Palms (Arecaceae) are prominent elements in African traditional medicines. It is, however, a challenge to find detailed information on the ritual use of palms, which are an inextricable part of African medicinal and spiritual systems. This work reviews ritual uses of palms within African ethnomedicine. We studied over 200 publications on uses of African palms and found information about ritual uses in 26 of them. At least 12 palm species in sub-Saharan Africa are involved in various ritual practices: Borassus aethiopum, Cocos nucifera, Dypsis canaliculata, D. fibrosa, D. pinnatifrons, Elaeis guineensis, Hyphaene coriacea, H. petersiana, Phoenix reclinata, Raphia farinifera, R. hookeri, and R. vinifera. In some rituals, palms play a central role as sacred objects, for example the seeds accompany oracles and palm leaves are used in offerings. In other cases, palms are added as a support to other powerful ingredients, for example palm oil used as a medium to blend and make coherent the healing mixture. A better understanding of the cultural context of medicinal use of palms is needed in order to obtain a more accurate and complete insight into palm-based traditional medicines.