Lycium barbarum is widely used as a functional food and medicinal herb to promote health and longevity in China and in some other Asian countries. In modern pharmacological and chemical studies, the most valuable and well-researched component of L. barbarum is a group of unique water-soluble glycoconjugates that are collectively termed Lycium barbarum polysaccharides (LBPs). Numerous modern pharmacological studies have revealed that LBPs possess antiaging, antidiabetic, antifibrotic, neuroprotective, and immunomodulation properties, while the immunomodulatory effect is primary and is involved in other activities. However, due to their structural heterogeneity and lack of chromophores, it has long been unclear how LBPs work on the immune system. A few studies have recently provided some insights into the proposed mode of action of LBPs, such as structure-activity relationships, receptor recognition, and gut microbiota modulation of LBPs. This review provides a comprehensive overview of the immunoregulating properties of LBPs and their related mechanisms of action.