Vascular dementia (VD) is a common cognitive impairment syndrome, for which there is currently no effective treatment. As a distinctive acupuncture therapy founded by Professor Jin Rui, the intelligence three-needling (Zhisanzhen, a specific set of 3 acupuncture points) selects the acupoints Shenting (GV24) and bilateral Benshen (GB13), and has shown significant clinical efficacy in improving cognitive function in patients with vascular dementia. This article systematically reviewed the research progress of intelligence three-needling in treating vascular dementia from both clinical and mechanistic perspectives: (1) Clinically, intelligence three-needling, applied via manual acupuncture or electroacupuncture, either alone or in combination with medication and rehabilitation training, can effectively improve patients’ scores on the Mini-Mental State Examination and Hasegawa Dementia Scale, as well as their daily living abilities. (2) Mechanistically, intelligence three-needling exerts multi-target and multi-pathway neuroprotective effects, including reducing neurotoxic substances such as homocysteine and β-amyloid, inhibiting neuroinflammatory responses, modulating synaptic plasticity-related proteins, improving cerebral blood flow perfusion, and promoting neuronal repair and functional recovery by regulating the Eph/ephrin signaling pathway and GABAergic system.