Objective: This study aims to improve the reliability and robustness of medical named entity recognition (NER) in Chinese atopic dermatitis (AD) clinical texts through explanation-guided learning. Methods: We propose a stability and boundary-aware explanation-guided NER framework. Perturbation-based analysis is used to evaluate explanation stability and entity boundary sensitivity. An adaptive fusion strategy dynamically combines local and global explanation to generate more reliable token-level explanations. The fused explanation signals are further incorporated into model training through stability, boundary-aware, and consistency constraints. Results: Experiments on Chinese AD NER datasets show that the proposed framework improves explanation robustness and achieves consistent performance gains across multiple NER models. The adaptive fusion strategy also provides more stable explanations and stronger boundary perception than individual explanation methods. Conclusion: The proposed method effectively integrates reliable explanation signals into medical NER training, improving both recognition performance and explanation reliability. The framework provides a practical and generalizable solution for explainable medical NER and offers reliable support for downstream clinical decision-making and medical knowledge applications.

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