肥胖作为全球流行的慢性代谢性疾病，与2型糖尿病、代谢相关脂肪性肝病及心血管疾病等并发症密切相关。磷脂酰肌醇-3-羟激酶（phosphatidylinositol-3-hydroxykinase，PI3K）/蛋白激酶B（protein kinase B，Akt）信号通路是调控细胞生长、代谢及胰岛素信号转导的核心枢纽，其功能紊乱是驱动肥胖及其并发症发生发展的关键分子机制。中医药凭借多成分、多靶点与整体调节的特色，在肥胖防治领域展现出独特潜力。系统阐释了PI3K/Akt信号通路的分子构成及其在脂肪、肝脏、肌肉、心血管、胰腺和大脑等多组织能量代谢中的核心调控作用；深入剖析了该通路在肥胖状态下与慢性炎症、脂代谢失衡及细胞异常增殖之间的病理联系；并重点归纳了皂苷、黄酮、生物碱、萜类、酚酸及多糖等中药活性成分，以及经典复方通过精准调控PI3K/Akt通路改善肥胖的作用机制。现有证据表明，中医药可通过激活或抑制PI3K/Akt信号，有效调节糖脂代谢、缓解胰岛素抵抗、抑制炎症与氧化应激，从而多途径干预肥胖及其合并症，为阐释中医药代谢调控的现代科学内涵及推动靶向治疗策略提供了重要理论依据与研究方向。

Obesity, a chronic metabolic disease prevalent worldwide, is closely associated with complications such as type 2 diabetes, metabolism-related fatty liver disease, and cardiovascular disease. The phosphatidylinositol-3-hydroxykinase (PI3K)/protein kinase B (Akt) signaling pathway is a core hub for regulating cell growth, metabolism, and insulin signal transduction, and its dysfunction is a key molecular mechanism driving the occurrence and development of obesity and its complications. Traditional Chinese medicine (TCM), with its multi-component, multi-target, and holistic regulatory features, has demonstrated unique potential in the prevention and treatment of obesity. This review systematically explains the molecular composition of the PI3K/Akt signaling pathway and its core regulatory role in the energy metabolism of multiple tissues, including adipose, liver, muscle, cardiovascular, pancreatic, and brain. It also deeply analyzes the pathological connection between this pathway and chronic inflammation, lipid metabolism imbalance, and abnormal cell proliferation in obesity. It also focuses on summarizing the active ingredients of TCM, such as saponins, flavonoids, alkaloids, terpenes, phenolic acids, and polysaccharides, as well as the pharmacological mechanisms of classic compound prescriptions in improving obesity through precise regulation of the PI3K/Akt pathway. Existing evidence shows that TCM can effectively regulate glucose and lipid metabolism, alleviate insulin resistance, and inhibit inflammation and oxidative stress by activating or inhibiting PI3K/Akt signaling, thereby intervening in obesity and its complications through multiple pathways. This provides an important theoretical basis and research direction for explaining the modern scientific connotation of metabolic regulation in TCM and promoting the development of targeted treatment strategies.

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国家重点研发计划资助项目（2018YFC2000600）；中国中医科学院科技创新工程（CI2021A03005）；北京薪火传承3＋3项目：施奠邦名家研究室（2023-SZ-A51）