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Objective: To investigate the influence of Tongxinluo capsule (TXL, 通心络胶囊) on regional cerebral blood flow (rCBF) with 99mTc-ECD single photon emission computed tomography ( SPECT) brain perfusion imaging, and to observe the therapeutic effects of TXL on acute small cerebral infarction (ASCI).Methods: Thirty-four patients with ASCI were enrolled and randomly divided into two groups: the control group ( n = 17) was treated with the conventional treatment, i.e. 1.0g of Citicoline added into 300 mi normal saline for intravenous dripping daily for 2 weeks and 0.8 g of Piracetam taken three times a day orally for 4 weeks, and the treatment group ( n = 17)was treated additionally with 4 TXL capsules three times a day for 4 weeks besides the conventional treatment. The 99mTc-ECD SPECT brain perfusion imaging was performed before and after treatment to observe the change of rCBF, and the neurological deficit was evaluated by Edinburgh-Scandinavia stroke scale (SSS) scores and Barthel index (BI) at the same time. Results: After treatment, the rCBF in the treatment group was significantly improved ( P＜0.01), while that in the control group remained unchanged, with the comparison of the rCBF in the two groups after treatment showing significant difference (P＜0.01). In addition, the SSS score was significantly lower and BI significantly higher in the treatment group than those in the control group respectively after treatment. Conclusion: TXL could effectively improve rCBF and lessen the neurological deficit symptoms in patients with ASCI.