Abstract: To evaluate the health resource allocation efficiency of TCM medical institutions in the Yangtze River Economic Belt and the Yellow River Basin from 2014 to 2023. Using the DEA-Malmquist index to measure the efficiency, and the Markov chain method is used to study the dynamic changes of the efficiency. The results showed that the comprehensive efficiency of TCM medical institutions in the Yangtze River Economic Belt and the Yellow River Basin in 2023 was 0.892 and 0.883, respectively, and the efficiency was low. The total factor productivity of the two regions was greater than 1, and the overall trend was increasing. However, the efficiency type was unstable, there was a risk of transfer, and there was a 'jump' transfer in some areas. Spatial factors had an impact on efficiency transfer and are related to the initial level of resource allocation. In some provinces (districts,cities), there was a phenomenon of diminishing returns to scale, input redundancy and insufficient output. The configuration of low level and high level was relatively stable, but there was also a risk of grade decline. It is suggested to reasonably adjust the scale of TCM medical institutions, pay attention to redundant resources, promote technological progress, optimize resource allocation, and improve the dynamic evaluation and supervision mechanism, so as to improve the efficiency of resource utilization.