The invention discloses a large-diameter medium-carbon low-alloy wear-resistant steel ball. The large-diameter medium-carbon low-alloy wear-resistant steel ball comprises the following raw materials of, in percentage by weight, 0.4% to 0.5% of C, 0.8% to 1.0% of Cr, 0.5% to 0.7% of Mn, 1.2% to 1.4% of Si, 0.1% to 0.2% of Ni, 0.001% to 0.002% of B, 0.06% to 0.07% of Nb, P less than or equal to 0.05%, S less than or equal to 0.05% and the balance Fe and inevitable impurities. The invention further discloses a preparation method of the large-diameter medium-carbon low-alloy wear-resistant steel ball. The preparation method comprises the following steps that S1, raw materials such as the alloy in the claim 1 or 2 are smelted and cast into a continuous casting billet; and S2, the continuous casting billet is heated and then rolled into a steel ball, air cooling is carried out, then heating and heat preservation are carried out, quenching, tempering and natural cooling are carried out, and the large-diameter medium-carbon low-alloy wear-resistant steel ball is obtained. The steel ball is large in diameter and has good hardness and impact toughness.