diff --git a/src/medications/models/medication-record.model.ts b/src/medications/models/medication-record.model.ts
index 5f4d5fa..94cee59 100644
--- a/src/medications/models/medication-record.model.ts
+++ b/src/medications/models/medication-record.model.ts
@@ -91,6 +91,14 @@ export class MedicationRecord extends Model {
   })
   declare reminderSent: boolean;
 
+  @Column({
+    type: DataType.BOOLEAN,
+    allowNull: false,
+    defaultValue: false,
+    comment: '是否已发送超时提醒',
+  })
+  declare overdueReminderSent: boolean;
+
   // 关联关系
   @BelongsTo(() => Medication, 'medicationId')
   declare medication: Medication;
diff --git a/src/medications/services/medication-reminder.service.ts b/src/medications/services/medication-reminder.service.ts
index 16cebb7..38b4eeb 100644
--- a/src/medications/services/medication-reminder.service.ts
+++ b/src/medications/services/medication-reminder.service.ts
@@ -11,12 +11,13 @@ import * as dayjs from 'dayjs';
 
 /**
  * 药物提醒推送服务
- * 在服药时间前15分钟发送推送提醒
+ * 在服药时间前15分钟发送推送提醒，并在超过服药时间1小时后发送鼓励提醒
  */
 @Injectable()
 export class MedicationReminderService {
   private readonly logger = new Logger(MedicationReminderService.name);
   private readonly REMINDER_MINUTES_BEFORE = 15; // 提前15分钟提醒
+  private readonly OVERDUE_HOURS_THRESHOLD = 1; // 超过1小时后发送超时提醒
 
   constructor(
     @InjectModel(Medication)
@@ -28,7 +29,7 @@ export class MedicationReminderService {
   ) {}
 
   /**
-   * 每1分钟检查一次需要发送的提醒
+   * 每1分钟检查一次需要发送的提前提醒
    * 只有主进程（NODE_APP_INSTANCE=0）执行，避免多进程重复发送
    */
   @Cron('*/1 * * * *')
@@ -117,6 +118,90 @@ export class MedicationReminderService {
     }
   }
 
+  /**
+   * 每10分钟检查一次是否有超过服药时间1小时的未服用记录
+   * 只有主进程（NODE_APP_INSTANCE=0）执行，避免多进程重复发送
+   */
+  @Cron('*/10 * * * *')
+  async checkAndSendOverdueReminders(): Promise<void> {
+    this.logger.log('开始检查超时服药提醒');
+
+    try {
+      // 检查是否为主进程（NODE_APP_INSTANCE 为 0）
+      const nodeAppInstance = this.configService.get<number>('NODE_APP_INSTANCE', 0);
+      if (Number(nodeAppInstance) !== 0) {
+        this.logger.debug(`不是主进程 (instance: ${nodeAppInstance})，跳过超时服药提醒检查`);
+        return;
+      }
+
+      this.logger.log('主进程检测到，执行超时服药提醒检查...');
+
+      // 计算时间范围：当前时间减去1小时
+      const now = new Date();
+      const overdueThreshold = dayjs(now)
+        .subtract(this.OVERDUE_HOURS_THRESHOLD, 'hour')
+        .toDate();
+
+      // 查找超过计划服用时间1小时但状态仍为UPCOMING的记录
+      const overdueRecords = await this.recordModel.findAll({
+        where: {
+          status: MedicationStatusEnum.UPCOMING,
+          deleted: false,
+          overdueReminderSent: false, // 只查询未发送超时提醒的记录
+          scheduledTime: {
+            [Op.lt]: overdueThreshold, // 计划时间早于1小时前
+          },
+        },
+        include: [
+          {
+            model: Medication,
+            as: 'medication',
+            where: {
+              isActive: true,
+              deleted: false,
+            },
+          },
+        ],
+      });
+
+      if (overdueRecords.length === 0) {
+        this.logger.debug('没有需要发送的超时服药提醒');
+        return;
+      }
+
+      this.logger.log(`找到 ${overdueRecords.length} 条需要发送超时提醒的记录`);
+
+      // 按用户分组发送提醒
+      const userRecordsMap = new Map<string, MedicationRecord[]>();
+      for (const record of overdueRecords) {
+        const userId = record.userId;
+        if (!userRecordsMap.has(userId)) {
+          userRecordsMap.set(userId, []);
+        }
+        userRecordsMap.get(userId)!.push(record);
+      }
+
+      // 为每个用户发送超时提醒
+      let successCount = 0;
+      let failedCount = 0;
+
+      for (const [userId, records] of userRecordsMap.entries()) {
+        const success = await this.sendOverdueReminderToUser(userId, records);
+        if (success) {
+          successCount += records.length;
+          // 标记这些记录已发送超时提醒
+          await this.markRecordsAsOverdueReminded(records.map(r => r.id));
+        } else {
+          failedCount += records.length;
+        }
+      }
+
+      this.logger.log(`超时服药提醒发送完成 - 成功: ${successCount}, 失败: ${failedCount}`);
+    } catch (error) {
+      this.logger.error('检查超时服药提醒失败', error.stack);
+    }
+  }
+
   /**
    * 为单个用户发送提醒
    * @returns 是否发送成功
@@ -161,6 +246,55 @@ export class MedicationReminderService {
     }
   }
 
+  /**
+   * 为单个用户发送超时鼓励提醒
+   * @returns 是否发送成功
+   */
+  private async sendOverdueReminderToUser(
+    userId: string,
+    records: MedicationRecord[],
+  ): Promise<boolean> {
+    try {
+      const medicationNames = records
+        .map((r) => r.medication?.name)
+        .filter(Boolean)
+        .join('、');
+
+      // 计算超时时间
+      const overdueHours = Math.max(...records.map(r =>
+        Math.floor(dayjs().diff(dayjs(r.scheduledTime), 'hour'))
+      ));
+
+      const title = '服药超时提醒';
+      const body =
+        records.length === 1
+          ? `您已经错过了 ${medicationNames} 的服用时间超过 ${overdueHours} 小时，请尽快服用！坚持按时服药有助于您的健康恢复。`
+          : `您已经错过了 ${records.length} 种药物的服用时间，请尽快服用！坚持按时服药有助于您的健康恢复。`;
+
+      await this.pushService.sendNotification({
+        userIds: [userId],
+        title,
+        body,
+        payload: {
+          type: 'medication_overdue_reminder',
+          recordIds: records.map((r) => r.id),
+          medicationIds: records.map((r) => r.medicationId),
+        },
+        sound: 'default',
+        badge: 1,
+      });
+
+      this.logger.log(`成功向用户 ${userId} 发送超时服药提醒`);
+      return true;
+    } catch (error) {
+      this.logger.error(
+        `向用户 ${userId} 发送超时服药提醒失败`,
+        error.stack,
+      );
+      return false;
+    }
+  }
+
   /**
    * 标记记录为已发送提醒
    */
@@ -182,6 +316,27 @@ export class MedicationReminderService {
     }
   }
 
+  /**
+   * 标记记录为已发送超时提醒
+   */
+  private async markRecordsAsOverdueReminded(recordIds: string[]): Promise<void> {
+    try {
+      await this.recordModel.update(
+        { overdueReminderSent: true },
+        {
+          where: {
+            id: {
+              [Op.in]: recordIds,
+            },
+          },
+        },
+      );
+      this.logger.debug(`已标记 ${recordIds.length} 条记录为已超时提醒`);
+    } catch (error) {
+      this.logger.error('标记记录为已超时提醒失败', error.stack);
+    }
+  }
+
   /**
    * 手动为用户发送即时提醒（用于测试或特殊情况）
    */