Schistosomiasis is closely related to natural environmental factors. The changes of environmental factors, such as temperature, hydrology, vegetation, soil etc., all impact the scope and extent of schistosomiasis transmission. Poyang Lake is the largest freshwater lake and one of the major endemic areas with schistosomiasis in China. With global warming, the implementation of the Three Gorges Dam operation, and the Poyang Lake Ecological Economic Planning, the natural environment in Poyang Lake area has been and will continue to change, especially, the water environment and climate environment, which are more closely related to the schistosomiasis transmission. These changes, to some extent, have affected and will continue to affect the prevalence and transmission of schistosomiasis. This article reviews the relationship between the natural environment and its changes and schistosomiasis transmission in the Poyang Lake region.