Objective: To observe the clinical effect and safety of Tongbian decoction in the treatment of elderly patients with laxative constipation

and investigate its possible mechanism. Method: A multicenter

large sample

randomized controlled clinical trial was designed.Ninety-two elderly patients with slow transit constipation (STC) were randomly divided into treatment group (Tongbian decoction

47 cases) and control group (Clostridium butyricum powder

45 cases).The treatment course of each group was 30 days.The clinical symptom score

fecal character score and clinical efficiency of constipation were observed before and after treatment in both groups.PCA-QOL score was used to evaluate the life quality in both groups.Short chain fatty acid and butyric acid contents in feces were detected; and the recurrence rates and adverse reactions after drug withdrawal for 4

8 weeks were also observed. Result: The total clinical efficacy was 91.4% in treatment group

superior to 80.0% in control group

with statistical difference.After treatment by Tongbian decoction

the treatment group could significantly increase the short chain fatty acid and butyric acid contents in feces (P < 0.01)

improve defecation character score

defecation time score

defecation interval score

interval difficulty score and principal components analysis (PCA)-QOL score (P < 0.05).The recurrence rates in treatment groups were lower than those in control group after drug withdrawal for 4 weeks and 8 weeks

without significant adverse reactions in both groups. Conclusion: It is worth spreading that Tongbian decoction can decrease the recurrence incidence of laxative constipation with an significant role in clinical effect

and its effect may be relevant to rising short chain fatty acids and acid casein in feces

thus improving colonic motility.