Diminished Ovarian Reserve (DOR) refers to a complex gynecological disorder characterized by reduced quantity and impaired quality of oocytes in the ovaries. It affects millions of women worldwide, often leading to menstrual irregularities and infertility. With the delayed age of marriage and childbearing, DOR has become a key factor impacting women's fertility.This article summarizes the multiple pathogenic mechanisms and signaling pathways involved in the occurrence and development of DOR, among which the Phosphatidylinositol 3-Kinase/Protein Kinase B (PI3K/AKT) signaling pathway plays a core role in the regulation of ovarian function. The article demonstrates that the PI3K/AKT pathway exerts a significant effect on the pathogenesis of DOR: it influences the occurrence and progression of DOR by regulating granulosa cell apoptosis, modulating ovarian inflammatory responses, and governing the autophagy and oxidative stress processes of granulosa cells and follicular cells.Furthermore, this article focuses on summarizing the close association between the PI3K/AKT pathway and the pathogenic mechanism of DOR, as well as reviewing the latest experimental studies on the treatment of DOR using traditional Chinese medicine (TCM) monomers and compound prescriptions via this pathway, thereby providing references for the further advancement of DOR treatment research.