The traditional Chinese medicine (TCM) industry is a traditional advantageous industry in Henan Province, boasting profound cultural heritage and prominent resource endowments. Against the backdrop of the global upgrade in health concepts and the accelerated internationalization of traditional Chinese medicine, Henan’s TCM exports face both opportunities and challenges. Based on Henan’s TCM export data from 2018 to 2023, this paper conducts a quantitative evaluation of its export competitiveness using the Trade Competitiveness Index (TC), International Market Share (MS), and Revealed Comparative Advantage Index (RCA). The study finds that the overall export competitiveness of Henan’s TCM shows an upward trend, but the exports are still dominated by raw materials, with insufficient international recognition of proprietary Chinese medicines. Accordingly, this paper proposes countermeasures from four aspects: strengthening the international promotion of proprietary Chinese medicines, breaking through international regulatory barriers, optimizing the export structure, and promoting the transformation towards high value-added products, so as to facilitate the high-quality development and internationalization of Henan’s TCM industry.