Objective To observe the efficacy of Tongxinluo（ TXL） ultrafine powder combined with peripheral blood mesenchymal stem cell transplantation in the treatment of lower limb ischemia in diabetic rats. Methods Diabetic rat models were established by high-fat diet combined with low dose of streptozotocin（ STZ） injection. Then the right femoral artery and vein were ligated to make the lower limb ischemia models. In total 100 successful models were randomly divided into model group

TXL group

stem cell group

and combined treatment group

with 20 in each. Another 20 healthy rats from the same batch were selected as normal group. The TXL group and combined treatment group received TXL ultrafine powder 0. 4 g /（ kg·d） by gavage for 28 days. Three days post-operation

the stem cell group and combined treatment group were injected with 0. 4 ml of cell suspension（ PB-MSCs1. 0 × 106/ml） at 8 points in the subcutaneous muscle layer of the lower extremity with ischemia

0. 05 ml each point. The normal group

model group and stem cell group received the same volume of normal saline by gavage and were injected with the same volume of sterile RPM1640 medium at the same points in muscles. The laser Doppler perfusion imaging was applied before and after operation

as well as on day 7 and day 28 of treatment

to detect the difference of blood flow between the two hind limbs

and on day 28 of treatment

lower limb angiography was applied to detect the arterial blood flow. Results Compared with the normal group

the differences of blood flow between the two hind limbs in the other groups were significantly larger post-op and on day 7 and day 28 of treatment（ P < 0. 01）. Compared with the model group

the differences of blood flow between the two hind limbs in each treatment group were significantly smaller on day 7 and day 28 of treatment

and compared with the TXL group and stem cell group

the difference of blood flow between the two hind limbs in the combined treatment group on day 28 of treatment was significantly smaller（ P < 0. 05 or P < 0. 01）. Compared within the group pre-op

the differences of blood flow between the two hind limbs in each treatment group post-op and on day 7 and day 28 increased significantly（ P < 0. 01）

but compared with that post-op

the differences of blood flow between the two hind limbs decreased on day 7 and day 28 of treatment in each treatment group

especially on day 28（ P < 0. 01）. Arteriography showed that in the model group and each treatment groups

especially in the combined treatment group

there were collateral circulation and capillary angiogenesis

with which and the existing capillaries networks were formed. Conclusion TXL ultrafine powder with peripheral blood mesenchymal stem cell transplantation could improve the lower limb ischemia in diabetic rats

and it was superior to stem cell transplantation alone.