Dregea sinensis Hemsl is an important herbal medicine in the Dai nationality of China. Its prominent clinical application has generated interest in the polyoxypregnane glycosides of the plant. This paper describes an extension of previous research on the polyoxypregnane di- and triglycosides of D. sinensis, aiming at identifying related tetraglycosides. On the basis of HPLC-ESI-MSn analysis in positive mode, twenty-five previously undescribed polyoxypregnane tetraglycosides were characterized (regarding molecular masses and fragmentation in MSn) from an ethyl acetate fraction that was not previously investigated. Guided by MSn fragmentation and known structures of related di- and triglycosides from D. sinensis, tentative structures were predicted from the MS data. In order to test the predictions, eight of the glycosides were isolated and their structures were elucidated by 1D and 2D NMR methods, confirming the tentative predictions. Finally, the cytotoxicity of the isolates was evaluated on several human cell lines with little effect in general, even though slight inhibitory effects of four polyoxypregnane glycosides were detected at 10 μM against the human leukemia cell line HL-60.