通过动态演化推理原则，提升医疗多模态模型的决策能力。

Despite recent progress, the reasoning capabilities of large multimodal language models (MLLMs) remain fundamentally constrained by static supervision, where fixed prompts, rules, or reward models provide non-adaptive guidance throughout training. Such static signals are often sufficient to enforce output formats, but fail to shape the underlying reasoning process, leading to brittle generalization and performance saturation in complex decision-making tasks. We propose Evo-PI, a principle-centric learning framework that treats reasoning principles as explicit, language-based supervision signals that can be generated, evaluated, and iteratively evolved. Instead of relying on fixed rewards, Evo-PI enables a co-evolutionary loop in which principles guide model reasoning, while model behaviors in turn refine the principles that supervise them. This dynamic alignment mechanism allows supervision to progressively adapt to the model's reasoning deficiencies. We instantiate Evo-PI in medical visual question answering as a high-stakes testbed requiring structured visual-textual reasoning. Across eight benchmarks and multiple model backbones, Evo-PI consistently improves reasoning accuracy, achieving gains of up to 24.6%. Our results suggest that evolving principle-guided supervision offers a scalable and general paradigm for training expert-aligned reasoning in MLLMs. Code is available at https://github.com/zhengxianda/Evo_PI.