Objective To develop the ancient evidence grading and recommendation system for adopting evidence from traditional Chinese medicine（TCM） ancient books in developing clinical practice guidelines. Methods A questionnaire was designed to explore the evaluation standards of ancient TCM books

ancient evidence grading

and ancient evidence recommendation. Experts in TCM

integrated traditional Chinese and Western medicine

and TCM medical history document were surveyed. Each item score and their weights were calculated after consistency and importance evaluation analysis. After reaching the experts consensus

the ancient evidence grading and recommendation system was finally formulated. Results Thirty questionnaires were sent and returned; and the response rate was 100%. The evaluation of ancient TCM books included cited situation and author items; Cited situation item had four sub-items including catalog cited

abstract cited

book cited and book series cited

each with a full score of 5 points

while author item classified the documents into official or famous authors level

well-known authors level

and general authors level

each rated as 5

3 and 1 point. The ancient evidence grading standard included two items: evidence background and evidence evaluation; evidence background focused on literature background and citation

while evidence evaluation included patient self-evaluation

medical evaluation and evaluations of other related personnel

each with a five-point full score; the score of evidence background and that of evidence evaluation were summed up as the score of ancient evidence score

which was graded into different levels with thresholds of 4 and 7 points. Accordingly

the evidence recommendation standards were formulated

which were strongly recommended（level Ⅰ

≥7 and ≤10 points）

weakly recommended（level Ⅱ

≥4 and <7 points）

unclearly recommended（level Ⅲ

>0 and <4 points） and not recommended（level Ⅲ

0 points）. Conclusion The ancient evidence grading and re-commendation system is developed by clearly defining the standards of ancient TCM books

ancient evidence grading

and ancient evidence recommendation

which can be used to adopt evidence from ancient books in developing TCM clinical practice guidelines