Objective To investigate the clinical effect of acupuncture and moxibustion at four specific acupoints in the treatment of elderly functional constipation. Methods A total of 70 elderly patients with functional constipation were randomly divided into treatment group and control group, with 35 patients in each group. The patients in the treatment group were given acupuncture and moxibustion at four specific acupoints, and those in the control group were given conventional acupuncture. The two groups were observed in terms of weekly number of times of spontaneous bowel movements (SBM), Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) score, and 36-Item Short-Form Health Survey (SF-36) score before and after treatment, and the levels of nitric oxide (NO), nitric oxide synthase (NOS), and vasoactive intestinal peptide (VIP) were also measured. Results The treatment group had a significantly better clinical outcome than the control group (P<0.05), and after 2 and 4 weeks of treatment, the treatment group had a significantly higher number of times of SBM than the control group (P<0.05). Both groups had significant improvements in total scores of PAC-QOL and SF-36 after treatment (P<0.05), and the treatment group had significantly greater improvements than the control group (P<0.05). After treatment, the treatment group had significantly greater reductions in NO, NOS, and VIP compared with the control group (P<0.05). Conclusion Acupuncture and moxibustion at four specific acupoints has a good clinical effect in the treatment of elderly functional constipation, possibly by reducing serum NO.