Poria cocos, Ganoderma lucidum, and Ganoderma sinense, as the famous medicine and food homologous fungal, has been used as traditional Chinese medicine for a long history. Polysaccharide is one of the most important bioactive ingredients of P. cocos and Ganoderma, which possess a wide range of biological activities including immunomodulation, anti-tumor, anti-inflammation, antioxidative stress, modulation of gut microbiota properties, etc. This review systematically recapitulates the recent advances in the extraction and purification methods, structural characterization, biological activities, synthesis of derivates, and potential application of polysaccharides derived from P. cocos and Ganoderma. Therefore, the information provides a reference point for the in-depth development of medicinal value and health functions of medicine and food homologous fungal polysaccharides and their resource utilization.