With rapid globalization and the increasing demand for traditional Chinese medicines, quality and safety has become a critical priority for both domestic and international markets. However, traditional Chinese medicines are susceptible to contamination by pathogenic microorganisms during the process of cultivation, growth, processing, storage, and transportation, which can lead to mycotoxin contamination that adversely affect the quality and safety of traditional Chinese medicines, and may pose potential threats to human health. This review summarizes mycotoxin contamination, the common detection methods, prevention and control measures, and regulatory recommendations, aiming to provide references for improving the quality standards and ensuring safety of these medications.