Background: Essential medicine is WHO’s most successful strategy for national drug policy. Policy makers need evidence to select proper essential medicine for people in rural area and urban area. Objectives: To discuss Chengdu (Chinese) essential medicine list and improve rational drug use by analyzing drug use in five townships and two community health institutions. Methods: Data were obtained from local drug wholesaler. Quantities were converted into Defined Daily Dose, and drug expenditures, volumes and quantities were then ranked according to their order. Evidence-based synthesis methods were use to compare the WHO essential medicine list, the SFDA essential medicine list and the Sichuan province medicine insurance list. Results: The top 60 drugs occupied 50% of the total drug expenditures, and the top 90 drugs occupied 90% of the total quantities. Traditional Chinese medicine preparations occupied 40% of the total drug expenditures, but there was lack of evidence in costutility. Conclusions: The top 200 drugs will be the research priorities in the matter of ensuring the provision of essential drugs or containing drug expenditures. More evidence should be created to support the use of traditional Chinese medicine preparations.