To analyze the effect of Jianpi Huazhuo ointment on protein-energy wasting in hemodialysis patients based on amino acid and carnitine metabolism. Methods 164 cases of end stage renal disease with protein-energy wasting (PEW) patients from Jul. 2018 to Jul. 2020 in our hospital were randomly divided into control group and observation group, with 82 cases in each group. The control group was treated with basic treatment, and the observation group was treated with Jianpi Huazhuo ointment, additionally. They were treated for 16 weeks. Before and after treatment, the scores of MQSGA and TCM syndrome were compared between the two groups, biochemical indexes and anthropometric indexes were detected. Amino acid spectrum and carnitine spectrum were measured by UHPLC/MS/MS, and adverse reactions were observed. 〖WTHZ〗Results Before treatment, all indexes of two groups showed no significant difference (P＞0.05). After treatment, the MQSGA score and TCM syndrome scores (less food, nausea and vomiting, limb sleepiness, abdominal distension, mouth greasy) of the two groups were significantly decreased (P＜0.05), and the above scores of the observation group were significantly lower than those of the control group (P＜0.05). The albumin, hemoglobin, transferrin, lean body weight, triceps skinfold (TSF), upper arm muscle circumference and lifting force of the two groups were significantly improved, and observation group were significantly higher than those of the control group (P＜0.05). There was no significant difference in total cholesterol and triglyceride between the two groups before and after treatment (P＞0.05). The arginine, valine, methionine, total amino acids, essential amino acids and branched chain amino acids of the two groups were significantly increased, and the above indexes of the observation group were significantly higher than those of the control group (P＜0.05). Serum free carnitine and total carnitine in the two groups were significantly increased, and the observation group was significantly higher than the control group (P＜0.05). The ratio of ester acyl carnitine / free carnitine decreased significantly in both groups, and the observation group was significantly lower than the control group (P＜0.05). The blood calcium in the observation group was significantly higher than that in the control group, and the blood phosphorus was significantly lower than that in the control group (P＜0.05). No serious adverse reactions occurred. Conclusion Jianpi Huazhuo ointment can significantly improve PEW symptoms of dialysis patients, improve malnutrition, and increase plasma amino acid and carnitine content. It is safe and effective, and worthy of clinical promotion.