Vascular dementia (VaD) is the second most common type of dementia after Alzheimer's disease, and its pathogenesis is closely related to chronic cerebral ischemia, neuroinflammation, and neuronal apoptosis. Recent studies have indicated that endoplasmic reticulum stress (ERS) plays a critical role in the pathological process of VaD. Cerebral ischemia and hypoxia can lead to the accumulation of unfolded/misfolded proteins in the endoplasmic reticulum lumen, triggering the unfolded protein response (UPR). Persistent ERS excessively activates core signaling pathways such as protein kinase RNA-like endoplasmic reticulum kinase (PERK)-eukaryotic translation initiation factor 2A (eIF2α)-activating transcription factor (ATF)4-C/EBP homologous protein (CHOP), inositol-requiring enzyme 1 (IRE1)α-X-box binding protein 1 (XBP1), and ATF6, ultimately inducing neuronal apoptosis. This article reviews the mechanism of ERS in VaD and focuses on the potential strategies of traditional Chinese medicine (TCM) for preventing and treating VaD. Research has shown that various TCM compound formulations (e.g., Taohong Siwu Decoction, and Buyang Huanwu Decoction) and TCM extracts (e.g., crocin, and tetrahydroxystilbene glucoside) can effectively inhibit ERS through multi-target and multi-pathway synergistic effects, alleviate oxidative stress and neuroinflammation, reduce neuronal apoptosis, and thereby improve cognitive function. Targeting the regulation of ERS provides a new direction for VaD treatment. In-depth research into the specific molecular mechanisms of TCM in preventing and treating VaD via the ERS pathway holds significant theoretical value and clinical translation prospects.