Panax quinquefolium L., a renowned medicinal and edible plant with a long history, was once referred to as "The King of Herbs". Due to its excellent medicinal and nutritional values, it has been developed into a variety of functional products. Polysaccharides are the main bioactive component of Panax quinquefolium L. and have various bioactivities, such as immunomodulation, antioxidant properties, anti-aging benefits, and other biological properties. Due to the distinctive bioactivity of Panax quinquefolium L. polysaccharides (PQPs), the research on PQPs is booming. Although a series of PQPs have been isolated and characterized, the chemical structure and mechanism are unclear and need further study. This article reviewed recent progress in isolation, identification, pharmacological properties, and possible therapeutic mechanisms of PQPs to update awareness of these value-added natural polysaccharides. Additionally, the article discussed the challenges and opportunities facing PQPs in the nutraceutical, pharmaceutical and food sectors and scrutinized its potential development and future research directions. This paper provides comprehensive knowledge and a foundation for further research and application of PQPs as a therapeutic drug and functional food ingredient.