Steroid-induced osteonecrosis of the femoral head (SONFH) is a common bone and joint disease, mainly due to long-term or high-dose use of glucocorticoids leading to femoral head blood supply disorders and bone tissue necrosis. At present, the most effective treatment for SONFH is hip replacement, but there are some limitations and complications. As a traditional medical system, traditional Chinese medicine has the characteristics of multitarget, multi-channel and multi-component, which may provide a new treatment strategy for SONFH. In recent years, more and more studies have shown that traditional Chinese medicine can act on the PI3K/Akt signaling pathway, affect the angiogenesis, osteogenic differentiation, apoptosis and other processes in the necrotic area of the femoral head, thereby promoting angiogenesis and bone repair, and achieving the purpose of protecting the femoral head. This article reviews the research results of traditional Chinese medicine in the treatment of SONFH based on PI3K/Akt signaling pathway, and further provides a reference for the clinical application of traditional Chinese medicine in the treatment of SONFH.