Abstract: BACKGROUND: Chinese herbal prescription with head acupuncture exercise therapy has significant clinical efficacy in the treatment of limb spasticity after ischemic stroke; however, the exact mechanism is not clear.
OBJECTIVE: To explore the possible mechanism of the combination of Chinese herbal prescription with head acupuncture exercise therapy in improving limb spasticity after stroke. 
METHODS: Seventy Sprague-Dawley rats were divided into blank, model, exercise therapy, head-acupuncture, Chinese herbal prescription, Chinese herbal prescription with head acupuncture exercise therapy, and sham-operation groups using the random number method, with 10 rats in each group. Except for the blank group and the sham-operation group, a rat model of cerebral ischemia/reperfusion injury was made by using the middle cerebral artery cable embolism method in the rest of the groups. Interventions in each group started on the 3rd day after modeling. In the Chinese herbal prescription group, rats were given 1.5 g/kg Yi’nao Fujian herbal prescription by gavage; in the head acupuncture group, acupuncture was applied to Baihui and 2 mm on the left and right sides of Baihui, and was left in place for 30 minutes; in the exercise therapy group, rats were exercised on a treadmill for 30 minutes; in the Chinese herbal prescription with head acupuncture exercise therapy group, 1.5 g/kg Yi’nao Fujian herbal prescription was given by gavage followed by acupuncture treatment (identical to that in the head acupuncture group, and then the animals were exercised for 30 minutes on the treadmill while the acupuncture needles remained in place. Rats in the model and sham-operation groups were subjected to grasping under the same environmental conditions and placed on a rat immobilizer for 30 minutes, and the blank group did not have any intervention. The frequency of intervention in each group was once a day for 7 consecutive days. The neurological deficit score and muscle tone were evaluated in each group before and after treatment. Pathological changes in rat brain tissue were observed. Protein and mRNA expressions of glutamic acid decarboxylase 67, succinate semialdehyde dehydrogenase, and γ-aminobutyric acid transaminase in the cerebral cortex of the rats were detected. 
RESULTS AND CONCLUSION: (1) Compared with the model group, the Chinese herbal prescription with head acupuncture exercise therapy group had lower neurological deficit scores and modified Ashworth spasticity scale (MAS) muscle tone scores (P < 0.01), decreased expression of succinate semialdehyde dehydrogenase andγ-aminobutyric acid transaminase at protein and mRNA levels, and increased expression of expression of glutamic acid decarboxylase 67 at protein and mRNA levels (P < 0.01); the neuronal cell structure was relatively intact, with only some irregular cavities visible and reduced nuclear consolidation. (2) Compared with the Chinese herbal prescription with head acupuncture exercise therapy group, the neurological deficit scores and MAS muscle tone scores were higher in the exercise therapy group (P < 0.05), and the MAS muscle tone scores were higher in the head-acupuncture group and the Chinese herbal prescription group (P < 0.05, P < 0.01), while the expressions of glutamic acid decarboxylase 67 protein and succinate semialdehyde dehydrogenase andγ-aminobutyric acid transaminase mRNAs were increased in all the other intervention groups (P < 0.05, P < 0.01). Neuronal cells in the Chinese herbal prescription with head acupuncture exercise therapy group were more orderly arranged and clearly outlined, with less nuclear consolidation and shape irregularity compared with the other intervention groups. (3) The neurological deficit score and MAS muscle tone score in the Chinese herbal prescription with head acupuncture exercise therapy group were significantly lower after treatment (P < 0.01). To conclude, Yi’nao Fujian herbal prescription combined with head-acupuncture exercise therapy can improve post-stroke spasticity by affecting the expression of γ-aminobutyric acid transaminase in rats, which is more effective than Chinese herbal prescription alone, exercise therapy alone, and head-acupuncture alone.

Key words: traditional Chinese medicine, head acupuncture exercise therapy, post-stroke spasticity, glutamic acid decarboxylase 67, succinate semialdehyde dehydrogenase, γ-aminobutyric acid transaminase, Yi’nao Fujian herbal prescription, stroke, muscle tone