Fermented pastes are some of the most popular traditional products in China. Many studies reported a strong possibility that fermented pastes promote exposure to mycotoxins, including aflatoxins, ochratoxins, and cereulide, which were proven to be carcinogenic and neurotoxic to humans. The primary mechanism of pathogenicity is by inhibiting protein synthesis and inducing oxidative stress using cytochrome P450 (CYP) enzymes. The level of mycotoxin production is dependent on the pre-harvest or post-harvest stage. It is possible to implement methods to control mycotoxins by using appropriate antagonistic microorganisms, such as Aspergillus niger, Lactobacillus plantarum, and Saccharomyces cerevisiae isolated from ordinary foods. Also, drying products as soon as possible to avoid condensation or moisture absorption in order to reduce the water activity to lower than 0.82 during storage is also effective. Furthermore, organic acid treatment during the soaking process reduces toxins by more than 90%. Some novel detection technologies based on magnetic adsorption, aptamer probes, and molecular-based methods were applied to rapidly and accurately detect mycotoxins in fermented pastes.