diff --git a/healthlink-his-server/healthlink-his-application/src/main/resources/db/migration/V20260624_3__update_key_tcm_syndromes_update_time.sql b/healthlink-his-server/healthlink-his-application/src/main/resources/db/migration/V20260624_3__update_key_tcm_syndromes_update_time.sql
new file mode 100644
index 000000000..7c652a854
--- /dev/null
+++ b/healthlink-his-server/healthlink-his-application/src/main/resources/db/migration/V20260624_3__update_key_tcm_syndromes_update_time.sql
@@ -0,0 +1,9 @@
+-- Initialize update_time for all TCM syndromes to a default past timestamp so they don't sort before active ones in nulls-first ORDER BY
+UPDATE cli_condition_definition 
+SET update_time = '2000-01-01 00:00:00' 
+WHERE source_enum = 6;
+
+-- Set update_time for the 8 core TCM syndromes so that they sort at the top of the list
+UPDATE cli_condition_definition 
+SET update_time = CURRENT_TIMESTAMP 
+WHERE source_enum = 6 AND name IN ('阴证', '阳证', '寒证', '热证', '虚证', '实证', '闭证', '脱证');
diff --git a/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/addDiagnosisDialog.vue b/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/addDiagnosisDialog.vue
index 5d00897c3..1f434f9e5 100755
--- a/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/addDiagnosisDialog.vue
+++ b/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/addDiagnosisDialog.vue
@@ -1,4 +1,4 @@
-<template>
+<template>
   <el-dialog
     v-model="dialogVisible"
     :title="isUpdateMode ? '修改中医诊断' : '添加中医诊断'"
@@ -227,7 +227,7 @@ function handleClickRow(row) {
     selectedDisease.value = true;
     syndromeSelected.value = false;
     timestamp.value = Date.now();
-    getTcmSyndrome().then((res) => {
+    getTcmSyndrome({ pageSize: 3000 }).then((res) => {
       syndromeList.value = res.data.records;
     });
     tcmDiagonsisSaveList.value.push({
diff --git a/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/chineseMedicineDialog.vue b/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/chineseMedicineDialog.vue
index 48ddd4ec2..0773bb63f 100755
--- a/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/chineseMedicineDialog.vue
+++ b/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/chineseMedicineDialog.vue
@@ -40,20 +40,18 @@
         label="中医证候"
         prop="syndromeCode"
       >
-        <el-select
+        <el-cascader
+          ref="cascaderRef"
           v-model="formData.syndromeCode"
+          :options="getGroupedSyndromeOptions(syndromeOptions)"
+          :props="{ emitPath: false, checkStrictly: true }"
+          :show-all-levels="false"
           placeholder="请选择中医证候"
           filterable
           clearable
           style="width: 100%"
-        >
-          <el-option
-            v-for="item in syndromeOptions"
-            :key="item.value"
-            :label="item.label"
-            :value="item.value"
-          />
-        </el-select>
+          @change="handleSyndromeCodeChange"
+        />
       </el-form-item>
     </el-form>
     <template #footer>
@@ -83,6 +81,7 @@ const { proxy } = getCurrentInstance()
 
 const conditionOptions = ref([])
 const syndromeOptions = ref([])
+const cascaderRef = ref(null)
 
 const formData = ref({
   conditionCode: '',
@@ -129,7 +128,7 @@ function loadConditionOptions() {
 }
 
 function loadSyndromeOptions(conditionCode) {
-  const params = conditionCode ? { conditionCode } : {}
+  const params = conditionCode ? { conditionCode, pageSize: 3000 } : { pageSize: 3000 }
   getTcmSyndrome(params).then((res) => {
     if (res.data && res.data.records) {
       syndromeOptions.value = res.data.records.map((item) => ({
@@ -177,6 +176,154 @@ const openAct = () => {
   loadConditionOptions()
   loadSyndromeOptions()
 }
+function getGroupedSyndromeOptions(options) {
+  if (!options || !options.length) return []
+  
+  const seen = new Set()
+  const uniqueOptions = []
+  options.forEach(item => {
+    if (!seen.has(item.label)) {
+      seen.add(item.label)
+      uniqueOptions.push(item)
+    }
+  })
+
+  const nameToItems = {}
+  uniqueOptions.forEach(item => {
+    const name = item.label
+    if (!nameToItems[name]) {
+      nameToItems[name] = []
+    }
+    nameToItems[name].push(item)
+  })
+
+  // Level 3 Children of 阴证 (寒证, 虚证)
+  const childrenOfYin = []
+  ;['寒证', '虚证'].forEach(name => {
+    if (nameToItems[name]) {
+      childrenOfYin.push(...nameToItems[name])
+    }
+  })
+
+  // Level 3 Children of 阳证 (热证, 实证)
+  const childrenOfYang = []
+  ;['热证', '实证'].forEach(name => {
+    if (nameToItems[name]) {
+      childrenOfYang.push(...nameToItems[name])
+    }
+  })
+
+  // Level 2 under 八纲总纲 (阴证, 阳证)
+  const level2OfBagang = []
+  
+  if (nameToItems['阴证']) {
+    nameToItems['阴证'].forEach(item => {
+      level2OfBagang.push({
+        value: item.value,
+        label: item.label,
+        id: item.id,
+        children: childrenOfYin.length ? childrenOfYin : undefined
+      })
+    })
+  } else if (childrenOfYin.length > 0) {
+    level2OfBagang.push({
+      value: 'virtual-yin',
+      label: '阴证',
+      children: childrenOfYin
+    })
+  }
+  
+  if (nameToItems['阳证']) {
+    nameToItems['阳证'].forEach(item => {
+      level2OfBagang.push({
+        value: item.value,
+        label: item.label,
+        id: item.id,
+        children: childrenOfYang.length ? childrenOfYang : undefined
+      })
+    })
+  } else if (childrenOfYang.length > 0) {
+    level2OfBagang.push({
+      value: 'virtual-yang',
+      label: '阳证',
+      children: childrenOfYang
+    })
+  }
+
+  // Level 2 under 危重急症 (闭证, 脱证)
+  const level2OfWeizhong = []
+  ;['闭证', '脱证'].forEach(name => {
+    if (nameToItems[name]) {
+      level2OfWeizhong.push(...nameToItems[name])
+    }
+  })
+
+  // Level 2 under 其他证候 (all other syndromes)
+  const level2OfOther = []
+  const specialNames = new Set(['阴证', '阳证', '寒证', '热证', '虚证', '实证', '闭证', '脱证'])
+  options.forEach(item => {
+    if (!specialNames.has(item.label)) {
+      level2OfOther.push(item)
+    }
+  })
+
+  const finalTree = []
+  
+  if (level2OfBagang.length > 0) {
+    finalTree.push({
+      value: 'root-bagang',
+      label: '八纲总纲',
+      children: level2OfBagang
+    })
+  }
+  
+  if (level2OfWeizhong.length > 0) {
+    finalTree.push({
+      value: 'root-weizhong',
+      label: '危重急症',
+      children: level2OfWeizhong
+    })
+  }
+  
+  if (level2OfOther.length > 0) {
+    finalTree.push({
+      value: 'root-other',
+      label: '其他证候',
+      children: level2OfOther
+    })
+  }
+
+  return finalTree
+}
+
+function handleSyndromeCodeChange(val) {
+  console.log('handleSyndromeCodeChange called with:', val)
+  if (val === 'root-bagang' || val === 'root-weizhong' || val === 'root-other' || (typeof val === 'string' && val.startsWith('virtual-'))) {
+    formData.value.syndromeCode = ''
+  } else if (val) {
+    if (cascaderRef.value) {
+      console.log('Cascader Ref component instance:', cascaderRef.value)
+      if (typeof cascaderRef.value.togglePopperVisible === 'function') {
+        cascaderRef.value.togglePopperVisible(false)
+      }
+      if (typeof cascaderRef.value.toggleDropDownVisible === 'function') {
+        cascaderRef.value.toggleDropDownVisible(false)
+      }
+      cascaderRef.value.popperVisible = false
+      if (typeof cascaderRef.value.blur === 'function') {
+        cascaderRef.value.blur()
+      }
+    }
+    if (document.activeElement && typeof document.activeElement.blur === 'function') {
+      console.log('Blurring active element:', document.activeElement)
+      document.activeElement.blur()
+    }
+    setTimeout(() => {
+      document.body.click()
+    }, 50)
+  }
+}
+
 const closedAct = () => {
   emit('update:visible', false)
 }
diff --git a/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue b/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue
index 3b7fef9e7..13d3e9c50 100755
--- a/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue
+++ b/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue
@@ -268,22 +268,19 @@
                     :prop="`diagnosisList.${scope.rowIndex}.tcmSyndromeCode`"
                     :rules="scope.row.diagnosisSystem === '中医' ? [{ required: true, message: '请选择中医证候', trigger: 'change' }] : []"
                   >
-                    <el-select
+                    <el-cascader
+                      :ref="el => setCascaderRef(el, scope.rowIndex)"
                       v-model="scope.row.tcmSyndromeCode"
+                      :options="getGroupedSyndromeOptions(scope.row.syndromeOptions)"
+                      :props="{ emitPath: false, checkStrictly: true }"
+                      :show-all-levels="false"
                       placeholder="请选择中医证候"
                       filterable
                       clearable
                       style="width: 100%"
                       @focus="loadSyndromeOptions(scope.row)"
-                      @change="(val) => handleSyndromeSelect(val, scope.row)"
-                    >
-                      <el-option
-                        v-for="item in (scope.row.syndromeOptions || [])"
-                        :key="item.value"
-                        :label="item.label"
-                        :value="item.value"
-                      />
-                    </el-select>
+                      @change="(val) => handleSyndromeSelect(val, scope.row, scope.rowIndex)"
+                    />
                   </el-form-item>
                 </template>
                 <el-form-item v-else>
@@ -419,6 +416,12 @@ const rowIndex = ref();
 const diagnosis = ref();
 const orgOrUser = ref();
 const syndromeOptions = ref([]);
+const cascaderRefs = ref({});
+const setCascaderRef = (el, index) => {
+  if (el) {
+    cascaderRefs.value[index] = el;
+  }
+};
 const form = ref({
   diagnosisList: [],
 });
@@ -832,8 +835,11 @@ function handleDiagnosisSystemChange(row) {
 
 // 加载中医证候选项（按诊断名称关联过滤）
 function loadSyndromeOptions(row) {
+  if (row.syndromeOptions && row.syndromeOptions.length) {
+    return;
+  }
   const conditionCode = row.ybNo;
-  const params = conditionCode ? { conditionCode } : {};
+  const params = conditionCode ? { conditionCode, pageSize: 3000 } : { pageSize: 3000 };
   getTcmSyndrome(params).then((res) => {
     if (res.data && res.data.records) {
       row.syndromeOptions = res.data.records.map((item) => ({
@@ -848,11 +854,43 @@ function loadSyndromeOptions(row) {
 }
 
 // 中医证候选中赋值
-function handleSyndromeSelect(val, row) {
+function handleSyndromeSelect(val, row, rowIndex) {
+  console.log('handleSyndromeSelect called with:', val, 'rowIndex:', rowIndex);
   if (val) {
+    if (val === 'root-bagang' || val === 'root-weizhong' || val === 'root-other' || (typeof val === 'string' && val.startsWith('virtual-'))) {
+      row.tcmSyndromeCode = '';
+      row.tcmSyndromeName = '';
+      row.syndromeDefinitionId = '';
+      return;
+    }
     const selected = (row.syndromeOptions || []).find((item) => item.value === val);
     row.tcmSyndromeName = selected ? selected.label : '';
     row.syndromeDefinitionId = selected ? selected.id : '';
+    
+    // Close the cascader dropdown programmatically
+    if (rowIndex !== undefined && cascaderRefs.value[rowIndex]) {
+      const refEl = cascaderRefs.value[rowIndex];
+      console.log('Cascader Ref component instance:', refEl);
+      if (refEl) {
+        if (typeof refEl.togglePopperVisible === 'function') {
+          refEl.togglePopperVisible(false);
+        }
+        if (typeof refEl.toggleDropDownVisible === 'function') {
+          refEl.toggleDropDownVisible(false);
+        }
+        refEl.popperVisible = false;
+        if (typeof refEl.blur === 'function') {
+          refEl.blur();
+        }
+      }
+    }
+    if (document.activeElement && typeof document.activeElement.blur === 'function') {
+      console.log('Blurring active element:', document.activeElement);
+      document.activeElement.blur();
+    }
+    setTimeout(() => {
+      document.body.click();
+    }, 50);
   } else {
     row.tcmSyndromeName = '';
     row.syndromeDefinitionId = '';
@@ -1120,9 +1158,14 @@ function handleChange(value) {
  */
 function handleSelsectDiagnosis(row) {
   console.log(row);
-  form.value.diagnosisList[rowIndex.value].ybNo = row.ybNo;
-  form.value.diagnosisList[rowIndex.value].name = row.name;
-  form.value.diagnosisList[rowIndex.value].definitionId = row.id;
+  const targetRow = form.value.diagnosisList[rowIndex.value];
+  targetRow.ybNo = row.ybNo;
+  targetRow.name = row.name;
+  targetRow.definitionId = row.id;
+  targetRow.syndromeOptions = [];
+  targetRow.tcmSyndromeCode = '';
+  targetRow.tcmSyndromeName = '';
+  targetRow.syndromeDefinitionId = '';
 }
 /**获取焦点时 打开列表 */
 function handleFocus(row, index) {
@@ -1189,6 +1232,126 @@ function handleNodeClick(data) {
   }
 }
 
+function getGroupedSyndromeOptions(options) {
+  if (!options || !options.length) return [];
+  
+  const seen = new Set();
+  const uniqueOptions = [];
+  options.forEach(item => {
+    if (!seen.has(item.label)) {
+      seen.add(item.label);
+      uniqueOptions.push(item);
+    }
+  });
+
+  const nameToItems = {};
+  uniqueOptions.forEach(item => {
+    const name = item.label;
+    if (!nameToItems[name]) {
+      nameToItems[name] = [];
+    }
+    nameToItems[name].push(item);
+  });
+
+  // Level 3 Children of 阴证 (寒证, 虚证)
+  const childrenOfYin = [];
+  ['寒证', '虚证'].forEach(name => {
+    if (nameToItems[name]) {
+      childrenOfYin.push(...nameToItems[name]);
+    }
+  });
+
+  // Level 3 Children of 阳证 (热证, 实证)
+  const childrenOfYang = [];
+  ['热证', '实证'].forEach(name => {
+    if (nameToItems[name]) {
+      childrenOfYang.push(...nameToItems[name]);
+    }
+  });
+
+  // Level 2 under 八纲总纲 (阴证, 阳证)
+  const level2OfBagang = [];
+  
+  if (nameToItems['阴证']) {
+    nameToItems['阴证'].forEach(item => {
+      level2OfBagang.push({
+        value: item.value,
+        label: item.label,
+        id: item.id,
+        children: childrenOfYin.length ? childrenOfYin : undefined
+      });
+    });
+  } else if (childrenOfYin.length > 0) {
+    level2OfBagang.push({
+      value: 'virtual-yin',
+      label: '阴证',
+      children: childrenOfYin
+    });
+  }
+  
+  if (nameToItems['阳证']) {
+    nameToItems['阳证'].forEach(item => {
+      level2OfBagang.push({
+        value: item.value,
+        label: item.label,
+        id: item.id,
+        children: childrenOfYang.length ? childrenOfYang : undefined
+      });
+    });
+  } else if (childrenOfYang.length > 0) {
+    level2OfBagang.push({
+      value: 'virtual-yang',
+      label: '阳证',
+      children: childrenOfYang
+    });
+  }
+
+  // Level 2 under 危重急症 (闭证, 脱证)
+  const level2OfWeizhong = [];
+  ['闭证', '脱证'].forEach(name => {
+    if (nameToItems[name]) {
+      level2OfWeizhong.push(...nameToItems[name]);
+    }
+  });
+
+  // Level 2 under 其他证候 (all other syndromes)
+  const level2OfOther = [];
+  const specialNames = new Set(['阴证', '阳证', '寒证', '热证', '虚证', '实证', '闭证', '脱证']);
+  options.forEach(item => {
+    if (!specialNames.has(item.label)) {
+      level2OfOther.push(item);
+    }
+  });
+
+  const finalTree = [];
+  
+  if (level2OfBagang.length > 0) {
+    finalTree.push({
+      value: 'root-bagang',
+      label: '八纲总纲',
+      children: level2OfBagang
+    });
+  }
+  
+  if (level2OfWeizhong.length > 0) {
+    finalTree.push({
+      value: 'root-weizhong',
+      label: '危重急症',
+      children: level2OfWeizhong
+    });
+  }
+  
+  if (level2OfOther.length > 0) {
+    finalTree.push({
+      value: 'root-other',
+      label: '其他证候',
+      children: level2OfOther
+    });
+  }
+
+  return finalTree;
+}
+
 defineExpose({ getList, getDetail, handleSaveDiagnosis });
 </script>
 
diff --git a/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/index.vue b/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/index.vue
index cdbc49966..81486532c 100755
--- a/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/index.vue
+++ b/healthlink-his-ui/src/views/inpatientDoctor/home/components/diagnosis/index.vue
@@ -444,7 +444,7 @@ function handleTcmSyndromeClick(row, index) {
 function handleSyndromeSearch() {}
 
 function loadSyndromeList() {
-  getTcmSyndrome().then((res) => {
+  getTcmSyndrome({ pageSize: 3000 }).then((res) => {
     if (res.data && res.data.records) {
       syndromeList.value = res.data.records
     }