Traditional Chinese Medicine Constitution (TCMC) provides valuable insights into an individual’s physical, mental, and overall health profile. Gaining a deeper understanding of TCMC types and their influencing factors may help promote health and prevent disease. While previous cross-sectional studies have identified common characteristics of TCMC and their associated factors, there remains a lack of longitudinal research tracking these changes over time. This follow-up study aimed to investigate how TCMC types evolve and identify the factors influencing their development from baseline to a 4-year follow-up. A cohort of Chinese women in Hong Kong participated in the study, with their TCMC profiles and associated variables assessed at both time points. Of the 249 participants, 81.5% had unbalanced constitutions. Most of the unbalanced constitution types showed a significant increase over time. Stepwise logistic regression showed that poor health conditions (OR = 1.37–2.56), negative effects on body-mind health (OR = 2.70–4.06), and negative emotions (OR = 2.57) were positively associated with specific types of unbalanced TCMC. Conversely, advancing age (OR = 0.91–0.93), consistent physical activity (OR = 0.71), habitual use of TCM practices (OR = 0.12), and menopause (OR = 0.37–0.39) were negatively associated with some types of unbalanced constitution. These findings suggest that various factors can contribute to imbalances in TCMC, while regular exercise and habitual use of TCM practices may help maintain a balanced constitution.
