diff --git a/crates/erp-health/src/service/patient_service/crud.rs b/crates/erp-health/src/service/patient_service/crud.rs
index 3863a76..6706f70 100644
--- a/crates/erp-health/src/service/patient_service/crud.rs
+++ b/crates/erp-health/src/service/patient_service/crud.rs
@@ -283,10 +283,10 @@ pub async fn update_patient(
         ])?;
     }
 
-    // 记录变更前的关键临床值（过敏史、病史、身份证号）
+    // 记录变更前的关键临床值（加密字段用 REDACTED 替代）
     let old_snapshot = serde_json::json!({
-        "allergy_history": model.allergy_history,
-        "medical_history_summary": model.medical_history_summary,
+        "allergy_history": model.allergy_history.as_ref().map(|_| "[REDACTED]"),
+        "medical_history_summary": model.medical_history_summary.as_ref().map(|_| "[REDACTED]"),
         "status": model.status,
         "verification_status": model.verification_status,
     });
@@ -329,10 +329,10 @@ pub async fn update_patient(
 
     let updated = active.update(&state.db).await?;
 
-    // 变更后快照
+    // 变更后快照（加密字段用 REDACTED 替代）
     let new_snapshot = serde_json::json!({
-        "allergy_history": updated.allergy_history,
-        "medical_history_summary": updated.medical_history_summary,
+        "allergy_history": updated.allergy_history.as_ref().map(|_| "[REDACTED]"),
+        "medical_history_summary": updated.medical_history_summary.as_ref().map(|_| "[REDACTED]"),
         "status": updated.status,
         "verification_status": updated.verification_status,
     });