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The autonomic nervous system (ANS) is a vital component of the peripheral nervous system that regulates involuntary physiological processes, including heart rate, blood pressure, respiration, digestion, and sexual arousal. The ANS is traditionally divided into the sympathetic and parasympathetic divisions, with a complementary role from the enteric nervous system. This article provides a comprehensive review of the anatomical structure, functional roles, neurochemical mediators, and clinical relevance of the ANS. Emerging insights into its plasticity and interactions with the immune system and microbiome highlight the evolving understanding of autonomic regulation. Additionally, the article explores disorders associated with autonomic dysfunction and discusses current therapeutic approaches.