治疗意见', value: 'treatment_advice' },
+  ...MEDICAL_RECORD_FIELD_OPTIONS.filter((f) =>
+    [
+      'family_history',
+      'epidemic_history',
+      'past_history',
+      'menstrual_history',
+      'marital_history',
+      'personal_history',
+      'allergy_history',
+      'physical_exam',
+      'auxiliary_exam',
+    ].includes(f.value),
+  ),
+];
+
+const emit = defineEmits<{
+  (
+    e: 'import',
+    payload: { chief_complaint: string; fields: Record<string, string> },
+  ): void;
+}>();
+
+const registerId = ref(0);
+const storeId = ref(0);
+const patientName = ref('');
+const patientSex = ref(0);
+const patientAge = ref(0);
+const chiefComplaint = ref('');
+const histLoading = ref(false);
+const generating = ref(false);
+const detailLoading = ref(false);
+const historyList = ref<any[]>([]);
+const activeId = ref(0);
+const previewFields = ref<Record<string, string>>({});
+const previewChief = ref('');
+
+const sexLabel = computed(() => {
+  const s = Number(patientSex.value);
+  if (s === 1) return '男';
+  if (s === 2) return '女';
+  return '未知';
+});
+
+const previewRows = computed(() =>
+  PREVIEW_FIELDS.map((f) => ({
+    label: f.label,
+    value: String(previewFields.value[f.value] || '').trim(),
+    code: f.value,
+  })).filter((r) => r.value !== ''),
+);
+
+const [Drawer, drawerApi] = useVbenDrawer({
+  title: 'AI写病历',
+  class: 'w-[860px]',
+  footer: false,
+  showCancelButton: false,
+  showConfirmButton: false,
+  contentClass: '!flex !flex-col !overflow-hidden',
+  onOpenChange(isOpen) {
+    if (!isOpen) {
+      resetState();
+      return;
+    }
+    const data = drawerApi.getData<{
+      registerId: number;
+      storeId?: number;
+      patientName?: string;
+      patientSex?: number;
+      patientAge?: number;
+      chiefComplaint?: string;
+    }>();
+    registerId.value = Number(data?.registerId || 0);
+    storeId.value = Number(data?.storeId || 0);
+    patientName.value = String(data?.patientName || '');
+    patientSex.value = Number(data?.patientSex || 0);
+    patientAge.value = Number(data?.patientAge || 0);
+    chiefComplaint.value = String(data?.chiefComplaint || '');
+    previewFields.value = {};
+    previewChief.value = '';
+    activeId.value = 0;
+    void bootstrapHistory();
+  },
+});
+
+const [GenModal, genModalApi] = useVbenModal({
+  title: '生成病历',
+  class: 'w-[560px]',
+  confirmText: '开始生成',
+  cancelText: '取消',
+  onConfirm: async () => confirmGenerateAndClose(),
+});
+
+function resetState() {
+  histLoading.value = false;
+  generating.value = false;
+  detailLoading.value = false;
+  historyList.value = [];
+  activeId.value = 0;
+  previewFields.value = {};
+  previewChief.value = '';
+  chiefComplaint.value = '';
+  genModalApi.close();
+}
+
+function formatTime(ts: number) {
+  const n = Number(ts || 0);
+  if (!n) return '—';
+  const d = new Date(n * 1000);
+  const pad = (x: number) => (x < 10 ? `0${x}` : `${x}`);
+  return `${pad(d.getMonth() + 1)}-${pad(d.getDate())} ${pad(d.getHours())}:${pad(d.getMinutes())}`;
+}
+
+async function loadHistory() {
+  histLoading.value = true;
+  try {
+    const list = await aiListGenerations({
+      register_id: registerId.value,
+      scene: 'medical_record',
+      limit: 30,
+    });
+    historyList.value = Array.isArray(list) ? list : [];
+  } catch (e: any) {
+    historyList.value = [];
+    message.error(e?.message || e?.msg || '加载历史失败');
+  } finally {
+    histLoading.value = false;
+  }
+}
+
+/** 有历史选最新；无历史自动打开生成框 */
+async function bootstrapHistory() {
+  if (!registerId.value) return;
+  await loadHistory();
+  if (historyList.value.length) {
+    await onSelectHistory(historyList.value[0]);
+  } else {
+    openGenerateModal();
+  }
+}
+
+function openGenerateModal() {
+  genModalApi.open();
+}
+
+async function onSelectHistory(row: any) {
+  if (!row?.id) return;
+  activeId.value = Number(row.id);
+  detailLoading.value = true;
+  try {
+    const data = await aiGenerationDetail({ id: Number(row.id) });
+    const fields = (data?.fields || {}) as Record<string, string>;
+    previewFields.value = { ...fields };
+    const snap = data?.input_snapshot || {};
+    previewChief.value = String(
+      snap.chief_complaint || chiefComplaint.value || '',
+    ).trim();
+  } catch (e: any) {
+    previewFields.value = {};
+    previewChief.value = '';
+    message.error(e?.message || e?.msg || '加载详情失败');
+  } finally {
+    detailLoading.value = false;
+  }
+}
+
+/** 先关弹窗，回抽屉等待生成 */
+async function confirmGenerateAndClose(): Promise<boolean> {
+  if (generating.value) return false;
+  const chief = chiefComplaint.value.trim();
+  if (!chief) {
+    message.warning('请先填写主诉后再生成');
+    return false;
+  }
+  if (!registerId.value) {
+    message.warning('挂号无效');
+    return false;
+  }
+  genModalApi.close();
+  void runGenerateInDrawer(chief);
+  return true;
+}
+
+async function runGenerateInDrawer(chief: string) {
+  generating.value = true;
+  previewFields.value = {};
+  previewChief.value = chief;
+  try {
+    const data = await aiGenerateMedicalRecord({
+      register_id: registerId.value,
+      store_id: storeId.value || undefined,
+      chief_complaint: chief,
+    });
+    previewFields.value = (data?.fields || {}) as Record<string, string>;
+    await loadHistory();
+    activeId.value = Number(data?.generation_id || 0);
+    message.success('已生成，请预览后确认导入');
+  } catch (e: any) {
+    message.error(e?.message || e?.msg || 'AI写病历失败');
+  } finally {
+    generating.value = false;
+  }
+}
+
+function onConfirmImport() {
+  if (!Object.keys(previewFields.value || {}).length && !previewChief.value) {
+    message.warning('暂无可导入内容');
+    return;
+  }
+  emit('import', {
+    chief_complaint: String(previewChief.value || chiefComplaint.value || '').trim(),
+    fields: { ...previewFields.value },
+  });
+  drawerApi.close();
+}
+
+defineExpose({
+  open(payload: {
+    registerId: number;
+    storeId?: number;
+    patientName?: string;
+    patientSex?: number;
+    patientAge?: number;
+    chiefComplaint?: string;
+  }) {
+    drawerApi.setData(payload);
+    drawerApi.open();
+  },
+});
+</script>
+
+<template>
+  <Drawer>
+    <div class="flex min-h-0 flex-1 flex-col gap-2 overflow-hidden text-foreground">
+      <div class="shrink-0 text-sm text-muted-foreground">
+        {{ patientName || '—' }} · {{ sexLabel }} · {{ patientAge || '—' }}岁
+      </div>
+      <div class="flex min-h-0 flex-1 gap-3 overflow-hidden">
+        <div class="w-44 shrink-0 overflow-y-auto border-r border-border pr-2">
+          <div class="mb-2 text-sm font-medium">历史记录</div>
+          <div v-if="histLoading" class="text-xs text-muted-foreground">加载中…</div>
+          <div v-else-if="!historyList.length" class="text-xs text-muted-foreground">
+            暂无记录，可点击下方「生成病历」
+          </div>
+          <div
+            v-for="row in historyList"
+            :key="row.id"
+            class="mb-1 cursor-pointer rounded-md px-2 py-1.5 text-xs transition-colors hover:bg-accent"
+            :class="{
+              'bg-primary/10 ring-1 ring-primary/20': activeId === Number(row.id),
+            }"
+            @click="onSelectHistory(row)"
+          >
+            <div class="truncate font-medium">
+              {{ row.name || `病历 #${row.id}` }}
+            </div>
+            <div class="mt-0.5 text-muted-foreground">
+              {{ formatTime(row.created_at) }}
+            </div>
+          </div>
+        </div>
+        <div class="min-h-0 min-w-0 flex-1 overflow-y-auto pl-1 pb-2">
+          <div
+            v-if="generating || detailLoading"
+            class="flex h-full min-h-[260px] items-center justify-center"
+          >
+            <PrescriptionLoading
+              type="medical_record"
+              :text="
+                generating ? 'AI正在生成病历' : 'AI正在加载病历'
+              "
+              class="h-[280px] w-full max-w-[420px]"
+            />
+          </div>
+          <template v-else>
+            <div
+              v-if="!previewRows.length && !previewChief"
+              class="py-8 text-center text-muted-foreground"
+            >
+              请选择左侧历史，或点击「生成病历」
+            </div>
+            <template v-else>
+              <Descriptions
+                v-if="previewChief || previewRows.length"
+                :column="2"
+                bordered
+                size="small"
+                class="ai-mr-preview-desc"
+              >
+                <Descriptions.Item
+                  v-if="previewChief"
+                  label="主诉"
+                  :span="2"
+                >
+                  <div class="max-h-20 overflow-y-auto whitespace-pre-wrap leading-relaxed">
+                    {{ previewChief }}
+                  </div>
+                </Descriptions.Item>
+                <Descriptions.Item
+                  v-for="row in previewRows"
+                  :key="row.code"
+                  :label="row.label"
+                  :span="FULL_SPAN_KEYS.has(row.code) ? 2 : 1"
+                >
+                  <div class="max-h-20 overflow-y-auto whitespace-pre-wrap leading-relaxed">
+                    {{ row.value }}
+                  </div>
+                </Descriptions.Item>
+              </Descriptions>
+              <div
+                v-else
+                class="py-4 text-center text-xs text-muted-foreground"
+              >
+                暂无生成字段
+              </div>
+            </template>
+          </template>
+        </div>
+      </div>
+      <div class="flex shrink-0 justify-end gap-2 border-t border-border pt-3">
+        <Button @click="drawerApi.close()">关闭</Button>
+        <Button type="default" @click="openGenerateModal">生成病历</Button>
+        <Button
+          type="primary"
+          :disabled="generating || detailLoading || (!previewRows.length && !previewChief)"
+          @click="onConfirmImport"
+        >
+          确认导入
+        </Button>
+      </div>
+    </div>
+  </Drawer>
+
+  <GenModal>
+    <div class="space-y-3 text-sm text-foreground">
+      <div class="rounded-lg border border-border bg-muted/40 p-3">
+        <div class="mb-1 font-medium">患者信息确认</div>
+        <div class="text-muted-foreground">
+          姓名：{{ patientName || '—' }}　性别：{{ sexLabel }}　年龄：{{
+            patientAge || '—'
+          }}岁
+        </div>
+      </div>
+      <div>
+        <div class="mb-2 font-medium">主诉（可编辑）</div>
+        <Input.TextArea
+          v-model:value="chiefComplaint"
+          :rows="4"
+          placeholder="请确认或补充主诉后再生成"
+        />
+      </div>
+      <div class="text-xs text-muted-foreground">
+        点击「开始生成」后将关闭本弹窗，请在抽屉中等待结果。
+      </div>
+    </div>
+  </GenModal>
+</template>
+
+<style scoped>
+.ai-mr-preview-desc :deep(.ant-descriptions-item-label) {
+  width: 88px;
+  white-space: nowrap;
+}
+.ai-mr-preview-desc :deep(.ant-descriptions-item-content) {
+  font-size: 12px;
+}
+</style>
diff --git a/apps/web-antd/src/views/doctor/medical-record/components/EntryListPage.vue b/apps/web-antd/src/views/doctor/medical-record/components/EntryListPage.vue
index aac59397..3f7cbd1e 100644
--- a/apps/web-antd/src/views/doctor/medical-record/components/EntryListPage.vue
+++ b/apps/web-antd/src/views/doctor/medical-record/components/EntryListPage.vue
@@ -175,7 +175,10 @@ async function handleImportFile(file: File) {
   importing.value = true;
   try {
     const buffer = await file.arrayBuffer();
-    const parsed = await parseMedicalRecordEntryExcelBuffer(buffer);
+    // 按字段拆分页传入 defaultFieldCode：允许 Excel 字段编码留空 / 填中文名
+    const parsed = await parseMedicalRecordEntryExcelBuffer(buffer, {
+      defaultFieldCode: props.fixedFieldCode || '',
+    });
     let rows = parsed.items;
     if (props.fixedFieldCode) {
       rows = rows
@@ -183,10 +186,13 @@ async function handleImportFile(file: File) {
         .filter((r) => r.title);
     }
     if (!rows.length) {
+      const detail = parsed.firstInvalidReason
+        ? `：${parsed.firstInvalidReason}`
+        : '';
       message.warning(
         parsed.invalidCount
-          ? `没有可导入的有效行（无效 ${parsed.invalidCount} 行）`
-          : '文件无有效数据',
+          ? `没有可导入的有效行（无效 ${parsed.invalidCount} 行）${detail}`
+          : '文件无有效数据，请确认填写的是「词条导入」工作表',
       );
       return false;
     }
diff --git a/apps/web-antd/src/views/doctor/medical-record/components/PatientMedicalRecordDrawer.vue b/apps/web-antd/src/views/doctor/medical-record/components/PatientMedicalRecordDrawer.vue
index 36308862..953f65ed 100644
--- a/apps/web-antd/src/views/doctor/medical-record/components/PatientMedicalRecordDrawer.vue
+++ b/apps/web-antd/src/views/doctor/medical-record/components/PatientMedicalRecordDrawer.vue
@@ -3,12 +3,12 @@
  * 患者历史病历抽屉
  * - view：只读查看
  * - cite：选择一条后点「引用此病历」回填到当前接诊病历
- * （修复：原 latest 接口会排除当前挂号，仅有本次病历时会误报「暂无」）
+ * 右侧预览用 Descriptions 双列，跳过空字段
  */
 import { computed, ref } from 'vue';
 
 import { useVbenDrawer } from '@vben/common-ui';
-import { Empty, Spin, Tag, message } from 'ant-design-vue';
+import { Descriptions, Empty, Spin, Tag, message } from 'ant-design-vue';
 
 import { getMedicalRecordListByPatient } from '../api';
 import { MEDICAL_RECORD_VIEW_FIELDS } from '../config/constants';
@@ -19,14 +19,22 @@ type DrawerData = {
   userPatientId?: number;
   storeId?: number;
   patientName?: string;
-  /** view=查看；cite=引用到当前病历 */
   mode?: 'view' | 'cite';
-  /** 引用模式下排除当前挂号（仍展示，但默认选中其他挂号） */
   excludeRegisterId?: number;
-  /** 引用确认回调 */
   onCite?: (record: Record<string, any>) => void;
 };
 
+/** Descriptions 通栏字段 */
+const FULL_SPAN_KEYS = new Set([
+  'chief_complaint',
+  'present_illness',
+  'tcm_case',
+  'treatment_advice',
+  'doctor_order',
+  'auxiliary_exam',
+  'physical_exam',
+]);
+
 const loading = ref(false);
 const list = ref<Record<string, any>[]>([]);
 const activeId = ref(0);
@@ -38,7 +46,6 @@ const activeRecord = computed(() => {
   return list.value.find((r) => Number(r.id) === activeId.value) || null;
 });
 
-/** 体征摘要文案 */
 function vitalsText(row: Record<string, any>) {
   const parts: string[] = [];
   if (row.temperature) parts.push(`体温 ${row.temperature}℃`);
@@ -56,13 +63,25 @@ function fieldDisplay(row: Record<string, any>, key: string) {
     const body = String(row.physical_exam || '').trim();
     const vitals = vitalsText(row);
     if (body && vitals) return `${vitals}\n${body}`;
-    return body || vitals || '—';
+    return body || vitals || '';
   }
   const v = row[key];
-  if (v === null || v === undefined || v === '' || v === 0) return '—';
-  return String(v);
+  if (v === null || v === undefined || v === '' || v === 0) return '';
+  return String(v).trim();
 }
 
+/** 仅有内容的字段，供 Descriptions 渲染 */
+const filledViewFields = computed(() => {
+  const row = activeRecord.value;
+  if (!row) return [];
+  return MEDICAL_RECORD_VIEW_FIELDS.map((f) => ({
+    label: f.label,
+    value: f.value,
+    text: fieldDisplay(row, f.value),
+    span: FULL_SPAN_KEYS.has(f.value) ? 2 : 1,
+  })).filter((f) => !!f.text);
+});
+
 function listTitle(row: Record<string, any>) {
   const dx = String(row.diagnosis || '').trim();
   if (dx) return dx.length > 28 ? `${dx.slice(0, 28)}…` : dx;
@@ -74,9 +93,6 @@ function isCurrentRegister(row: Record<string, any>) {
   return exclude > 0 && Number(row.register_id) === exclude;
 }
 
-/**
- * 默认选中：优先「非当前挂号」的最近一条，否则选第一条
- */
 function pickDefaultActiveId(rows: Record<string, any>[]) {
   if (!rows.length) return 0;
   const exclude = Number(meta.value.excludeRegisterId || 0);
@@ -113,7 +129,7 @@ async function loadList() {
 }
 
 const [Drawer, drawerApi] = useVbenDrawer({
-  class: 'w-[860px]',
+  class: 'w-[900px]',
   title: '查看患者病历',
   cancelText: '关闭',
   confirmText: '引用此病历',
@@ -177,27 +193,50 @@ const [Drawer, drawerApi] = useVbenDrawer({
         </div>
         <div class="mr-view-detail">
           <template v-if="activeRecord">
-            <div class="mr-view-detail__head">
-              <span>挂号 ID：{{ activeRecord.register_id || '-' }}</span>
-              <span>创建：{{ activeRecord.created_at || '—' }}</span>
-              <span>更新：{{ activeRecord.updated_at || '—' }}</span>
-            </div>
+            <Descriptions
+              :column="2"
+              bordered
+              size="small"
+              class="mb-3 mr-view-meta-desc"
+            >
+              <Descriptions.Item label="挂号 ID">
+                {{ activeRecord.register_id || '-' }}
+              </Descriptions.Item>
+              <Descriptions.Item label="创建">
+                {{ activeRecord.created_at || '—' }}
+              </Descriptions.Item>
+              <Descriptions.Item label="更新" :span="2">
+                {{ activeRecord.updated_at || '—' }}
+              </Descriptions.Item>
+            </Descriptions>
             <div
               v-if="isCiteMode && isCurrentRegister(activeRecord)"
               class="mr-view-tip"
             >
               当前选中的是本次挂号病历，引用后会覆盖编辑区内容（仍可继续改）。
             </div>
-            <div
-              v-for="f in MEDICAL_RECORD_VIEW_FIELDS"
-              :key="f.value"
-              class="mr-view-field"
+            <Empty
+              v-if="!filledViewFields.length"
+              description="该病历暂无填写内容"
+              class="py-6"
+            />
+            <Descriptions
+              v-else
+              :column="2"
+              bordered
+              size="small"
+              title="病历内容"
+              class="mr-view-content-desc"
             >
-              <div class="mr-view-field__label">{{ f.label }}</div>
-              <div class="mr-view-field__value">
-                {{ fieldDisplay(activeRecord, f.value) }}
-              </div>
-            </div>
+              <Descriptions.Item
+                v-for="f in filledViewFields"
+                :key="f.value"
+                :label="f.label"
+                :span="f.span"
+              >
+                <div class="mr-view-content-text">{{ f.text }}</div>
+              </Descriptions.Item>
+            </Descriptions>
           </template>
           <Empty v-else description="请选择左侧病历" />
         </div>
@@ -208,22 +247,22 @@ const [Drawer, drawerApi] = useVbenDrawer({
 <style scoped>
 .mr-view-layout {
   display: grid;
-  grid-template-columns: 240px 1fr;
-  gap: 16px;
-  min-height: 520px;
+  grid-template-columns: 220px 1fr;
+  gap: 12px;
+  min-height: 480px;
 }
 .mr-view-list {
   border-right: 1px solid hsl(var(--border));
-  padding-right: 12px;
+  padding-right: 10px;
   max-height: 70vh;
   overflow-y: auto;
 }
 .mr-view-item {
-  padding: 10px 12px;
+  padding: 8px 10px;
   border-radius: 8px;
   cursor: pointer;
   border: 1px solid transparent;
-  margin-bottom: 8px;
+  margin-bottom: 6px;
   background: hsl(var(--muted) / 0.35);
   transition: all 0.2s;
 }
@@ -237,56 +276,44 @@ const [Drawer, drawerApi] = useVbenDrawer({
 .mr-view-item__title {
   font-size: 13px;
   font-weight: 600;
-  line-height: 1.4;
+  line-height: 1.35;
   word-break: break-all;
 }
 .mr-view-item__meta {
-  margin-top: 6px;
+  margin-top: 4px;
   display: flex;
   flex-wrap: wrap;
-  gap: 6px;
+  gap: 4px;
   align-items: center;
-  font-size: 12px;
+  font-size: 11px;
   color: hsl(var(--muted-foreground));
 }
 .mr-view-detail {
   max-height: 70vh;
   overflow-y: auto;
-  padding-right: 4px;
-}
-.mr-view-detail__head {
-  display: flex;
-  flex-wrap: wrap;
-  gap: 12px;
-  margin-bottom: 12px;
-  font-size: 12px;
-  color: hsl(var(--muted-foreground));
+  padding-right: 2px;
 }
 .mr-view-tip {
-  margin-bottom: 12px;
-  padding: 8px 10px;
+  margin-bottom: 10px;
+  padding: 6px 8px;
   font-size: 12px;
   color: #ad6800;
   background: #fff7e6;
   border-radius: 6px;
 }
-.mr-view-field {
-  margin-bottom: 12px;
+.mr-view-meta-desc :deep(.ant-descriptions-item-label),
+.mr-view-content-desc :deep(.ant-descriptions-item-label) {
+  width: 88px;
+  white-space: nowrap;
 }
-.mr-view-field__label {
+.mr-view-content-desc :deep(.ant-descriptions-item-content) {
   font-size: 12px;
-  font-weight: 600;
-  color: hsl(var(--muted-foreground));
-  margin-bottom: 4px;
 }
-.mr-view-field__value {
-  font-size: 13px;
-  line-height: 1.55;
+.mr-view-content-text {
+  max-height: 88px;
+  overflow-y: auto;
   white-space: pre-wrap;
   word-break: break-word;
-  padding: 8px 10px;
-  border-radius: 6px;
-  background: hsl(var(--muted) / 0.4);
-  min-height: 36px;
+  line-height: 1.45;
 }
 </style>
diff --git a/apps/web-antd/src/views/doctor/medical-record/utils/exportMedicalRecordEntryExcel.ts b/apps/web-antd/src/views/doctor/medical-record/utils/exportMedicalRecordEntryExcel.ts
index a9f78d97..eb8a364a 100644
--- a/apps/web-antd/src/views/doctor/medical-record/utils/exportMedicalRecordEntryExcel.ts
+++ b/apps/web-antd/src/views/doctor/medical-record/utils/exportMedicalRecordEntryExcel.ts
@@ -78,8 +78,28 @@ export async function exportMedicalRecordEntryTemplate(): Promise<ArrayBuffer> {
     });
   });
   tip.addRow([]);
+  tip.addRow([
+    '填写说明',
+    '「字段编码」可填右侧英文编码，也可直接填左侧中文名（如：主诉）',
+  ]);
   tip.addRow(['状态说明', '1=启用，0=禁用；空默认启用']);
   tip.addRow(['拼音首拼', '由系统根据词条名称自动生成，无需填写']);
+  tip.addRow([
+    '按字段菜单导入',
+    '在「主诉/既往史」等拆分页导入时，字段编码列可留空，系统自动归属当前字段',
+  ]);
+
+  // 给「字段编码」列加下拉，减少填错中文/编码混用导致整表无效
+  const codeList = MEDICAL_RECORD_FIELD_OPTIONS.map((o) => o.value).join(',');
+  // Excel 数据验证公式长度有限；字段不多时可直接列枚举
+  sheet.dataValidations.add('A2:A2001', {
+    type: 'list',
+    allowBlank: true,
+    formulae: [`"${codeList}"`],
+    showErrorMessage: true,
+    errorTitle: '字段编码',
+    error: '请从下拉选择英文编码，或手动填写中文名（如：主诉）',
+  });
 
   return workbook.xlsx.writeBuffer() as Promise<ArrayBuffer>;
 }
diff --git a/apps/web-antd/src/views/doctor/medical-record/utils/parseMedicalRecordEntryExcel.ts b/apps/web-antd/src/views/doctor/medical-record/utils/parseMedicalRecordEntryExcel.ts
index be6cab8c..e7dedfad 100644
--- a/apps/web-antd/src/views/doctor/medical-record/utils/parseMedicalRecordEntryExcel.ts
+++ b/apps/web-antd/src/views/doctor/medical-record/utils/parseMedicalRecordEntryExcel.ts
@@ -17,18 +17,45 @@ export type ParseMedicalRecordEntryResult = {
   items: ParsedMedicalRecordEntryRow[];
   invalidCount: number;
   rowCount: number;
+  /** 首条无效原因，便于前端提示（如填了中文名未识别等） */
+  firstInvalidReason?: string;
+};
+
+export type ParseMedicalRecordEntryOptions = {
+  /**
+   * 按字段拆分菜单导入时传入：字段编码列可留空，自动落到当前字段
+   * 为什么需要：运营在「主诉词条」页导入时常不填字段编码，旧逻辑会整行判无效
+   */
+  defaultFieldCode?: string;
 };
 
 function normalizeCell(value: ExcelJS.CellValue): string {
   if (value === null || value === undefined) {
     return '';
   }
-  if (typeof value === 'object' && 'text' in value) {
-    return String((value as any).text ?? '').trim();
+  if (typeof value === 'object') {
+    // 富文本：Excel/WPS 局部加粗后常见 { richText: [...] }
+    if ('richText' in value && Array.isArray((value as any).richText)) {
+      return (value as any).richText
+        .map((p: { text?: string }) => p?.text ?? '')
+        .join('')
+        .trim();
+    }
+    // 超链接 / 带 text 的复合值
+    if ('text' in value) {
+      return String((value as any).text ?? '').trim();
+    }
+    // 公式结果
+    if ('result' in value) {
+      return normalizeCell((value as any).result as ExcelJS.CellValue);
+    }
   }
   if (typeof value === 'number') {
     return Number.isInteger(value) ? String(value) : String(value).trim();
   }
+  if (typeof value === 'boolean') {
+    return value ? '1' : '0';
+  }
   return String(value).trim();
 }
 
@@ -45,6 +72,23 @@ const STATUS_ALIASES = ['状态', 'status'];
 
 const VALID_FIELDS = new Set(MEDICAL_RECORD_FIELD_OPTIONS.map((o) => o.value));
 
+/** 中文名 / 英文编码 → 标准 field_code（运营常按「字段编码说明」里的中文名填写） */
+const FIELD_LABEL_TO_CODE = new Map<string, string>(
+  MEDICAL_RECORD_FIELD_OPTIONS.flatMap((o) => [
+    [normalizeHeader(o.value), o.value],
+    [normalizeHeader(o.label), o.value],
+  ]),
+);
+
+/**
+ * 把单元格里的字段编码或中文名解析成标准 code；无法识别则返回空串
+ */
+function resolveFieldCode(raw: string): string {
+  const key = normalizeHeader(raw);
+  if (!key) return '';
+  return FIELD_LABEL_TO_CODE.get(key) || (VALID_FIELDS.has(raw) ? raw : '');
+}
+
 function buildHeaderIndexMap(headerRow: ExcelJS.Row): Record<string, number> {
   const map: Record<string, number> = {};
   headerRow.eachCell({ includeEmpty: true }, (cell, colNumber) => {
@@ -81,25 +125,38 @@ function getCellInt(row: ExcelJS.Row, col?: number, fallback = 0): number {
 }
 
 function rowIsEmpty(row: ExcelJS.Row): boolean {
-  let empty = true;
-  row.eachCell({ includeEmpty: false }, () => {
-    empty = false;
+  let hasValue = false;
+  row.eachCell({ includeEmpty: false }, (cell) => {
+    if (normalizeCell(cell.value) !== '') {
+      hasValue = true;
+    }
   });
-  return empty;
+  return !hasValue;
+}
+
+/**
+ * 优先取「词条导入」sheet；避免用户改完后激活了「字段编码说明」导致读错表
+ */
+function pickImportSheet(workbook: ExcelJS.Workbook): ExcelJS.Worksheet | undefined {
+  const byName = workbook.worksheets.find((s) => s.name === '词条导入');
+  return byName || workbook.worksheets[0];
 }
 
 /**
  * 解析词条导入 Excel（首行为表头）
+ * 字段编码列支持英文 code 或中文名；按字段页可传 defaultFieldCode 允许留空
  */
 export async function parseMedicalRecordEntryExcelBuffer(
   buffer: ArrayBuffer,
+  options: ParseMedicalRecordEntryOptions = {},
 ): Promise<ParseMedicalRecordEntryResult> {
   const workbook = new ExcelJS.Workbook();
   await workbook.xlsx.load(buffer);
-  const sheet = workbook.worksheets[0];
+  const sheet = pickImportSheet(workbook);
   if (!sheet) {
     return { items: [], invalidCount: 0, rowCount: 0 };
   }
+  const defaultFieldCode = resolveFieldCode(options.defaultFieldCode || '');
   const headerRow = sheet.getRow(1);
   const headerMap = buildHeaderIndexMap(headerRow);
   const fieldCol = pickColumn(headerMap, FIELD_ALIASES);
@@ -108,21 +165,44 @@ export async function parseMedicalRecordEntryExcelBuffer(
   const remarkCol = pickColumn(headerMap, REMARK_ALIASES);
   const sortCol = pickColumn(headerMap, SORT_ALIASES);
   const statusCol = pickColumn(headerMap, STATUS_ALIASES);
-  if (!fieldCol || !titleCol) {
-    throw new Error('模板表头缺少「字段编码」或「词条名称」列');
+  // 无默认字段时必须有「字段编码」列；有默认字段时仅要求「词条名称」
+  if (!titleCol) {
+    throw new Error('模板表头缺少「词条名称」列，请重新下载模板');
+  }
+  if (!fieldCol && !defaultFieldCode) {
+    throw new Error('模板表头缺少「字段编码」列，请重新下载模板');
   }
   const items: ParsedMedicalRecordEntryRow[] = [];
   let invalidCount = 0;
   let rowCount = 0;
-  sheet.eachRow({ includeEmpty: false }, (row, rowNumber) => {
-    if (rowNumber === 1 || rowIsEmpty(row)) return;
+  let firstInvalidReason: string | undefined;
+  const maxRow = Math.min(sheet.rowCount || 0, MAX_ROWS + 1);
+  for (let rowNumber = 2; rowNumber <= maxRow; rowNumber++) {
+    const row = sheet.getRow(rowNumber);
+    if (rowIsEmpty(row)) continue;
     rowCount++;
-    if (items.length >= MAX_ROWS) return;
-    const field_code = getCellText(row, fieldCol);
+    if (items.length >= MAX_ROWS) break;
+    const rawField = getCellText(row, fieldCol);
     const title = getCellText(row, titleCol);
-    if (!field_code || !title || !VALID_FIELDS.has(field_code)) {
+    let field_code = resolveFieldCode(rawField);
+    if (!field_code && defaultFieldCode) {
+      field_code = defaultFieldCode;
+    }
+    if (!title) {
       invalidCount++;
-      return;
+      if (!firstInvalidReason) {
+        firstInvalidReason = `第${rowNumber}行：词条名称为空`;
+      }
+      continue;
+    }
+    if (!field_code) {
+      invalidCount++;
+      if (!firstInvalidReason) {
+        firstInvalidReason = rawField
+          ? `第${rowNumber}行：字段「${rawField}」无法识别（请填英文编码如 chief_complaint，或中文名如「主诉」）`
+          : `第${rowNumber}行：字段编码为空（请对照「字段编码说明」填写，或从对应字段菜单页导入）`;
+      }
+      continue;
     }
     const statusRaw = getCellInt(row, statusCol, 1);
     items.push({
@@ -133,6 +213,6 @@ export async function parseMedicalRecordEntryExcelBuffer(
       sort: getCellInt(row, sortCol, 0),
       status: statusRaw === 0 ? 0 : 1,
     });
-  });
-  return { items, invalidCount, rowCount };
+  }
+  return { items, invalidCount, rowCount, firstInvalidReason };
 }