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Unlike disease\u2010specific prior works, it identifies BBB dysfunction as a unifying pathological bottleneck in central nervous system (CNS) disorders, offering a cohesive lens to interpret these polysaccharides\u2019 multitarget actions. We synthesize evidence on their structural characteristics and bioactivities, focusing on the regulation of tight junction (TJ) proteins, NVU homeostasis, and key signaling pathways. This synthesis elucidates their potential mechanisms in maintaining NVU homeostasis and modulating BBB permeability. Critical limitations are highlighted, including overreliance on preclinical models and the lack of direct evidence for BBB translocation and causal mechanisms. The review also discusses the therapeutic potential of TCM polysaccharides in preclinical models of stroke, AD, and PD, while evaluating current advances in extraction and purification technologies, pharmacokinetic characterization, and emerging nano\u2010delivery strategies. Despite the promising findings, significant challenges persist\u2014including structural heterogeneity, batch\u2010to\u2010batch variability, insufficient pharmacokinetic data, and substantial translational barriers. 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