Diminished ovarian reserve (DOR) is a common gynecological condition. The incidence of DOR is increasing in line with the trend of delayed marriage and childbirth, showing a younger age of onset and seriously affecting female fertility and quality of life. Current Western medical treatments for DOR mainly rely on hormone replacement and assisted reproductive technologies, but these are associated with significant side effects and unreliable efficacy. Traditional Chinese medicine ( TCM ) offers advantages in terms of multi-target and multi-pathway regulation, effectively modulating hormone levels, promoting follicular development, and delaying ovarian aging with high safety, making it an important complementary clinical approach. The phosphatidylinositol 3-kinase / protein kinase B ( PI3K/ Akt ) signaling pathway is a core regulator of ovarian granulosa cell proliferation, apoptosis,autophagy, and oxidative stress, and its dysregulation is closely linked to the pathogenesis and progression of DOR.This article reviews the mechanisms of the PI3K/ Akt pathway in DOR, including apoptosis, the inflammatory response, autophagy, and oxidative stress, and summarizes recent research progress on the role of TCM monomers (such as kaempferol and curcumin) and compound formulas (such as Yulin Formula and Yulin Hukun Decoction) in improving DOR by regulating this pathway, providing a theoretical basis for precise TCM interventions in DOR.