diff --git a/server/app/adminapi/logic/tcm/DiagnosisAiLogic.php b/server/app/adminapi/logic/tcm/DiagnosisAiLogic.php
index a5cc76367..faf8c2461 100644
--- a/server/app/adminapi/logic/tcm/DiagnosisAiLogic.php
+++ b/server/app/adminapi/logic/tcm/DiagnosisAiLogic.php
@@ -25,7 +25,7 @@ class DiagnosisAiLogic extends BaseLogic
 
     private const ASSISTANT_PROMPT_VERSION = 'patient-context-assistant-nihaixia-v3';
 
-    private const ANALYSIS_PROMPT_VERSION = 'patient-context-analysis-nihaixia-v3';
+    private const ANALYSIS_PROMPT_VERSION = 'patient-context-analysis-nihaixia-v4';
 
     private const MAX_ASSISTANT_PROMPT_LENGTH = 500;
 
@@ -791,35 +791,39 @@ class DiagnosisAiLogic extends BaseLogic
             return null;
         }
 
-        try {
-            $result = DifyChatService::chat(
-                $profile,
-                self::buildUpstreamInputs(
-                    $context,
-                    '诊单结构化分析',
-                    self::ANALYSIS_PROMPT_VERSION
-                ),
-                self::buildAnalysisPrompt($context),
-                'admin-diagnosis-analysis-' . $adminId,
-                is_array($context['files'] ?? null) ? $context['files'] : []
-            );
-        } catch (\Throwable $e) {
-            Log::warning('diagnosis ai analysis upstream call failed', [
-                'diagnosis_id' => $diagnosisId,
-                'profile' => $profile,
-                'admin_id' => $adminId,
-                'exception_class' => get_class($e),
-            ]);
-            self::setError('AI智能分析暂时不可用，请稍后重试');
-            return null;
-        }
+        $inputs = self::buildUpstreamInputs($context, '诊单结构化分析', self::ANALYSIS_PROMPT_VERSION);
+        $prompt = self::buildAnalysisPrompt($context);
+        $files = is_array($context['files'] ?? null) ? $context['files'] : [];
+        $analysis = null;
+        for ($attempt = 0; $attempt < 2; $attempt++) {
+            try {
+                $result = DifyChatService::chat(
+                    $profile,
+                    $inputs,
+                    $attempt === 0 ? $prompt : self::buildAnalysisRepairPrompt($prompt),
+                    'admin-diagnosis-analysis-' . $adminId,
+                    $files
+                );
+            } catch (\Throwable $e) {
+                Log::warning('diagnosis ai analysis upstream call failed', [
+                    'diagnosis_id' => $diagnosisId,
+                    'profile' => $profile,
+                    'admin_id' => $adminId,
+                    'exception_class' => get_class($e),
+                ]);
+                self::setError('AI智能分析暂时不可用，请稍后重试');
+                return null;
+            }
 
-        if (empty($result['ok'])) {
-            self::setError('AI智能分析暂时不可用，请稍后重试');
-            return null;
+            if (empty($result['ok'])) {
+                self::setError('AI智能分析暂时不可用，请稍后重试');
+                return null;
+            }
+            $analysis = self::parseAnalysisResponse((string) ($result['content'] ?? ''));
+            if ($analysis !== null) {
+                break;
+            }
         }
-
-        $analysis = self::parseAnalysisResponse((string) ($result['content'] ?? ''));
         if ($analysis === null) {
             self::setError('AI返回的分析结构不符合要求，请重试');
             return null;
@@ -832,7 +836,7 @@ class DiagnosisAiLogic extends BaseLogic
             'model_name' => $modelName,
             'generated_at' => date('Y-m-d H:i:s'),
             'context_scope' => (string) ($context['context_scope'] ?? 'patient_longitudinal'),
-            'context_version' => (string) ($context['context_version'] ?? self::ANALYSIS_PROMPT_VERSION),
+            'context_version' => self::ANALYSIS_PROMPT_VERSION,
             'source_summary' => is_array($context['source_summary'] ?? null)
                 ? $context['source_summary']
                 : [],
@@ -1450,6 +1454,13 @@ PROMPT;
 PROMPT;
     }
 
+    private static function buildAnalysisRepairPrompt(string $originalPrompt): string
+    {
+        return $originalPrompt . "\n\n格式校验提醒：请重新独立作答，只输出一个可解析的 JSON 对象，且仅有 diagnosis_advice、risk_assessment、treatment_advice 三个键。"
+            . '前后不要解释、代码块或参考资料版本标识；两个建议字段各不超过 500 字；risk_assessment 最多 5 项，'
+            . '每项仅有 label（不超过 80 字）与小写 level（high、medium、low）。资料不足时说明缺口，不能编造风险或处方。';
+    }
+
     /**
      * 让患者纵向资料适配单次上游请求的体积上限。
      *
diff --git a/server/tests/DiagnosisAiAnalysisContractTest.php b/server/tests/DiagnosisAiAnalysisContractTest.php
index 5e7cdbc8d..2c2cd3e05 100644
--- a/server/tests/DiagnosisAiAnalysisContractTest.php
+++ b/server/tests/DiagnosisAiAnalysisContractTest.php
@@ -50,7 +50,19 @@ $analysisSource = implode('', array_slice(
 ));
 analysisContractExpect(
     substr_count($analysisSource, 'DifyChatService::chat(') === 1,
-    'one analysis request performs exactly one upstream chat call'
+    'analysis retries malformed output through the same bounded upstream call site'
+);
+analysisContractExpect(
+    str_contains($analysisSource, '$attempt < 2')
+        && str_contains($analysisSource, 'buildAnalysisRepairPrompt($prompt)'),
+    'malformed structured output receives at most one format repair attempt'
+);
+$repair = $logicReflection->getMethod('buildAnalysisRepairPrompt')->invoke(null, 'ORIGINAL_CASE_PROMPT');
+analysisContractExpect(
+    str_contains($repair, 'ORIGINAL_CASE_PROMPT')
+        && str_contains($repair, '仅有 diagnosis_advice、risk_assessment、treatment_advice 三个键')
+        && str_contains($repair, '资料不足时说明缺口'),
+    'repair keeps the original patient evidence and constrained schema'
 );
 foreach ([
     "'diagnosis_advice'",