The invention relates to a cyclic progressive health management system for chronic and high-risk disease patients. The system is characterized by comprising an archive establishment module, a screening grading module, a management planning module, a self-management module, a follow-up evaluation module and a plan update module, wherein the archive establishment module, the screening grading module, the management planning module, the self-management module, the follow-up evaluation module and the plan update module are sequentially connected end to end to form the cyclic enclosed chain ring structure, health disease management of the patients with chronic and high-risk diseases is integrated, through archive establishment, screening, grading, management planning, self-management, follow-upevaluation and plan update, health management works such as effective documentation, screening, grading, classification, intervention, evaluation, early warning, etc. for the patients with chronic and high-risk diseases are effectively achieved.