Abstract: Ichthyotoxins exhibit potent biological activities through specific mechanisms, targeting ion channels, cell membranes, enzymes, and other cellular structures. These molecules impact the nervous, circulatory, and muscular systems, which benefits rapid and efficient predation and defense in fish. This study provides a comprehensive overview of the sources, distribution, components, targets, and detection methods of fish toxins, along with their known applications in the medical field. A comprehensive review of fish toxins enhances our understanding of the natural ecological functions and improve the identification of new toxin-derived pharmacological tools, drug precursors, and new medications, advancing both scientific research and medical applications of fish toxins.