Poria cocos (PC) refers to a fungal species which is also known as "Fuling" in China. For >2000 years, PC has demonstrated its therapeutic values as a kind of traditional medicine. It is believed that the various biological benefits created by PCs highly rely on the Poria cocos polysaccharide (PCP). This review recapitulates the recent progress made in PCP in four aspects: i) the methods of extraction, separation, and purification, ii) structural characterization and identification, iii) the related bioactivities and mechanism of action, and iv) structure-activity relationships. Through discussion about the objective as mentioned above, it can be found out that PCP is categorized into water-soluble polysaccharide (WPCP) and alkaline-soluble polysaccharide (APCP), which are totally different in structure and bioactivity. The structures of WPCP are multiplicity whose backbone can be (1,6)-α-galactan and (1,3)-β-mannoglucan etc. to perform various bioactivities including anti-tumor effect, anti-depressant effect, anti-Alzheimer effect, anti-atherosclerosis effect, hepatoprotection etc. The structures of APCP are much more single with backbone of (1,3)-β-D-glucan and the studies of activity concentrate on anti-tumor effect, anti-inflammatory effect and immunomodulation. Besides, the future opportunities of WPCP are primary structure identification. For APCP, scholars can focus on the conformation of polysaccharide and its relationship with activity.