Objective To develope grading criteria on recommendations in clinical guidelines/consensus for traditional Chinese medicine（TCM） in order to guide the framers of TCM clinical guidelines and expert consensus to form scientific and standard recommendations. Methods Combination of literature study and expert consensus study was applied. In the literature study

33 versions of Evidence-based TCM Clinical Practice Guidelines and 32 guideline developing handbooks were taken as objects. Information about recommendation development

grading and reporting was extracted. The expert consensus study included questionnaire survey and an expert consensus meeting. Firstly

on the basis of the literature study

primary items were developed to conduct expert questionnaire survey. After that

the expert consensus meeting was held to further discuss the results of questionnaire survey

reaching a consensus and finally form the criteria. Results At present

the recommendation grading criteria in the TCM guidelines and guideline developing handbooks are different from each other. Different guideline developing groups usually adapted international unified standards according to their actual situation. Besides

there is still a certain gap between the included evidence-based TCM clinical guidelines and requirements in the developing handbooks of international guidelines in terms of guideline recommendation report. A total of 36 experts covering different fields were invited to conduct questionnaire survey on the primary items of the criteria

and 14 experts attended the consensus meeting to form Grading Criteria on Recommendation Strength in Clinical Guidelines/Consensus for TCM

including 4 parts: report principles on developing methods of recommendations

factors affecting recommendations

grading and expressing of recommendation strength

and content report of recommendations. Conclusion When developing guidelines and expert consensus in TCM

different factors should be taken into fully consideration. Recommendations and strength should be developed by a standard expert consensus method. Moreover

the process of recommendation development should be standard

and its content should also be reported specifically.