Objective To investigate the neuroprotective effect of Buyang Huanwu decoction on the phosphatidylinositol 3-kinase/serine/threonine protein kinase (PI3K/AKT) signaling pathway in the brain tissue of rats with cerebral hemorrhage and possible mechanisms.Methods A total of 72 Sprague-Dawley rats were randomly divided into sham-operation group, model group, Buyang Huanwu decoction group, and Ginkgo leaf tablet group, with 18 rats in each group. In the model group, Buyang Huanwu decoction group, and Ginkgo leaf tablet group, the Rosenberg method was used to establish the rat model of cerebral hemorrhage. The Garcia method was used to determine the neurological score, electron microscopy was performed to observe the neuronal mitochondrial ultrastructure, Western blot was used to measure the protein expression of phosphorylated protein kinase (p-AKT), TUNEL was used to measure the changes in cell apoptosis, immunohistochemistry was used to measure the expression of B cell lymphoma-2 protein (bcl-2) and bcl-2-associated X protein (bax), formamide assay was performed to determine the permeability of blood-brain barrier (BBB), and the wet-dry weighting method was used to measure the water content in brain tissue.Results Compared with the cerebral hemorrhage model group, Buyang Huanwu decoction significantly increased neurological score (P<0.05), reduced the permeability of BBB, reduced the water content in brain tissue (P<0.05), upreguated the protein expression of p-AKT and bcl-2, downregulated the protein expression of bax, relieved mitochondrial injury, and inhibited neuronal apoptosis.Conclusions The mechanism of the protective effect of Buyang Huanwu decoction against cerebral hemorrhage caused by brain injury may be related to the activation of the PI3K/AKT signaling pathway, inhibition of neuronal apoptosis, reduction in BBB permeability, and alleviation of cerebral edema.