The total amount of China's exports of Chinese medicinal materials to the world and the trade competitiveness index gradually declined, but the exports of Chinese medicinal materials along the "the Belt and Road" increased significantly. The main problems faced by China's export trade of traditional Chinese medicine include the lack of quality standard system, the establishment of technical barriers to trade in importing countries, and the insufficient development of the export market of traditional Chinese medicine. The "the Belt and Road" initiative has brought opportunities to the international development of Chinese medicine, and has provided a broad market space for the development of Chinese medicine industry. The "the Belt and Road" strategy and the expansion of demand for traditional Chinese medicine in the international market have brought good development opportunities for the export trade of traditional Chinese medicine. However, cultural differences at home and abroad, international trade barriers and competition in the same industry have also brought threats and challenges to the export trade of traditional Chinese medicine in Gansu.