Objective: The purpose of this study is to systematicaly evaluate the safety of acupuncture in the treatment of chronic constipation in order to minimize clinical risk.Methods: The Cochrane database, MEDLINE, EMBASE, CBM, CNKI, VIP database and Wanfang database were searched systematically. Randomized controlled trials (RCTs) with safety assessment of acupuncture for chronic constipation were included. The included trial data were independently extracted by two authors and analyzed using Cochrane Collaboration Review Manager software (RevMan 5.3.5) after bias risk assessment. The primary outcome measure in this systematic review was the incidence of adverse effects.Results: A total of 20 RCTs were included, involving 3,747 patients, and were treated for 2 to 8 weeks. After integrating data from 9 trials comparing acupuncturing Tianshu (ST25) solely with oral lactulose, the incidence of adverse effects in the experimental group was significantly lower than that in the control group (RR 0.38, 95％CI 0.23 to 0.64). Seven studies compared deep ST25 with shalow ST25 showed no significant difference in the incidence of adverse effects (RR 1.39, 95％CI 0.59 to 3.28). 6 studies compared acupuncture a group of points including ST25 with western medicine, result indicated the incidence of adverse effects in the experimental group was significantly lower than that in the control group (RR 0.42, 95％CI 0.32 to 0.55).Conclusion: Acupuncture for chronic constipation is generaly safe. The operation of deep acupuncture at Tianshu (ST25) should be conducted by professional acupuncturists with certain experience, and individualized deep acupuncture should be used as far as possible. The needle insertion should be slow, without lifting, inserting, twisting and other manipulations.