Abstract： Objective： To observe the clinical efficacy of Xingqi Daozhi Tongbian Decoction combined with western medicine in treating moderate-to-severe functional constipation of qi stagnation type. Methods： A total of 120 patients with moderate-to-severe functional constipation of qi stagnation type treated at The First People's Hospital of Pingdingshan from January 2022 to January 2024 were selected as the research subjects and divided into a control group and a study group using a random number table method，with 60 cases in each group. The control group received western medicine treatment，while the study group received Xingqi Daozhi Tongbian Decoction combined with western medicine treatment. Both groups were treated continuously for four weeks. Clinical efficacy， traditional Chinese medicine（TCM） syndrome scores， intestinal barrier function indicators [serum endotoxin lipopolysaccharide （LPS）， D-lactic acid （DLA） ， and diamine oxidase （DAO） ]， gastrointestinal hormone [plasma gastrin （GAS） ， somatostatin （SS） ， motilin （MTL）]， orocecal transit time （OCTT） ， Patient Assessment of Constipation Symptoms （PAC-SYM）， Patient Assessment of Constipation Quality of Life （PAC-QOL）， adverse reactions， and recurrence rates were compared between the two groups. Results：After four weeks of treatment，the total effective rate in the study group was 93.33% （56/60）， higher than that in the control group at 78.33% （47/60） （P＜0.05）. The scores of symptoms such as difficult defecation，abdominal distension，intestinal rumbling and flatulence，fullness in the chest and hypochondria， and belching in both groups were decreased compared to before treatment （P＜0.05）， with the study group achieving lower scores than the control group （P＜0.05）. The serum LPS，DLA and DAO levels， as well as plasma GAS and SS levels，were decreased in both groups compared to before treatment （P＜0.05），with the study group achieving lower levels than the control group （P＜0.05）. The plasma MTL levels were increased in both groups compared to before treatment （P＜0.05）， with the study group achieving higher levels than the control group （P＜0.05）. The OCTT shortened in both groups compared to before treatment （P＜0.05），with the study group achieving a shorter OCTT than the control group （P＜0.05）. The rectal symptom， abdominal symptom， and stool characteristic scores in PAC-SYM，as well as the PAC-QOL scores，were decreased in both groups compared to before treatment （P＜0.05），with the study group achieving lower scores than the control group （P＜0.05）. The incidence of adverse reactions in the study group was 6.67% （4/60），with no significant difference compared to the control group at 10.00% （6/60） （P＞0.05）. The recurrence rate in the study group was 3.57% （2/56）， with no significant difference compared to the control group at 8.51% （4/47） （P＞0.05）. Conclusion：Xingqi Daozhi Tongbian Decoction combined with western medicine treatment can improve intestinal barrier function， enhance gastrointestinal motility， alleviate clinical symptoms， and improve quality of life in patients with moderate-to-severe functional constipation of qi stagnation type，with high safety.