While vision-language models dominate medical representation learning, unstructured text lacks the dense, quantitative diagnostic phenotypes inherent in structured clinical tables. However, existing multimodal pre-training methods underutilize this potential due to semantic-agnostic designs that treat tabular inputs as flat vectors and employ unstable continuous regression objectives. To overcome this, we propose a novel semantic-aware framework explicitly modeling the intrinsic two-dimensional structure of tabular data. First, addressing the inter-feature hierarchy of varying diagnostic importance, we introduce Importance-Aware Adaptive Masking to construct a label-free curriculum prioritizing salient features. Second, addressing the intra-feature continuity-discreteness duality, we propose a Soft-Label Discretized Module that replaces unstable numerical regression with stable distribution matching, thereby mathematically preserving ordinal relationships. Extensive experiments across large-scale dermatology (SLICE-3D, HOP) and ophthalmology (EyePACS) datasets establish a new state-of-the-art (SOTA), demonstrating exceptional robustness and cross-domain generalizability.

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