diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationDiagnosisAppServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationDiagnosisAppServiceImpl.java
index 2a1fd9356..73a865a3c 100755
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationDiagnosisAppServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/doctorstation/appservice/impl/DoctorStationDiagnosisAppServiceImpl.java
@@ -246,7 +246,8 @@ public class DoctorStationDiagnosisAppServiceImpl implements IDoctorStationDiagn
         EncounterDiagnosis encounterDiagnosis;
         for (SaveDiagnosisChildParam saveDiagnosisChildParam : diagnosisChildList) {
             encounterDiagnosis = new EncounterDiagnosis();
-            encounterDiagnosis.setId(saveDiagnosisChildParam.getEncounterDiagnosisId());
+            // 注意：不设置 encounterDiagnosisId，因为上面已经删除了所有记录
+            // 如果设置旧的 ID，saveOrUpdate 会尝试 UPDATE 不存在的记录导致失败或重复插入
             encounterDiagnosis.setEncounterId(encounterId);
             encounterDiagnosis.setConditionId(saveDiagnosisChildParam.getConditionId());
             encounterDiagnosis.setMaindiseFlag(saveDiagnosisChildParam.getMaindiseFlag());
diff --git a/openhis-ui-vue3/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue b/openhis-ui-vue3/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue
index e50513b32..8cda4020b 100755
--- a/openhis-ui-vue3/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue
+++ b/openhis-ui-vue3/src/views/inpatientDoctor/home/components/diagnosis/diagnosis.vue
@@ -289,43 +289,62 @@ function getList() {
         return obj;
       });
       form.value.diagnosisList = datas;
-      // form.value.diagnosisList = res.data;
+      // 去重：按 conditionId 去重，防止后端重复插入导致重复记录
+      deduplicateDiagnosisList();
       emits('diagnosisSave', false);
     }
   });
   getTcmDiagnosis({ encounterId: props.patientInfo.encounterId }).then((res) => {
-    console.log('getTcmDiagnosis=======>', JSON.stringify(res.data.illness));
+    console.log('getTcmDiagnosis=======>', JSON.stringify(res.data?.illness));
 
-    if (res.code == 200) {
-      if (res.data.illness.length > 0) {
-        diagnosisNetDatas.value = res.data.illness;
-        res.data.illness.forEach((item, index) => {
-          newList.push({
-            name: item.name + '-' + (res.data.symptom[index]?.name || ''),
-            ybNo: item.ybNo,
-            medTypeCode: item.medTypeCode,
-            diagnosisDoctor: props.patientInfo.practitionerName || props.patientInfo.doctorName || props.patientInfo.physicianName || userStore.name,
-            diagnosisTime: new Date().toLocaleString('zh-CN')
-          });
+    if (res.code == 200 && res.data?.illness?.length > 0) {
+      diagnosisNetDatas.value = res.data.illness;
+      res.data.illness.forEach((item, index) => {
+        newList.push({
+          name: item.name + '-' + (res.data.symptom?.[index]?.name || ''),
+          ybNo: item.ybNo,
+          medTypeCode: item.medTypeCode,
+          diagnosisDoctor: props.patientInfo.practitionerName || props.patientInfo.doctorName || props.patientInfo.physicianName || userStore.name,
+          diagnosisTime: new Date().toLocaleString('zh-CN')
         });
-        
-        // 将新数据添加到现有列表中
-        form.value.diagnosisList.push(...newList);
-        
-        // 重新排序整个列表
-        form.value.diagnosisList.sort((a, b) => {
-          const aNo = typeof a.diagSrtNo === 'number' ? a.diagSrtNo : 9999;
-          const bNo = typeof b.diagSrtNo === 'number' ? b.diagSrtNo : 9999;
-          return aNo - bNo;
-        });
-      }
-      emits('diagnosisSave', false);
+      });
+
+      // 将新数据添加到现有列表中
+      form.value.diagnosisList.push(...newList);
+
+      // 重新排序整个列表
+      form.value.diagnosisList.sort((a, b) => {
+        const aNo = typeof a.diagSrtNo === 'number' ? a.diagSrtNo : 9999;
+        const bNo = typeof b.diagSrtNo === 'number' ? b.diagSrtNo : 9999;
+        return aNo - bNo;
+      });
+      // TCM 数据添加后也去重
+      deduplicateDiagnosisList();
     }
+    emits('diagnosisSave', false);
   });
-  
+
   getTree();
 }
 
+/**
+ * 诊断列表去重：按 ybNo + name 组合去重，保留第一条记录
+ * 防止后端 saveOrUpdate 在删除后误 INSERT 导致重复
+ */
+function deduplicateDiagnosisList() {
+  const seen = new Set();
+  const dedupedList = [];
+  for (const item of form.value.diagnosisList) {
+    // 使用 ybNo 和 name 组合作为唯一标识（中医诊断没有 ybNo，用 name 去重）
+    const key = item.ybNo ? `${item.ybNo}` : `name_${item.name}`;
+    if (!seen.has(key)) {
+      seen.add(key);
+      dedupedList.push(item);
+    }
+  }
+  form.value.diagnosisList = dedupedList;
+}
+
 init();
 function init() {
   diagnosisInit().then((res) => {
@@ -603,6 +622,18 @@ function handleSaveDiagnosis() {
         return aNo - bNo;
       });
 
+      // 步骤1.5：确保每条诊断都有诊断医生和诊断时间（元数据补全）
+      const doctorName = props.patientInfo.practitionerName || props.patientInfo.doctorName || props.patientInfo.physicianName || userStore.name;
+      const now = new Date().toLocaleString('zh-CN');
+      sortedList.forEach((item) => {
+        if (!item.diagnosisDoctor) {
+          item.diagnosisDoctor = doctorName;
+        }
+        if (!item.diagnosisTime) {
+          item.diagnosisTime = now;
+        }
+      });
+
       // 步骤2：重新分配连续的序号（从1开始）
       sortedList.forEach((item, index) => {
         item.diagSrtNo = index + 1; // 这里是关键！把”诊断排序”改成新顺序