Atractylodis Macrocephalae Rhizoma(Baizhu), the dried rhizome of Atractylodes macrocephala in the Compositae family, was first recorded in the Shen Nong's Materia Medica(Shen Nong Ben Cao Jing). It is warm in nature, sweet and bitter in taste, and belongs to the spleen and stomach meridians. Baizhu exerts effects of strengthening the spleen and benefiting Qi, drying dampness and promoting diuresis. As a core drug in the traditional Chinese medicine(TCM) theory of "strengthening the spleen and regulating the bowels", its mechanism in treating constipation goes beyond the traditional single perspective of "strengthening the spleen and moistening the intestines", reflecting instead a systematic regulation of intestinal homeostasis. TCM holds that Baizhu tonifies the middle energizer and regulates Qi movement, restoring the physiological function of "the spleen governing the transportation of body fluids for the stomach", thereby fundamentally resolving intestinal transmission disorders caused by spleen deficiency, Qi stagnation, and body fluid imbalance. Modern research has confirmed that the main active components of Baizhu include volatile oils, polysaccharides, and lactones. Its mechanism in treating constipation exhibits multi-target synergy: regulating intestinal flora diversity, promoting the synthesis of short-chain fatty acids(SCFAs), and enhancing intestinal mucosal barrier function; activating the 5-hydroxytryptamine receptor 4(5-HT4) pathway of interstitial cells of Cajal(ICC) in the intestinal nerve plexus, enhancing the rhythmic contraction of intestinal smooth muscle, and significantly improving intestinal motility; protecting the intestinal mucosal barrier and promoting mucus secretion; regulating the expression of aquaporins(AQPs) and increasing fecal water content. In compound prescriptions, Baizhu exerts synergistic and enhancing effects guided by the clinical application: combined with Yin-nourishing drugs, it can enhance mucus secretion; combined with Qi-moving drugs, it can improve intestinal mechanical motility, forming a formula strategy that treats both symptoms and root causes. This article systematically analyzes the integrated effects of Baizhu on constipation from a three-dimensional perspective of "components-mechanisms-compatibility", providing new insights for developing precise therapies for constipation based on Baizhu, and demonstrating the application value of TCM in modern chronic disease management.