The Astragalus polysaccharides (APS) are important bioactive components of Astragali Radix, the dry root of Astragalus membranaceus, which has been used in traditional Chinese medicine. In this review, the extraction conditions and extraction rates of APS are first compared for water, microwave-assisted, ultrasonic wave, and enzymatic hydrolysis extraction methods. Some studies have also shown that different methods can be combined to improve the extraction rate of APS. Subsequently, the chemical composition and structure of APS are discussed, as related to the extraction and purification method. Most studies have shown that APS is mainly composed of glucose, in addition to rhamnose, galactose, arabinose, xylose, mannose, glucuronic acid, and galacturonic acid. We also reviewed studies on the modification of APS using chemical methods, including sulfated modification using the chlorosulfonic acid–pyridine method, which is commonly used for chemical modification of APS. Finally, the pharmacological activities and mechanisms of action of APS are summarized, with a special focus on its immunoregulatory, antitumor, anti-inflammatory, and antiviral effects. This review will serve as a valuable resource for the research on APS.