Objective To investigate the clinical efficacy of external application of Wanhua oil combined with physical therapy for arteriovenous fistula hematoma in hemodialysis patients with chronic renal failure. Methods Ninety-six hemodialysis patients with chronic renal failure and arteriovenous fistula hematoma were randomly and equally divided into control group and treatment group. The control group was given physical therapy including ice application, heat application, and infrared radiation, while the treatment group was treated with Wanhua oil in addition to the physical therapy. The two groups received treatment until hematoma disappeared. The resolution of hematoma after 3 days of treatment, hematoma local pain score, and incidence of complications at 6 months after treatment were compared between the two groups. Results The treatment group had significantly better outcomes in resolution of hematoma than the control group (P<0.05). The local pain due to fistula hematoma in both groups were significantly reduced after treatment (P<0.05), while the treatment group had a significantly larger decrease in pain score after treatment than the control group (P<0.05). After 6 months of follow-up, patients in the treatment group had significantly lower incidence rates of fistula blood deficiency, phlebitis, fistula stenosis, and thrombosis than those in the control group (P<0.05). Conclusion External application of Wanhua oil combined with physical therapy can promote the resolution of arteriovenous fistula hematoma, relieve local pain, and reduce the incidence of complications in hemodialysis patients.