Chronic constipation is a functional disorder of the digestive system that involves a complex interplay between the brain-gut-microbiome axis, with serotonin (5-HT) playing a key role.[1] Disorders in serotonin synthesis, release, receptor expression, or reuptake disrupt bowel movements and contribute to chronic constipation.[1] Traditional Chinese medicine, including herbal compounds, acupuncture, and tuina, has therapeutic effects through modulation of the serotonin signaling pathway.[1] Animal studies show that TCM interventions regulate gut microbiota and promote serotonin production through metabolites such as short-chain fatty acids and bile acids that act on specific receptors to increase bowel movements.[1] Clinical studies confirm the effectiveness of traditional Chinese medicine in normalizing serotonin levels and improving symptoms with the advantages of safety and a holistic approach.[1] Nevertheless, important gaps in knowledge remain, including an incomplete understanding of serotonin's mechanisms of action and limited research on the relationship between chronic constipation and emotional disturbances.[1]