This research report examines the emerging governance challenge of traditional pharmacopoeia in sport, analysing how existing regulatory anti-doping frameworks fail to adequately protect athletes who use culturally rooted herbal medicines. Through a qualitative comparative policy analysis of Australia and China within UNESCO’s Asia-Pacific region, this report identifies two distinct but convergent regulatory failures: Australia demonstrates systemic exclusion of Indigenous Bush Medicine from both health and anti-doping governance structures, creating knowledge gaps and epistemic injustice for First Nations athletes, while China exhibits institutional fragmentation where well-developed traditional medicine regulation operates in parallel rather than in coordination with anti-doping enforcement. Using the Ottawa Charter’s Promotion, Prevention, and Protection framework alongside Dahlgren and Whitehead’s social determinants model, this report offers evidence-based recommendations to support Member States in strengthening national policy frameworks ahead of UNESCO’s eleventh Conference of the Parties in 2027, ultimately arguing that athlete protection requires structural intervention addressing educational, evidentiary, and regulatory gaps rather than placing compliance burden solely on individual athletes under the World Anti-Doping Code’s strict liability principle.