Dammarane-type ginsengenins are active metabolites of ginsenosides in body, which have unique pharmacological effects of anti-tumor, antibacterial, anti-inflammatory, and protection of heart and brain system. Structural transformations of ginsengenins have been widely conducted in order to enhance their water solubility, bioavailability, and biological activity, reduce their side effects, and expand their clinical application. In recent years, some progress has been made in the structural transformations and biological activities of dammarane-type ginsengenins. In chemical methods, modification sites are mainly focused on hydroxyl groups of the molecule. Chemical methods included esterification, amidation, and introduction of nitrogen-containing group, etc. Biotransformation method has the characteristics of high specificity, high conversion, and abundant sources of microorganism. In this paper, structural transformations and biological activities of four dammarane-type ginsengenins were reviewed, in order to provide reference for the design, synthesis, further development, and utilization of ginsenogenin derivatives, and for the development and utilization of rich Panax notoginseng resources in Yunnan Province.