Atherosclerosis (AS), recognized by the World Health Organization (WHO) as a critical global public health challenge, serves as the primary pathological basis of cardiovascular diseases. Its hallmark pathological features include lipid deposition in the vascular intima, formation of atheromatous plaques, and fibrous cap thickening. These changes reduce vascular compliance, cause luminal stenosis, and culminate in end-organ ischemia. The Wnt/β-catenin pathway, an evolutionarily conserved core transduction cascade, plays pivotal roles in the pathophysiology of diverse diseases by orchestrating critical biological processes such as cell proliferation, differentiation, and metabolic homeostasis. Recent studies have revealed its essential regulatory functions in multiple key stages of AS progression, including endothelial dysfunction, vascular inflammatory responses, and vascular remodeling. Traditional Chinese Medicine (TCM) demonstrates unique advantages in AS prevention and treatment through its holistic synergistic characteristics of ”multi-component, multi-target, multi-pathway” regulation. Current evidence indicates that active components of TCM and compound formulations can modulate the Wnt/β-catenin pathway to exert multiple biological effects, including anti-inflammatory and antioxidant actions, regulation of macrophage activation, inhibition of abnormal vascular smooth muscle cell proliferation and migration, and improvement of lipid metabolism disorders, thereby retarding AS progression. Therefore, this article analyzes the Wnt/β-catenin pathway’s molecular features and its regulatory role in AS progression, while reviewing recent TCM interventions targeting this pathway. By elucidating the Wnt/β-catenin pathway’s role, this study supports the rational design of clinical interventions and next-generation AS therapeutics. Additionally, the study discusses TCM toxicological principles in its conclusion, offering practical references to enhance TCM’s clinical efficacy in AS treatment.