Objective To investigate the effect of ear acupuncture on cognitive function and hippocampal neurons in rats with vascular dementia (VD). Methods A total of 60 healthy male Sprague- Dawley rats were selected, among which 10 rats were enrolled as normal group and the remaining were treated with four- vessel occlusion to establish a model of VD and were then randomly divided into model group, auricular acupuncture group, and Western medicine group, with 10 rats in each group. On day 4 after modeling and on days 30 and 60 of treatment, the step- down test was performed to evaluate learning and memory performance and determine neurobehavioral score; on day 4 after modeling and on day 60 of treatment, the morphology of hippocampal CA1 neurons was observed under a light microscope. Results On day 4 after modeling, there were significant differences between the normal group and the model group in learning and memory performance, neurobehavioral score, and the number of viable pyramidal cells in the hippocampal CA1 region (P<0.05). On days 30 and 60 of ear acupuncture therapy, there were significant differences in learning and memory performance and neurobehavioral score between the auricular acupuncture/Western medicine groups and the model group (P<0.05), while there were no significant differences between the auricular acupuncture group and the Western medicine group (P>0.05). After 60 days of treatment, there were significant differences in these indices between the auricular acupuncture/Western medicine groups and the model group (P<0.05), while there were no significant differences between the auricular acupuncture group and the Western medicine group (P>0.05). Conclusion Auricular acupuncture can improve the learning and memory ability of VD rats and reduce their neurobehavioral score. It can also improve the degenerative hippocampal CA1 neurons, promote their recovery and regeneration, and thus improve the learning and memory ability of VD rats, which might be the possible mechanism of auricular acupuncture in the treatment of VD in clinical practice.