Recently a series of triterpenoids were isolated from ganoderma spores and have drawn the attention of chemists and pharmacists. The aim of this review is to summarize the triterpenoids and their bioactivities of ganoderma spores. The chemical and biological literatures of ganoderma spores dealing with the structural analysis and bioactivity assay were selected. Triterpenoids isolated from ganoderma spores showed significantly anti-HIV-1 protease, anti-tumor, and anti-complement activities. Triterpenoids are the main active constituents of ganoderma spores and show various bioactivities for its medicinal use. In addition, biological activities of ganoderma spores still need further assessment before they can be accepted not only by the traditional Asian medicine community, but also by western science and medicine.