Abstract: The efficiency of wound repair and the function of regenerated tissue are governed by the precise regulation of the wound microenvironment. At the physiological level, wounds undergo intricate cascades of signaling events, including persistent amplification of inflammation, remodeling of cytokine networks, disruption of redox homeostasis, and succession of microbial communities. The spatiotemporal dynamics of these signals directly determine the course and quality of wound repair. At the physical level, impaired exudate management, compromised microbial barriers, stress concentration at wound edges, and local thermal imbalance further exacerbate tissue injury and delay wound repair. Conventional wound therapies often fail to address the individualized features and dynamic pathological changes of wounds, underscoring the urgent need for a new generation of intelligent dressings capable of real-time sensing pathological signals and adaptive modulation of the wound microenvironment. Natural polysaccharides, characterised by their structural diversity and modifiability, provide a versatile design space for constructing multifunctional hydrogels. The integration of these platforms with exogenous stimulus-responsive platforms further expands the functional potential of wound dressings. This article systematically reviews the latest advances in precise regulation of wound microenvironment by natural polysaccharide hydrogels, focusing on the intelligent response mechanisms to physiological microenvironment and the functional design strategies for physical microenvironment. It aims to provide theoretical guidance for the rational design and clinical application of natural polysaccharide hydrogels.