The occurrence and development of premature ovarian insufficiency involves the abnormality of multiple signal pathways. It is a complex disease. Traditional Chinese medicine affects the relevant factors of the occurrence and development of premature ovarian insufficiency (granulosa cell apoptosis, ovarian blood supply, ovarian reserve, ovarian oxidative damage, gap junction, ovarian fibrosis, follicular development, follicular atresia, and other biological processes) by regulating a variety of signal pathways, thus playing the role in antioxidant stress, prevention and treatment of chemotherapy side effects, protection of ovarian function, control of aging, and improvement of ovarian reserve function. The research shows that the research on the related pathways of traditional Chinese medicine in the treatment of premature ovarian insufficiency has been quite extensive. Based on the search of the domestic and foreign literature, it is found that Yulinzhu and Xianziyizhen capsule and ginsenoside Rg1 can promote the proliferation and differentiation of granulosa cells, inhibit apoptosis, and reduce follicular atresia by affecting the PI3K/Akt/mTOR signal pathway; Guiluo's Anzang decoction, Kuntai capsule, and Yangyin Shugan granule can maintain the balance between pro-apoptotic protein and anti-apoptotic protein through the Bax/cytc/caspase-3 pathway to improve ovarian reserve function; Bushen Jianpi recipe can control cell apoptosis and promote the proliferation and development of ovarian granulosa cells by regulating the MAPK signal pathway; Siwu mixture and Zuo Gui pill can regulate the TGF-β/Smads signaling pathway to promote the recruitment of primordial follicles, promotes follicular development, inhibits follicular atresia, and regulates ovarian function; Erxian decoction, Yiqi Yangrong Fujing formula, and Cistanche deserticola can antagonize the inflammatory symptoms of premature ovarian failure, promote the secretion of relevant vascular growth factors, and enhance the ovarian reserve function through the NF-KB signal pathway; Bushen Culuan decoction can promote damage repair and protect normal ovarian cells through antioxidant stress. The above summary aims at providing reference for the in-depth study of traditional Chinese medicine in the treatment of premature ovarian insufficiency and inspiring new diagnosis and treatment ideas.