Abstract: Elderly acute myeloid leukemia (AML) is a syndrome with root deficiency and symptom excess, and its pathogenesis encompasses four elements: deficiency, heat, toxicity, and stasis. This paper argues that marrow deficiency is the pathological basis for the invasion of bone marrow by pathogenic factors, marrow toxicity is the root cause of AML development, stasis and toxicity are intermediate links in the dynamic evolution of AML, and the rise and fall of heat and toxicity are key to the transformation of AML syndromes. An individualized stratified and staged treatment strategy for elderly AML patients using traditional Chinese medicine (TCM) is proposed. During chemotherapy, when both root deficiency and symptom excess are present, the focus is on protecting the spleen and stomach; during the bone marrow suppression phase, when qi and blood are deficient, the focus is on replenishing essence and generating marrow; during the bone marrow recovery phase, when marrow is deficient and pathogenic factors are latent, the focus is on strengthening healthy qi and clearing residual pathogens. Key points for clinical differentiation and treatment of elderly AML include: differentiating yin and yang, clarifying deficiency and excess, and nourishing and clearing the marrow; differentiating stages and clarifying strata, combining TCM and Western medicine; differentiating the five zang organs, clarifying the disease location, and considering multiple organs; differentiating concomitant symptoms, clarifying primary and secondary aspects, and employing multiple methods. This aims to enrich and improve the individualized stratified TCM treatment strategy for elderly AML, providing guidance for the TCM differentiation and treatment of elderly AML.