Premature ovarian insufficiency belongs to the category of early menstrual cessation, blood depletion, and infertility in traditional Chinese medicine, which not only affects women′s fertility and forces them into a premature perimenopausal period, but also increases the risk of long-term complications such as osteoporosis, cognitive impairment, and cardiovascular diseases. Autophagy has a dual regulatory effect on follicular development and atresia, closely related to the onset of premature ovarian insufficiency. In women, blood is the basis and qi is the use. This article argues from the perspective of "qi", positing that the pathogenesis of premature ovarian insufficiency is fundamentally due to the deficiency of qi in the zang-fu organs leading to inadequate nourishment of the uterus, while the obstruction of the uterine vessels by qi depression in the zang-fu organs as manifestation. It also takes the correlation between autophagy and qi in the onset of premature ovarian insufficiency as the starting point, proposing a therapeutic principle centered on replenishing qi as the foundation and activating qi as the key. The internal and external treatment of traditional Chinese medicine can correct the abnormal autophagy of granulosa cells through "regulating qi", thus improving the ovarian microenvironment, protecting the ovarian function, and finally preventing and treating premature ovarian insufficiency.