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Tripterygium wilfordii Hook.f. has a long history of use in traditional Chinese medicine. The diterpene triepoxide triptolide 1, as the main bioactive constituent of Tripterygium extracts, has been used to treat a variety of autoimmune, inflammation-related conditions and neurodegenerative diseases, and it also displays antiinflammatory activity, antiproliferative and apoptotic effects, antifertility and insecticidal activity. Several synthetic studies and structure-activity relationships (SAR) have been carried out on triptolide as well as others structurally related molecules. This review focused on the biological and pharmacological activities, total syntheses and their structure-activity relationships of triptolide and congeners.