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Objective: To investigate the effect of low-frequency rTMS combined with fasudil on neurological function in patients with acute cerebral infarction and its mechanism. Method:120 patients with acute cerebral infarction admitted from January 2016 to January 2019 were randomly divided into four groups: control group (n = 30), fasudil group (n = 30), rTMS group (n = 30), fasudil + rTMS group (n = 30). The changes of NIHSS score, ADL score, serum GAP-43, serum RhoA and serum ROCK-Ⅱ were observed and recorded before and after treatment. Results: The ADL scores and serum GAP-43 levels of the four groups after treatment were higher than those before treatment (P < 0.05); the NIHSS scores, serum RhoA and serum ROCK-Ⅱ levels of the four groups after treatment were lower than those before treatment (P < 0.05); After treatment, ADL score and serum GAP-43 level in fasudil+rTMS group were higher than those in other three groups (P < 0.05); After treatment, NIHSS score, serum RhoA and serum ROCK-Ⅱ levels in fasudil+rTMS group were lower than those in other three groups (P < 0.05). After treatment, NIHSS score was positively correlated with RhoA and ROCK-Ⅱ content, negatively correlated with GAP-43 content and ADL score. Conclusions: Low-frequency rTMS combined with fasudil in the treatment of acute cerebral infarction can significantly improve neurological deficits, improve daily living ability, promote axonal remodeling and regeneration. It may be one of its mechanisms by increasing the expression of GAP-43 in serum and reducing the expression levels of RhoA and ROCK-Ⅱ in serum. It has high clinical value.