Gene and drug delivery is becoming more and more important in the treatment of complicated human diseases. Proper gene/drug delivery systems can effectively enhance therapeutic efficiency and minimize various side-effects. To date, a variety of delivery systems have been developed. Different from synthetic materials, natural polymers are abundant in nature, renewable, non-toxic, biocompatible and biodegradable. Owing to the presence of positive charges, natural cationic polymers have found important applications in many biological fields, such as drug/gene delivery and tissue engineering. In gene delivery, natural cationic polymers can condense nucleic acids, protect them from degradation, lower the immunogenicity and improve overall transfection efficiency. In drug delivery, cationic functional groups can alter the amphiphilic properties of the polymers to ensure their suitable applications for delivering hydrophobic or protein drugs. After simple chemical modification, the derivatives of natural cationic polymers show improved performance as functional delivery carriers. In this chapter, details on the chemical modification of natural cationic polymers and their applications in gene/drug delivery is discussed.