Meliaceae are widely distributed across the world in tropical or subtropical climates and are of considerable ethnobotanical importance as sources of traditional medicine and cosmetics. This comprehensive review summarizes the ethnobotanical uses and chemistry of 12 South African species, belonging to six genera: Ekebergia, Nymania, Entandrophragma, Pseudobersama, Trichilia, and Turraea. Eight of the species have ethnomedicinal records, classified into 17 major disease categories. The ethnomedicinal uses comprise 85 ailments dominated by gastrointestinal complaints, followed by gynaecological and obstetrics related problems. Chemical records were found for 10 species, which describe nine classes of compounds. In nearly all South African Meliaceae, limonoids are the predominant constituents while triterpenes, sterols, and coumarins are also common. The widest range of use-records and medicinal applications are found with the two most chemically diverse species, Ekebergiacapensis and Trichiliaemetica. Of the chemical compounds identified in the various plant organs of the 10 species of South African Meliaceae for which data are available, 42% was found in bark and 17% in seeds. Roots represent 35% and bark 33% of the organs that are used medicinally, and they are typically prepared as decoctions or infusions. Root and bark harvesting are destructive so that it may be important to examine the chemistry of plant parts such as wild-crafted leaves and fruits.