Chronic atrophic gastritis （CAG），as a key stage of precancerous lesions of gastric cancer，has an increasing incidence year by year，and it can gradually develop into gastric invasive cancer and mucosal cancer. At present，the main treatment focuses on the eradication of Helicobacter pylori （Hp），drug therapy， and pathological follow-up by gastroscopy，which can alleviate some symptoms，but it is difficult to curb the pathological progress，and the recurrence rate is high. Phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway is involved in the regulation of cell growth，differentiation，proliferation，apoptosis，autophagy， and other responses，and abnormal activation of this pathway can promote the progression of precancerous lesions of CAG. Traditional Chinese medicine is effective in the treatment of precancerous lesions of CAG through multi-component and multi-target comprehensive regulation. By regulating the PI3K/Akt pathway，the active ingredients and compounds of traditional Chinese medicine play therapeutic roles，such as inhibiting inflammation，glycolysis，angiogenesis， and epithelium-mesenchymal transformation，promoting autophagy，and regulating the balance of cell proliferation and apoptosis. This paper systematically reviewed the mechanism of traditional Chinese medicine intervention in the PI3K/Akt pathway in the treatment of precancerous lesions of CAG，so as to provide references for further understanding of the pathogenesis of precancerous lesions of CAG and search for potential therapeutic targets，and it provided new ideas for further research and drug development of precancerous lesions of CAG.