Abstract: OBJECTIVE To review anti-inflammatory effects of betulinic acid and the mechanisms. METHODS Literature about anti-inflammatory effects of betulinic acid was summarized and the pathways and mechanisms were analyzed. RESULTS Betulinic acid had significant anti-inflammatory effects on experimental inflammatory models and other models. The anti-inflammatory mechanisms involved glucocorticoid receptor, nitric oxide, oxidative stress, immune regulation, cytokines, adhesion molecules and inflammatory signaling pathways. In addition, betulinic acid could perform synergistic anti- inflammatory action with other natural products. CONCLUSION Betulinic acid exerts anti-inflammatory effects through multiple pathways. Studies on the anti-inflammatory activities of betulinic acid have important significance for the mechanism of its therapeutic effects.