Intestinal health is essential for maintaining systemic physiological balance through nutrient absorption, immune regulation, and host–microbiota interactions. Atractylodes macrocephala (Baizhu), a traditional medicinal plant long used for gastrointestinal dysfunction, has attracted growing interest because its polysaccharides (AMPs) show promises in intestinal disorders. In this review, we summarize preclinical studies on AMPs identified through searches of PubMed, Web of Science, ScienceDirect, Google Scholar and the China National Knowledge Infrastructure (CNKI), focusing on their extraction, purification, structural features and gut-related activities. Experimental evidence suggests that AMPs are metabolized by gut microbiota into short-chain fatty acids and other bioactive metabolites that regulate mucosal immunity, enhance epithelial barrier function and modulate host metabolic pathways. AMPs have been shown to promote the growth of beneficial taxa, restore dysbiotic communities, up-regulate tight junction proteins, suppress intestinal inflammation and modulate gut–brain axis signaling involved in intestinal motility and visceral sensitivity. These actions underlie their protective effects reported in models of irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), colorectal cancer, chemotherapy-induced mucosal injury, and metabolic-associated systemic inflammation. Overall, current data support AMPs as microbiota-modulating, immunomodulatory, epithelial-protective and neuro-regulatory agents with potential as functional food-derived interventions for intestinal health. In this review, we also highlight key limitations and priorities for future research on structure–function relationships and clinical translation.
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