--- server/app/adminapi/service/TcmClinicalFactStateGuard.php.before
+++ server/app/adminapi/service/TcmClinicalFactStateGuard.php
@@ -468,9 +468,10 @@
             $evidenceView = preg_replace('/^\s*(?:(?:主要|具体|直接)(?:依据|根据)\s*[：:]?|依据为)\s*/u', '', $assertionView) ?? $assertionView;
             $referenceView = self::sourceReferenceProse($ledger,
                 self::negatedInferenceProse(self::inferenceHeadProse($evidenceView)), $invalid);
+            $patientReviewView = self::patientReviewQuestionProse($referenceView);
             $pendingHead = preg_match('/^\s*适用前(?:需|须|应)(?:核实|复核|确认)[：:]/u', $referenceView) === 1;
             $questionView = ($question || $pendingHead || $pendingQuestion)
-                ? self::terminatedQuestionProse($referenceView) : $referenceView;
+                ? self::terminatedQuestionProse($patientReviewView) : $patientReviewView;
             preg_match('/^[。；;！？!?\r\n]+/u', $terminator, $separator);
             // Only the immediately preceding fully neutral question can
             // supply the antecedent of this closed contingency operator.
@@ -1145,6 +1146,19 @@
         return implode('', $pieces);
     }
 
+    /** A requested patient review owns its bounded whether-object, not its tail. */
+    private static function patientReviewQuestionProse(string $clause): string
+    {
+        if (!preg_match('/^\s*(?:(?:仍|还)?(?:需|须|应|请)(?:进一步|再次|逐项)?)?'
+            . '(?:补问|询问|核实|复核|核对|追问|确认|查明)[：:\s]*(?:患者|本例)[：:\s]*'
+            . '((?:是否|有无).+)$/uD', $clause, $request)) return $clause;
+        // Reuse the existing neutral-object grammar and assertion boundaries.
+        // A refused object keeps its original action/current/record markers;
+        // only a proved question may remove this collection instruction.
+        $view = self::terminatedQuestionProse($request[1]);
+        return $view !== $request[1] ? $view : $clause;
+    }
+
     /** A modal + collection action governs only its own neutral object list. */
     private static function collectionRequestProse(string $clause): string
     {
@@ -1624,7 +1638,7 @@
             foreach ($pieces as $piece) array_push($issues, ...self::fieldIssues($ledger, $piece, $pendingFields));
             return $issues;
         }
-        $text = trim($clause, " \t#>*-");
+        $text = self::unwrappedFieldUnknown(trim($clause, " \t#>*-"));
         $carried = $pendingFields;
         $pendingFields = [];
         foreach (self::FIELD_GROUPS as $group => $definition) {
@@ -1636,6 +1650,13 @@
         $dataGap = self::dataGapPart($text);
         foreach (self::FIELD_GROUPS as $group => $definition) {
             $state = $ledger['field_states'][$group] ?? ['state' => 'unknown', 'source_id' => 'report', 'date' => ''];
+            $aliases = implode('|', array_map(static fn (string $alias): string => preg_quote($alias, '/'), $definition['aliases']));
+            $value = null;
+            if (preg_match('/(?:' . $aliases . ')[：:]\s*(.+)$/uD', $text, $match)) $value = $match[1];
+            elseif (in_array($group, $carried, true)) $value = $text;
+            $unwrapped = $value !== null ? self::unwrappedFieldUnknown($value) : null;
+            $wrappedUnknown = $unwrapped !== $value;
+            $value = $unwrapped;
             if ($state['state'] !== 'unknown') {
                 // A missing named examination is different from a missing
                 // examination image; it cannot erase an existing result.
@@ -1648,15 +1669,14 @@
                     || ($dataGap !== null && $dataGap['topic'] === ''))) {
                     $issues[] = ['code' => 'RECORDED_TO_UNKNOWN', 'source_id' => $state['source_id']];
                 }
+                if ($wrappedUnknown && self::sameTime($ledger['sources'][$state['source_id']] ?? [], self::scope($text, 'current'), $text)) {
+                    $issues[] = ['code' => 'RECORDED_TO_UNKNOWN', 'source_id' => $state['source_id']];
+                }
                 continue;
             }
             if ($dataGap !== null) continue;
             $dates = self::calendarDates($text);
             if ($dates !== [] && $state['date'] !== '' && !in_array($state['date'], $dates, true)) continue;
-            $aliases = implode('|', array_map(static fn (string $alias): string => preg_quote($alias, '/'), $definition['aliases']));
-            $value = null;
-            if (preg_match('/(?:' . $aliases . ')[：:]\s*(.+)$/uD', $text, $match)) $value = $match[1];
-            elseif (in_array($group, $carried, true)) $value = $text;
             if ($value !== null && (preg_match('/^(?:' . self::UNKNOWN . '|未填|待补)/u', $value)
                 || self::conditional($value) || self::evidenceOnly($value))) continue;
             $absent = preg_match('/(?:' . self::OBSERVED_ABSENT . ')[^，,：:]{0,30}(?:' . $aliases . ')/u', $text)
@@ -1669,6 +1689,14 @@
             }
         }
         return $issues;
+    }
+
+    /** Paired punctuation around one unknown value is formatting, never a finding. */
+    private static function unwrappedFieldUnknown(string $value): string
+    {
+        if (preg_match('/^\s*(?:（\s*(' . self::UNKNOWN . ')\s*）|\(\s*(' . self::UNKNOWN . ')\s*\))\s*$/uD',
+            $value, $wrapped)) return ($wrapped[1] ?? '') !== '' ? $wrapped[1] : $wrapped[2];
+        return $value;
     }
 
     /** Explicit lexical polarity with inherited scope across enumerated items. */