Peripheral nerve injury (PNI), caused by contusions, fractures, and other traumas, leads to abnormal sensory functions, limited motor capabilities, neuropathic pain, and muscle atrophy, severely impacting patients' quality of life. Post-PNI, Wallerian degeneration occurs, involving axonal degeneration and myelin sheath collapse. Notably, the dorsal root ganglia (DRG), as the primary sensory neurons in pain signal transmission, are crucial targets in neuropathic pain (NP) induced by PNI. Therefore, changes in these targets trigger a series of complex signaling pathway alterations. Among them, the phosphatidylinositol 3-kinase/serine-threonine kinase (PI3K/AKT) signaling pathway, a vital regulator of cell survival and death, promotes Schwann cells (SCs) proliferation and migration, thereby enhancing axonal growth and myelination to facilitate nerve regeneration, and supports the survival of DRG neurons to alleviate NP. Current treatment methods include stem cell transplantation and neurotrophic medications, but all have certain limitations. Studies have shown that traditional Chinese medicine (TCM) has gained increasing attention and has been applied to some extent in the treatment of PNI due to its advantages of low cost and fewer side effects. This article discusses the relationship between oxidative stress, apoptosis, autophagy, inflammation, angiogenesis, the cell cycle, and other pathophysiological mechanisms in PNI and the PI3K/AKT signaling pathway, as well as its associated molecular targets. It also delves into the potential mechanisms of action of TCM monomers, compound formulas, and acupuncture based on the PI3K/AKT signaling pathway in the treatment of PNI, aiming to provide systematic and standardized theoretical guidance for the healing of PNI with TCM and a useful reference for the development of related medications.