Abstract：Objective：To observe the effect of three-part tuina combined with auricular point seed-pressing on fatigue and sleep quality in maintenance hemodialysis patients. Methods： A total of 126 maintenance hemodialysis patients treated at Nanyang Central Hospital from January to September 2025 were selected and randomly divided into a combination group and a control group using the random number table method，with 63 cases in each group. The control group received routine care，while the combination group received additional three-part tuina combined with auricular point seed-pressing based on the control group's regimen. Both groups were intervened for four weeks. Changes in scores of the Functional Assessment of Chronic Illness Therapy-Fatigue （FACIT-F） scale， Pittsburgh Sleep Quality Index （PSQI）， Hospital Anxiety and Depression Scale （HADS）， and traditional Chinese medicine syndrome， as well as polysomnography （PSG） parameters [total sleep time （TST）， wake after sleep onset （WASO）， sleep efficiency（ SE），sleep latency（ SL）] were compared between the two groups before and after the intervention. Results： After intervention， FACIT-F scores increased in both groups compared to before intervention， while PSQI scores decreased （P＜0.05）. The combination group had higher FACIT-F scores and lower PSQI scores than the control group （P＜0.05）. HADS scores and traditional Chinese medicine syndrome scores decreased in both groups after intervention （P＜0.05）， with lower scores in the combination group （P＜0.05）. After intervention， TST and SE increased in both groups compared to before intervention （P＜0.05），while WASO and SL decreased （P＜0.05）. The combination group had longer TST and higher SE and shorter WASO and SL than the control group （P＜0.05）. Conclusion：Three-part tuina combined with auricular point seed-pressing effectively improves fatigue，sleep quality and anxiety-depression states，and optimizes sleep structure in maintenance hemodialysis patients.