Granulomatous lobular mastitis (GLM), a clinically challenging inflammatory breast disease, is characterized by a high recurrence rate, strong invasiveness, and a trend of affecting younger individuals, posing significant challenges to patients and clinical practitioners. Its pathological processes involve the abnormal activation of multiple signaling pathways, including NF-κB, NLRP3, JAK/STAT, TLR, MAPK, PI3K/AKT/mTOR, and Nrf2/HO-1. These pathways contribute to the disease's onset and progression by regulating inflammatory responses, immune reactions, and oxidative stress. Traditional Chinese Medicine (TCM) demonstrates unique therapeutic value in the treatment of GLM by virtue of its multi-component and multi-target mechanisms. Through modulation of the aforementioned signaling pathways, TCM can effectively inhibit inflammatory cascades, regulate immune imbalance, and ameliorate oxidative stress, thereby reducing lesion size, shortening disease course, and lowering recurrence rates. This article systematically reviews the research progress on GLM-related signaling pathways and integrates the latest evidence on the interventional mechanisms of Chinese medicine, aiming to provide new insights for precision clinical treatment.