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Background The escalating burden of non-communicable diseases (NCDs) demands cross-culturally adaptive interventions. Yoga (India) and Tai Chi (China) are both valuable mind-body practices. However, their distinct health governance pathways have not been systematically compared. Objectives This study aimed to: (1) decipher differential health promotion mechanisms (cardiopulmonary/pain/anxiety outcomes); (2) quantitative assessment of the different trade-offs in cultural sustainability (analyzing the communication characteristics under market-oriented and institutionalized models); (3) the implications of different policy integration models for global public health scalability are evaluated. Methods We developed a comparative framework examining three interconnected dimensions: (1) Health Benefits—by synthesizing clinical trial evidence; (2) Cultural Sustainability—by analyzing patterns in global digital and academic discourse; and (3) Policy Integration—by reviewing official documents and modeling the relationships among all three dimensions. Results (1) Equivalent efficacy in cardiopulmonary function ( d = 0.45), chronic pain ( d = 0.62), and anxiety reduction ( d = 0.51); (2) Cultural Sustainability Exhibits an Asymmetric Pattern: although yoga boasts a more extensive and well-established clinical evidence base (particularly in the field of mental health), its standardized movement retention rate in the process of global dissemination (68%) is significantly lower than that of Tai Chi (82%, p < 0.001). It should be noted that yoga's inherent philosophical tenet of Viniyoga (i.e., individualized adaptation) may lead to a systematic underestimation of its cultural authenticity when assessed using standardized metrics; (3) Structural equation model of health-culture-policy interactions. Key pathways: health benefits → policy inclusivity (β = 0.63); cultural transmission → policy inclusivity (β = −0.30); policy feedback → cultural transmission (β = 0.45). Conclusion Yoga and Tai Chi represent two complementary paradigms in the modernization of mind-body practices. The former excels in market adaptability and rapid innovation diffusion, while the latter demonstrates strengths in institutional norms and community-based public provision. This study advocates that effective global health governance should avoid a single model and instead construct a contextualized hybrid framework. By selectively integrating the advantages of both approaches based on specific socio-cultural contexts and health system needs, we can simultaneously ensure the evidentiary validity, cultural relevance, and social accessibility of interventions.