Objective To investigate the effect of modiffed Mahuang decoction combined with autohemotherapy on wheal number and pruritus degree in patients with cold urticaria. Methods A total of 82 patients with cold urticaria admitted to Bijiang District People’s Hospital from January 2023 to October 2025 were selected, and they were divided into the reference group (n=41) and the study group (n=41) by the random number table method. The reference group was treated with levocetirizine hydrochloride, and the study group was treated with modiffed Mahuang decoction combined with autohemotherapy on the basis of the reference group. The clinical efffcacy, wheal count, pruritus degree, TCM syndrome scores and quality of life were compared between the two groups. Results The total effective rate of treatment in the study group was 97.56%, which was higher than 80.49% in the reference group (P<0.05). After treatment, the scores of wheal number and pruritus degree in the study group were lower than those in the reference group (P<0.05). After treatment, the scores of intolerable pruritus, pale complexion, shortness of breath and fatigue in the study group were lower than those in the reference group (P<0.05). After treatment, the scores of symptoms and conditions, daily activities, getting along with others, work and study, sleep, and treatment impact in the study group were lower than those in the reference group (P<0.05). Conclusion Modiffed Mahuang decoction combined with autohemotherapy can improve the clinical efffcacy of patients with cold urticaria, reduce TCM syndrome scores, relieve wheals and pruritus, and improve quality of life.