Gastrodia elata tuber (GET) has been widely used in China as a famous herbal medicine. However, the quality control markers (QCMs) for GET still need further investigation. To develop a rational strategy based on fingerprint-efficacy relationship modelling to discover the efficacy-related QCMs, using GET as a case study. The high-performance liquid chromatography (HPLC) fingerprints of 13 batches of GET extracts were established and 10 common peaks were structurally characterised by HPLC coupled with quadrupole time-of-flight mass spectrometry (QTOF-MS). The neuroprotective effects of GET samples were evaluated using the in vitro model of β-amyloid peptide (Aβ25-35 )-induced PC12 cell death. The fingerprint-efficacy relationship of chemical fingerprints and neuroprotective effects was linked by orthogonal projection to latent structure-discriminant analysis (OPLS-DA) model. The chemical combination of 5-hydroxymethyl-2-furaldehyde (5-HMF), parishin B (PB) and parishin C (PC) was discovered and confirmed as QCMs of GET by the OPLS-DA method. The selected QCMs allowed to evaluate the relative quality of GET samples. This study has demonstrated that the rational strategy based on fingerprint-efficacy relationship modelling might be generally applicable for the quality control of herbal medicines. Copyright © 2017 John Wiley & Sons, Ltd.