diff --git a/admin/src/views/patient/reception/components/NoteTimeline.vue b/admin/src/views/patient/reception/components/NoteTimeline.vue
index 0c30c477..b8b255f2 100644
--- a/admin/src/views/patient/reception/components/NoteTimeline.vue
+++ b/admin/src/views/patient/reception/components/NoteTimeline.vue
@@ -211,6 +211,7 @@ const handleDeleteImage = async (noteId: number, imageType: 'tongue_images' | 'r
 <style scoped lang="scss">
 .timeline-actions {
     display: flex;
+    flex-direction: column;
     gap: 12px;
     margin-bottom: 12px;
     padding-bottom: 12px;
diff --git a/admin/src/views/tcm/diagnosis/components/PatientOrderList.vue b/admin/src/views/tcm/diagnosis/components/PatientOrderList.vue
index 7e77ad55..e2bb8ee4 100644
--- a/admin/src/views/tcm/diagnosis/components/PatientOrderList.vue
+++ b/admin/src/views/tcm/diagnosis/components/PatientOrderList.vue
@@ -74,9 +74,13 @@ const { pager, getLists, resetPage } = usePaging({
 
 const buildParams = () => {
     Object.keys(queryParams).forEach((k) => delete queryParams[k])
+    if (props.diagnosisId > 0) {
+        queryParams.context_diagnosis_id = props.diagnosisId
+    }
     if (patientIdAvailable.value) {
         queryParams.patient_id = patientIdNum.value
     }
+    queryParams.scene = 'diagnosis_edit'
 }
 
 const formatAmount = (value: unknown) => {
diff --git a/server/app/adminapi/lists/tcm/PrescriptionOrderLists.php b/server/app/adminapi/lists/tcm/PrescriptionOrderLists.php
index 3f313620..e64809e4 100644
--- a/server/app/adminapi/lists/tcm/PrescriptionOrderLists.php
+++ b/server/app/adminapi/lists/tcm/PrescriptionOrderLists.php
@@ -26,6 +26,8 @@ class PrescriptionOrderLists extends BaseAdminDataLists implements ListsSearchIn
 {
     use HasDataScopeFilter;
 
+    private const SCENE_DIAGNOSIS_EDIT = 'diagnosis_edit';
+
     public function setSearch(): array
     {
         return [
@@ -100,8 +102,10 @@ class PrescriptionOrderLists extends BaseAdminDataLists implements ListsSearchIn
         $this->applyExpressCompanyFilter($query);
         $this->applyExpressKeywordFilter($query);
         $this->applySupplyModeFilter($query);
-        $this->applyCreatorOrOwnPrescriptionVisibility($query);
-        $this->applyDataScopeForPrescriptionOrder($query);
+        if (!$this->shouldBypassListVisibilityForDiagnosisEdit()) {
+            $this->applyCreatorOrOwnPrescriptionVisibility($query);
+            $this->applyDataScopeForPrescriptionOrder($query);
+        }
         // 业绩看板侧栏等：不展示履约已取消(4)，与 stats 业绩统计口径一致
         if ((int) ($this->params['exclude_fulfillment_cancelled'] ?? 0) === 1) {
             $query->where('fulfillment_status', '<>', 4);
@@ -267,6 +271,29 @@ class PrescriptionOrderLists extends BaseAdminDataLists implements ListsSearchIn
         });
     }
 
+    /**
+     * 仅诊单编辑页内的患者订单查询可跳过列表页权限，但必须显式带场景且保留患者/诊单范围收敛。
+     */
+    private function shouldBypassListVisibilityForDiagnosisEdit(): bool
+    {
+        $scene = trim((string) ($this->params['scene'] ?? ''));
+        if ($scene !== self::SCENE_DIAGNOSIS_EDIT) {
+            return false;
+        }
+
+        $patientId = (int) ($this->params['patient_id'] ?? 0);
+        $contextDiagnosisId = (int) ($this->params['context_diagnosis_id'] ?? 0);
+        if ($patientId <= 0 || $contextDiagnosisId <= 0) {
+            return false;
+        }
+
+        $diagnosisPatientId = (int) Diagnosis::where('id', $contextDiagnosisId)
+            ->whereNull('delete_time')
+            ->value('patient_id');
+
+        return $diagnosisPatientId > 0 && $diagnosisPatientId === $patientId;
+    }
+
     /**
      * 医助：仅「诊单医助=本人」的订单计业绩
      */
diff --git a/server/app/adminapi/logic/tcm/DiagnosisLogic.php b/server/app/adminapi/logic/tcm/DiagnosisLogic.php
index cefb585d..2e2532f6 100644
--- a/server/app/adminapi/logic/tcm/DiagnosisLogic.php
+++ b/server/app/adminapi/logic/tcm/DiagnosisLogic.php
@@ -15,6 +15,8 @@
 namespace app\adminapi\logic\tcm;
 
 use app\common\logic\BaseLogic;
+use app\common\enum\FileEnum;
+use app\common\model\file\File as FileModel;
 use app\common\model\tcm\Diagnosis;
 use app\common\model\tcm\DiagnosisGuahaoLog;
 use app\common\model\tcm\DiagnosisAssignLog;
@@ -29,8 +31,10 @@ use app\common\model\auth\AdminRole;
 use app\adminapi\logic\doctor\DoctorNoteLogic;
 use app\adminapi\logic\doctor\AppointmentLogic;
 use app\adminapi\logic\tcm\TrackingNoteLogic;
+use app\common\service\ConfigService;
 use app\common\service\FileService;
 use app\common\service\DataScope\DataScopeService;
+use app\common\service\storage\Driver as StorageDriver;
 use think\facade\Db;
 /**
  * 中医辨房病因诊单逻辑
@@ -963,10 +967,29 @@ class DiagnosisLogic extends BaseLogic
         if (empty($doctorAccounts)) {
             return [];
         }
+        $diagnosisId = (int)($diag['id'] ?? 0);
+        // 增量优化：按 doctor_peer_account 维度取归档表最大时间作为 MinTime 起点，
+        // 避免每次都从头拉取已归档的历史消息（节约腾讯云 admin_getroammsg 调用配额）
+        $minTimeMap = [];
+        if ($diagnosisId > 0) {
+            $rows = ImChatMessage::field('doctor_peer_account, MAX(msg_time) AS max_time')
+                ->where('diagnosis_id', $diagnosisId)
+                ->group('doctor_peer_account')
+                ->select()
+                ->toArray();
+            foreach ($rows as $r) {
+                $acct = (string)($r['doctor_peer_account'] ?? '');
+                if ($acct !== '') {
+                    $minTimeMap[$acct] = (int)($r['max_time'] ?? 0);
+                }
+            }
+        }
         $imService = new \app\common\service\TencentImService();
         $merged = [];
         foreach ($doctorAccounts as $docAccount) {
-            $batch = self::pullAllRoamMessages($imService, $docAccount, $patientImId);
+            // 已归档过：从最大已知 msg_time 起拉（含等于以兜底边界，配合 INSERT IGNORE 去重）
+            $minTime = isset($minTimeMap[$docAccount]) ? max(0, $minTimeMap[$docAccount]) : 0;
+            $batch = self::pullAllRoamMessages($imService, $docAccount, $patientImId, $minTime);
             foreach ($batch as $row) {
                 $merged[] = $row;
             }
@@ -1084,23 +1107,44 @@ class DiagnosisLogic extends BaseLogic
     /**
      * @return array<int, array<string, mixed>>
      */
-    private static function pullAllRoamMessages(\app\common\service\TencentImService $svc, string $operator, string $peer): array
+    private static function pullAllRoamMessages(\app\common\service\TencentImService $svc, string $operator, string $peer, int $minTime = 0): array
     {
         $out = [];
         $lastKey = null;
         $lastTime = null;
         $guard = 0;
+        $maxPages = 80;
         do {
-            $res = $svc->adminGetRoamMsg($operator, $peer, 100, 0, 4294967295, $lastKey, $lastTime);
-            if (!$res['success']) {
-                if (!empty($res['error'])) {
-                    \think\facade\Log::warning('IM漫游消息拉取失败', [
-                        'operator' => $operator,
-                        'peer' => $peer,
-                        'error' => $res['error'],
-                        'code' => $res['rawErrorCode'] ?? 0,
-                    ]);
+            // 单页失败重试：避免网络抖动 / 限频导致整段会话被丢弃
+            $res = null;
+            $attempt = 0;
+            while ($attempt < 3) {
+                $res = $svc->adminGetRoamMsg($operator, $peer, 100, $minTime, 4294967295, $lastKey, $lastTime);
+                if (!empty($res['success'])) {
+                    break;
                 }
+                $attempt++;
+                \think\facade\Log::warning('IM漫游消息拉取失败（待重试）', [
+                    'operator' => $operator,
+                    'peer' => $peer,
+                    'attempt' => $attempt,
+                    'error' => $res['error'] ?? '',
+                    'code' => $res['rawErrorCode'] ?? 0,
+                    'page' => $guard + 1,
+                ]);
+                if ($attempt < 3) {
+                    usleep(300000); // 300ms 退避
+                }
+            }
+            if (empty($res['success'])) {
+                \think\facade\Log::error('IM漫游消息拉取失败（重试耗尽，本轮中断）', [
+                    'operator' => $operator,
+                    'peer' => $peer,
+                    'page' => $guard + 1,
+                    'fetched_so_far' => count($out),
+                    'error' => $res['error'] ?? '',
+                    'code' => $res['rawErrorCode'] ?? 0,
+                ]);
                 break;
             }
             foreach ($res['msgList'] as $raw) {
@@ -1121,7 +1165,16 @@ class DiagnosisLogic extends BaseLogic
                 break;
             }
             $guard++;
-            if ($guard > 80) {
+            if ($guard >= $maxPages) {
+                // 触顶安全网：增量优化后通常拉不满 80 页，触顶意味着首次全量或会话异常多
+                \think\facade\Log::warning('IM漫游消息拉取触发分页上限（可能未拉完）', [
+                    'operator' => $operator,
+                    'peer' => $peer,
+                    'min_time' => $minTime,
+                    'pages_fetched' => $guard,
+                    'fetched_so_far' => count($out),
+                    'last_msg_time' => $lastTime,
+                ]);
                 break;
             }
         } while (true);
@@ -1720,22 +1773,14 @@ class DiagnosisLogic extends BaseLogic
             $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
             $adminId = (int)($params['admin_id'] ?? 0);
             $fileUrl = trim((string)($params['file_url'] ?? ''));
+            $callRecordId = (int)($params['call_record_id'] ?? 0);
             if ($diagnosisId <= 0 || $adminId <= 0 || $fileUrl === '') {
                 self::setError('参数错误');
 
                 return false;
             }
 
-            $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
-                ->where('caller_id', $adminId)
-                ->order('id', 'desc')
-                ->find();
-            // 与 startCall 的 caller_id 不一致或竞态时，回退到该诊单最新一条通话记录
-            if (!$record) {
-                $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
-                    ->order('id', 'desc')
-                    ->find();
-            }
+            $record = self::resolveCallRecordForAttachment($diagnosisId, $adminId, $callRecordId);
             if (!$record) {
                 self::setError('未找到通话记录');
 
@@ -1765,6 +1810,158 @@ class DiagnosisLogic extends BaseLogic
         }
     }
 
+    /**
+     * @notes 诊单回放视频分片上传，完成后显式关联到指定通话记录
+     * @param array $params
+     * @return array|false
+     */
+    public static function uploadCallRecording(array $params)
+    {
+        $uploadDir = '';
+        $mergedPath = '';
+        try {
+            $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
+            $callRecordId = (int)($params['call_record_id'] ?? 0);
+            $adminId = (int)($params['admin_id'] ?? 0);
+            $uploadId = trim((string)($params['upload_id'] ?? ''));
+            $fileName = trim((string)($params['file_name'] ?? ''));
+            $fileSize = (int)($params['file_size'] ?? 0);
+            $chunkIndex = (int)($params['chunk_index'] ?? -1);
+            $chunkTotal = (int)($params['chunk_total'] ?? 0);
+
+            if (
+                $diagnosisId <= 0 ||
+                $adminId <= 0 ||
+                $uploadId === '' ||
+                $fileName === '' ||
+                $fileSize <= 0 ||
+                $chunkIndex < 0 ||
+                $chunkTotal <= 0
+            ) {
+                self::setError('上传参数不完整');
+                return false;
+            }
+
+            $ext = strtolower((string)pathinfo($fileName, PATHINFO_EXTENSION));
+            if ($ext === '' || !in_array($ext, config('project.file_video'), true)) {
+                self::setError('视频格式不支持');
+                return false;
+            }
+
+            if ($callRecordId <= 0) {
+                $record = self::createSyntheticCallRecord($diagnosisId, $adminId, $fileName);
+                $callRecordId = (int)($record['id'] ?? 0);
+            } else {
+                $record = self::resolveCallRecordForAttachment($diagnosisId, $adminId, $callRecordId, false);
+            }
+            if (!$record) {
+                self::setError('通话记录不存在');
+                return false;
+            }
+
+            $chunkFile = request()->file('file');
+            if (!$chunkFile) {
+                self::setError('未找到上传分片');
+                return false;
+            }
+
+            $uploadDir = self::callRecordingChunkDir($uploadId);
+            if (!is_dir($uploadDir) && !mkdir($uploadDir, 0777, true) && !is_dir($uploadDir)) {
+                self::setError('创建上传目录失败');
+                return false;
+            }
+
+            file_put_contents($uploadDir . DIRECTORY_SEPARATOR . 'meta.json', json_encode([
+                'diagnosis_id' => $diagnosisId,
+                'call_record_id' => $callRecordId,
+                'admin_id' => $adminId,
+                'file_name' => $fileName,
+                'file_size' => $fileSize,
+                'chunk_total' => $chunkTotal,
+            ], JSON_UNESCAPED_UNICODE));
+
+            $chunkPath = $uploadDir . DIRECTORY_SEPARATOR . self::callRecordingChunkName($chunkIndex);
+            $moved = $chunkFile->move($uploadDir, basename($chunkPath));
+            if (!$moved) {
+                self::setError($chunkFile->getError() ?: '保存分片失败');
+                return false;
+            }
+
+            $uploadedCount = self::countUploadedCallRecordingChunks($uploadDir);
+            if ($uploadedCount < $chunkTotal) {
+                return [
+                    'completed' => false,
+                    'uploaded_chunks' => $uploadedCount,
+                    'chunk_total' => $chunkTotal,
+                    'call_record_id' => $callRecordId,
+                ];
+            }
+
+            $mergedPath = $uploadDir . DIRECTORY_SEPARATOR . 'merged.' . $ext;
+            self::mergeCallRecordingChunks($uploadDir, $mergedPath, $chunkTotal);
+
+            if (!is_file($mergedPath) || filesize($mergedPath) <= 0) {
+                self::setError('合并后的文件无效');
+                return false;
+            }
+
+            $uploadResult = self::storeMergedCallRecording($mergedPath, $fileName, $adminId);
+            if (empty($uploadResult['uri'])) {
+                self::setError('保存视频失败');
+                return false;
+            }
+
+            $attached = self::attachLocalCallRecording([
+                'diagnosis_id' => $diagnosisId,
+                'call_record_id' => $callRecordId,
+                'admin_id' => $adminId,
+                'file_url' => (string)$uploadResult['uri'],
+            ]);
+            if (!$attached) {
+                return false;
+            }
+
+            self::cleanupCallRecordingChunkDir($uploadDir);
+
+            return [
+                'completed' => true,
+                'uploaded_chunks' => $chunkTotal,
+                'chunk_total' => $chunkTotal,
+                'call_record_id' => $callRecordId,
+                'file_id' => $uploadResult['id'] ?? 0,
+                'file_url' => $uploadResult['uri'] ?? '',
+                'recording_status' => 2,
+            ];
+        } catch (\Throwable $e) {
+            if ($mergedPath !== '' && is_file($mergedPath)) {
+                @unlink($mergedPath);
+            }
+            self::setError($e->getMessage());
+            return false;
+        }
+    }
+
+    public static function createManualCallRecord(array $params)
+    {
+        $diagnosisId = (int)($params['diagnosis_id'] ?? 0);
+        $adminId = (int)($params['admin_id'] ?? 0);
+        if ($diagnosisId <= 0 || $adminId <= 0) {
+            self::setError('参数错误');
+            return false;
+        }
+
+        $record = self::createSyntheticCallRecord($diagnosisId, $adminId, 'manual-upload');
+        if (!$record) {
+            self::setError(self::getError() ?: '创建通话记录失败');
+            return false;
+        }
+
+        return [
+            'id' => (int)($record['id'] ?? 0),
+            'diagnosis_id' => $diagnosisId,
+        ];
+    }
+
     /**
      * @notes 医助进入当前诊单 TRTC 房间旁观（仅拉流，与医生端 doctor_{id} 账号体系一致）
      * @param array $params diagnosis_id、admin_id（当前登录后台用户）
@@ -3599,4 +3796,152 @@ class DiagnosisLogic extends BaseLogic
 
         return $rows;
     }
+
+    private static function resolveCallRecordForAttachment(
+        int $diagnosisId,
+        int $adminId,
+        int $callRecordId = 0,
+        bool $allowFallback = true
+    )
+    {
+        if ($callRecordId > 0) {
+            $record = \app\common\model\tcm\CallRecord::where('id', $callRecordId)
+                ->where('diagnosis_id', $diagnosisId)
+                ->find();
+            if ($record) {
+                return $record;
+            }
+            if (!$allowFallback) {
+                return null;
+            }
+        }
+
+        $record = \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
+            ->where('caller_id', $adminId)
+            ->order('id', 'desc')
+            ->find();
+        if ($record || !$allowFallback) {
+            return $record;
+        }
+
+        return \app\common\model\tcm\CallRecord::where('diagnosis_id', $diagnosisId)
+            ->order('id', 'desc')
+            ->find();
+    }
+
+    private static function createSyntheticCallRecord(int $diagnosisId, int $adminId, string $fileName = '')
+    {
+        $diagnosis = Diagnosis::where('id', $diagnosisId)->find();
+        if (!$diagnosis) {
+            self::setError('诊单不存在');
+            return null;
+        }
+
+        $now = time();
+        $roomSeed = substr(md5($diagnosisId . '-' . $adminId . '-' . $fileName . '-' . $now), 0, 8);
+
+        return \app\common\model\tcm\CallRecord::create([
+            'diagnosis_id' => $diagnosisId,
+            'caller_id' => $adminId,
+            'caller_type' => 'doctor',
+            'callee_id' => (int)($diagnosis['patient_id'] ?? 0),
+            'callee_type' => 'patient',
+            'call_type' => 2,
+            'status' => 2,
+            'start_time' => $now,
+            'end_time' => $now,
+            'duration' => 0,
+            'room_id' => 'manual_upload_' . $roomSeed,
+            'recording_status' => 0,
+            'create_time' => $now,
+            'update_time' => $now,
+        ]);
+    }
+
+    private static function callRecordingChunkDir(string $uploadId): string
+    {
+        $safeId = preg_replace('/[^a-zA-Z0-9_-]/', '', $uploadId);
+        return runtime_path() . 'call_recording_chunks' . DIRECTORY_SEPARATOR . $safeId;
+    }
+
+    private static function callRecordingChunkName(int $chunkIndex): string
+    {
+        return sprintf('chunk_%06d.part', $chunkIndex);
+    }
+
+    private static function countUploadedCallRecordingChunks(string $uploadDir): int
+    {
+        $files = glob($uploadDir . DIRECTORY_SEPARATOR . 'chunk_*.part');
+        return is_array($files) ? count($files) : 0;
+    }
+
+    private static function mergeCallRecordingChunks(string $uploadDir, string $mergedPath, int $chunkTotal): void
+    {
+        $out = fopen($mergedPath, 'wb');
+        if ($out === false) {
+            throw new \RuntimeException('创建合并文件失败');
+        }
+
+        try {
+            for ($i = 0; $i < $chunkTotal; $i++) {
+                $chunkPath = $uploadDir . DIRECTORY_SEPARATOR . self::callRecordingChunkName($i);
+                if (!is_file($chunkPath)) {
+                    throw new \RuntimeException('上传分片缺失，无法合并');
+                }
+                $in = fopen($chunkPath, 'rb');
+                if ($in === false) {
+                    throw new \RuntimeException('读取上传分片失败');
+                }
+                stream_copy_to_stream($in, $out);
+                fclose($in);
+            }
+        } finally {
+            fclose($out);
+        }
+    }
+
+    private static function storeMergedCallRecording(string $mergedPath, string $fileName, int $adminId): array
+    {
+        $config = [
+            'default' => ConfigService::get('storage', 'default', 'local'),
+            'engine' => ConfigService::get('storage') ?? ['local' => []],
+        ];
+
+        $storageDriver = new StorageDriver($config);
+        $storageDriver->setUploadFileByReal($mergedPath);
+        $saveDir = 'uploads/video/' . date('Ymd');
+        if (!$storageDriver->upload($saveDir)) {
+            throw new \RuntimeException($storageDriver->getError() ?: '上传视频到存储失败');
+        }
+
+        $relativePath = $saveDir . '/' . str_replace('\\', '/', $storageDriver->getFileName());
+        $storedFile = FileModel::create([
+            'cid' => 0,
+            'type' => FileEnum::VIDEO_TYPE,
+            'name' => mb_substr($fileName, 0, 128),
+            'uri' => $relativePath,
+            'source' => FileEnum::SOURCE_ADMIN,
+            'source_id' => $adminId,
+            'create_time' => time(),
+        ]);
+
+        return [
+            'id' => (int)($storedFile['id'] ?? 0),
+            'uri' => FileService::getFileUrl($relativePath),
+            'url' => $relativePath,
+        ];
+    }
+
+    private static function cleanupCallRecordingChunkDir(string $uploadDir): void
+    {
+        if ($uploadDir === '' || !is_dir($uploadDir)) {
+            return;
+        }
+        foreach ((array)glob($uploadDir . DIRECTORY_SEPARATOR . '*') as $item) {
+            if (is_file($item)) {
+                @unlink($item);
+            }
+        }
+        @rmdir($uploadDir);
+    }
 }