The elemental composition of medicinal materials (MMs) is directly linked to their therapeutic efficacy and clinical safety, making the development of accurate, efficient, and green analytical strategies of elements critically important. This review systematically evaluates recent methodological advancements in elemental analysis (covering both essential elements and toxic heavy metals) in MMs. Firstly, it highlights innovations in green sample pretreatment technologies, including efficient digestion or extraction techniques. Secondly, it comprehensively compares the performance and application scenarios of various analytical techniques, each offering distinct advantages in sensitivity, multi-element analysis capability, and on-site applicability. Subsequently, the review examined the potential influence of elements on the pharmacological activity of MMs and the migration patterns of various elements in the “soil-medicinal plant” system. Finally, it systematically elaborates on precise health risk assessment models, emphasizing the necessity of shifting from total content analysis to a risk-oriented evaluation paradigm. This review aims to provide a comprehensive reference for the development of green analytical methods, risk assessment, as well as quality and safety control of MMs.