Based on customs trade statistics from 1999 to 2008, a total of 1989 metric tons of shells of hard-shelled chelonians have been imported into Taiwan for consumption in the traditional Chinese medicine (TCM) market, with an average of 198.9 metric tons/y. The total amount of soft-shell turtle shells imported was 290 metric tons, averaging 29.0 metric tons/y. This volume indicates that millions of turtles and tortoises have been killed annually for the TCM market in Taiwan alone. The trade of turtle shells for TCM has existed in huge volumes for a long time, with no significant decrease in the market size through Convention on International Trade in Endangered Species of Wild Fauna and Flora listing of the main target species. Although the customs trade records were not species-specific, in the market survey conducted in 1996–2002, a total of 39 species of turtles and tortoises, mainly originating from China, Southeast and South Asia, were identified. Only 3 non-Asian species were found. The larger number and numerous species of origin in turtle-shell trade for the TCM market indicate blatant disregard by traders for law and authority of responsible agencies from both source and consumer countries. Observed levels of usage and trade of turtle shells appear to be highly unsustainable and may have a great impact on the chelonian fauna in source areas. For the sustainability of chelonian fauna in Asia, clear policies and close international cooperation for the regulation of turtle-shell trade are urgently needed.