diff --git a/openhis-ui-vue3/src/views/doctorstation/components/diagnosis/addDiagnosisDialog.vue b/openhis-ui-vue3/src/views/doctorstation/components/diagnosis/addDiagnosisDialog.vue
index 5ce1e1b0..8eee4dc5 100644
--- a/openhis-ui-vue3/src/views/doctorstation/components/diagnosis/addDiagnosisDialog.vue
+++ b/openhis-ui-vue3/src/views/doctorstation/components/diagnosis/addDiagnosisDialog.vue
@@ -91,6 +91,8 @@ import {
   getTcmCondition,
   getTcmSyndrome,
   saveTcmDiagnosis,
+  deleteTcmDiagnosis,
+  getTcmDiagnosis,
 } from '@/views/doctorstation/components/api';
 
 const props = defineProps({
@@ -115,9 +117,38 @@ const { proxy } = getCurrentInstance();
 const emit = defineEmits(['close']);
 
 function handleOpen() {
+  // 加载诊断和证候选项
   getTcmCondition().then((res) => {
     conditionList.value = res.data.records;
   });
+
+  // 加载已保存的中医诊断
+  getTcmDiagnosis({ encounterId: props.patientInfo.encounterId }).then((res) => {
+    if (res.data && res.data.illness && res.data.illness.length > 0) {
+      tcmDiagonsisList.value = [];
+      tcmDiagonsisSaveList.value = [];
+
+      res.data.illness.forEach((illness, index) => {
+        const symptom = res.data.symptom[index];
+        const syndromeGroupNo = illness.syndromeGroupNo || symptom.syndromeGroupNo;
+
+        tcmDiagonsisList.value.push({
+          conditionName: illness.name,
+          syndromeName: symptom.name,
+          syndromeGroupNo: syndromeGroupNo,
+          isSaved: true, // 标记为已保存的诊断
+        });
+
+        tcmDiagonsisSaveList.value.push({
+          definitionId: illness.definitionId,
+          syndromeGroupNo: syndromeGroupNo,
+          isSaved: true,
+        });
+      });
+    }
+  }).catch((error) => {
+    console.error('加载中医诊断失败:', error);
+  });
 }
 
 // 点击诊断列表处理，点击以后才显示证候列表
@@ -155,10 +186,34 @@ function clickSyndromeRow(row) {
 
 // 删除诊断
 function removeDiagnosis(row, index) {
-  tcmDiagonsisList.value.splice(index, 1);
-  tcmDiagonsisSaveList.value = tcmDiagonsisSaveList.filter((item) => {
-    return item.syndromeGroupNo !== row.syndromeGroupNo;
-  });
+  // 如果是已保存的诊断，需要调用API从服务器删除
+  if (row.isSaved && row.syndromeGroupNo) {
+    proxy.$modal.confirm('确定要删除这个中医诊断吗？').then(() => {
+      deleteTcmDiagnosis(row.syndromeGroupNo).then((res) => {
+        if (res.code === 200) {
+          proxy.$modal.msgSuccess('删除成功');
+          // 从列表中移除
+          tcmDiagonsisList.value.splice(index, 1);
+          tcmDiagonsisSaveList.value = tcmDiagonsisSaveList.value.filter((item) => {
+            return item.syndromeGroupNo !== row.syndromeGroupNo;
+          });
+        } else {
+          proxy.$modal.msgError(res.msg || '删除失败');
+        }
+      }).catch((error) => {
+        console.error('删除中医诊断失败:', error);
+        proxy.$modal.msgError('删除失败，请重试');
+      });
+    }).catch(() => {
+      // 用户取消删除
+    });
+  } else {
+    // 未保存的诊断，直接从数组中删除
+    tcmDiagonsisList.value.splice(index, 1);
+    tcmDiagonsisSaveList.value = tcmDiagonsisSaveList.value.filter((item) => {
+      return item.syndromeGroupNo !== row.syndromeGroupNo;
+    });
+  }
 }
 
 function save() {
diff --git a/openhis-ui-vue3/src/views/doctorstation/components/tcm/tcmAdvice.vue b/openhis-ui-vue3/src/views/doctorstation/components/tcm/tcmAdvice.vue
index 48065339..633e19fa 100644
--- a/openhis-ui-vue3/src/views/doctorstation/components/tcm/tcmAdvice.vue
+++ b/openhis-ui-vue3/src/views/doctorstation/components/tcm/tcmAdvice.vue
@@ -401,7 +401,7 @@
         </el-table>
       </div>
     </div>
-    <tcmdiagnosisDialog ref="tcmDianosis" :patientInfo="props.patientInfo" @flush="getListInfo()" />
+    <tcmdiagnosisDialog ref="tcmDianosis" :patientInfo="props.patientInfo" @flush="handleDiagnosisFlush()" />
   </div>
 </template>
       
@@ -414,6 +414,7 @@ import {
   getOrgTree,
   signTcmAdvice,
   getTcmDiagnosis,
+  deleteTcmDiagnosis,
   signOutTcmAdvice,
   updateGroupId,
   getContract,
@@ -645,17 +646,19 @@ function getListInfo(addNewRow) {
 function getDiagnosisInfo() {
   diagnosisList.value = [];
   getTcmDiagnosis({ encounterId: props.patientInfo.encounterId }).then((res) => {
-    if (res.data.illness.length > 0) {
+    if (res.data.illness && res.data.illness.length > 0) {
       res.data.illness.forEach((item, index) => {
         diagnosisList.value.push({
           name: item.name + '-' + res.data.symptom[index].name,
           definitionId: item.definitionId,
           encounterDiagnosisId: item.encounterDiagnosisId,
           conditionId: item.conditionId,
+          syndromeGroupNo: item.syndromeGroupNo || res.data.symptom[index].syndromeGroupNo, // 保存syndromeGroupNo用于删除
+          ...item, // 保存完整的item数据
         });
       });
     }
-    // 默认选择第一个诊断  
+    // 默认选择第一个诊断
     if (diagnosisList.value.length > 0) {
       const firstDiagnosis = diagnosisList.value[0];
       tcmPrescriptionList.value.forEach((prescription) => {
@@ -752,19 +755,31 @@ function openDialog() {
   tcmDianosis.value.openDialog();
 }
 
-function deleteDiagnosisBind(id) {
-  const data = localStorage.getItem(`tcmDiagnosisList_${props.patientInfo.encounterId}`);
-  let list = [];
-  list = JSON.parse(data);
-  // 添加到列表
-  const index = list.findIndex((item) => item.id === id);
-  if (index === -1) return;
+function deleteDiagnosisBind(syndromeGroupNo) {
+  if (!syndromeGroupNo) {
+    proxy.$modal.msgWarning('缺少诊断标识，无法删除');
+    return;
+  }
 
-  list.splice(index, 1);
-  localStorage.removeItem(`tcmDiagnosisList_${props.patientInfo.encounterId}`);
-  // 保存到本地缓存
-  localStorage.setItem(`tcmDiagnosisList_${props.patientInfo.encounterId}`, JSON.stringify(list));
+  // 调用API从服务器删除中医诊断
+  deleteTcmDiagnosis(syndromeGroupNo).then((res) => {
+    if (res.code === 200) {
+      proxy.$modal.msgSuccess('删除成功');
+      handleDiagnosisFlush();
+    } else {
+      proxy.$modal.msgError(res.msg || '删除失败');
+    }
+  }).catch((error) => {
+    console.error('删除中医诊断失败:', error);
+    proxy.$modal.msgError('删除失败，请重试');
+  });
+}
+
+// 诊断数据刷新处理函数
+function handleDiagnosisFlush() {
+  // 同时刷新医嘱列表和诊断列表，确保诊断数据同步
   getListInfo();
+  getDiagnosisInfo();
 }
 
 function addNewPrescription(){
diff --git a/openhis-ui-vue3/src/views/doctorstation/components/tcm/tcmdiagnosisDialog.vue b/openhis-ui-vue3/src/views/doctorstation/components/tcm/tcmdiagnosisDialog.vue
index ec01dd0d..4d25733c 100644
--- a/openhis-ui-vue3/src/views/doctorstation/components/tcm/tcmdiagnosisDialog.vue
+++ b/openhis-ui-vue3/src/views/doctorstation/components/tcm/tcmdiagnosisDialog.vue
@@ -82,28 +82,29 @@ function submit() {
     return; // 确保选择了诊断和证候
   }
 
-  // 构建诊断对象
-  const diagnosis = {
-    id: Date.now(), // 使用时间戳作为唯一ID
-    condition: conditionOptions.value.find((item) => item.value === condition.value)?.label || '',
+  // 构建诊断数据，调用API保存到服务器
+  const diagnosisChildList = [{
     conditionCode: condition.value,
-    syndrome: syndromeOptions.value.find((item) => item.value === syndrome.value)?.label || '',
     syndromeCode: syndrome.value,
-  };
-  const data = localStorage.getItem(`tcmDiagnosisList_${props.patientInfo.encounterId}`);
-  diagnosisList.value = JSON.parse(data);
-  // 添加到列表
-  diagnosisList.value.push(diagnosis);
-  localStorage.removeItem(`tcmDiagnosisList_${props.patientInfo.encounterId}`);
-  // 保存到本地缓存
-  localStorage.setItem(
-    `tcmDiagnosisList_${props.patientInfo.encounterId}`,
-    JSON.stringify(diagnosisList.value)
-  );
+  }];
 
-  console.log('当前诊断列表:', diagnosisList.value);
-  emit('flush')
-  close();
+  // 调用API保存到服务器
+  saveTcmDiagnosis({
+    patientId: props.patientInfo.patientId,
+    encounterId: props.patientInfo.encounterId,
+    diagnosisChildList: diagnosisChildList,
+  }).then((res) => {
+    if (res.code === 200) {
+      proxy.$modal.msgSuccess('保存成功');
+      emit('flush');
+      close();
+    } else {
+      proxy.$modal.msgError(res.msg || '保存失败');
+    }
+  }).catch((error) => {
+    console.error('保存中医诊断失败:', error);
+    proxy.$modal.msgError('保存失败，请重试');
+  });
 }
 
 function openDialog() {