Panax plants are known for their significant medicinal and economic value. Being perennial, they are prone to soil-borne diseases during cultivation. However, there has been limited research on the pathogenesis of soil-borne diseases and the diversity of pathogens. While biological control has gained attention for its efficacy and environmental benefits, the factors affecting its efficiency still need thorough evaluation. This review summarizes the influence of biotic factors, such as pathogens and hosts, and environmental factors on the occurrence of soil-borne diseases and pathogen diversity. Additionally, we synthesized bacterial, actinobacterial, and fungal diversity for the biocontrol of soil-borne diseases and their functional mechanisms. Moreover, the review delves into the factors influencing the efficacy of biocontrol, including microbial species, the inoculation method and inoculation volume, and inoculant composition. This article serves as a valuable resource for enhancing the efficiency of biological control and optimizing strategies for managing soil-borne diseases in Panax cultivation in the future.