Objective To investigate the cerebral protection mechanism of governor vessel moxibustion in rats with vascular dementia (VD) based on the p38 mitogen-activated protein kinase (MAPK) pathway.Methods A total of 60 specific pathogen-free healthy male Sprague-Dawley rats were randomly divided into sham operation group with 12 rats and experimental group with 48 rats.The rats in the experimental group were treated with permanent ligation of both common carotid arteries to establish a rat model of VD,and after successful modeling,the rats were randomly divided into model group,moxibustion group,inhibitor group,and moxibustion+inhibitor group,with 12 rats in each group.The rats in the moxibustion group were given mild-warm moxibustion at Baihui,Dazhui,and Fengfu points for 30 minutes each time,once a day for 6 days,followed by 1 day of rest, for 4 consecutive weeks; the rats in the inhibitor group were given intraperitoneal injection of p38 MAPK inhibitor (10 μmol/L SB203580) at 30 minutes before modeling,followed by the injection of 10 μmol/L SB203580 every other day after modeling at a dose of 1 mL/kg for 4 consecutive weeks;the rats in the moxibustion+inhibitor group were given moxibustion in addition to the intervention in the inhibitor group.The Morris water maze test was used to observe the cognitive function of rats;the TUNEL method was used to measure the apoptosis rate of neurons in the hippocampal CA1 region;Western blot and RT-qPCR were used to measure the protein and mRNA expression levels of p38 MAPK,B-cell lymphoma-2 (Bcl-2), Caspase-3, and Caspase-9 in the hippocampus. Results Compared with the model group, the moxibustion group,the inhibitor group,and the moxibustion+inhibitor group had a significantly shorter mean escape latency (P<0.05),a significant increase in the number of platform crossings (P<0.05),and a significant reduction in the apoptosis rate of neurons in the hippocampal CA1 region (P<0.05),as well as significant reductions in the protein and mRNA expression levels of p38 MAPK,Caspase-3,and Caspase-9 (P<0.05) and significant increases in the protein and mRNA expression levels of Bcl-2 (P<0.05).Compared with the moxibustion group and the inhibitor group,the moxibustion+inhibitor group had a significantly shorter escape latency (P<0.05),a significant increase in the number of platform crossings (P<0.05),and a significant reduction in the apoptosis rate of neurons in the hippocampal CA1 region (P<0.05),as well as significant reductions in the protein and mRNA expression levels of p38 MAPK, Caspase-3,and Caspase-9 (P<0.05) and significant increases in the protein and mRNA expression levels of Bcl-2 (P<0.05). Conclusion Governor vessel moxibustion has a certain effect in improving cognitive impairment in rats with VD,possibly by regulating the p38 MAPK signaling pathway and inhibiting the apoptosis of hippocampal neurons.