Objective To explore the clinical effect of Modified Ma Huang Decoction and autologous blood therapy in the treatment of cold urticaria. Methods A total of 82 patients with cold urticaria from January 2023 to October 2025 admitted to Bijiang District People's Hospital in Tongren City were randomly divided into both groups. The control group (n=41) was used Levocetirizine therapy, while the study group (n=41) was used Modified Ma Huang Decoction and autologous blood therapy on the basis of the control group. The clinical efficacy, number of wheals, degree of itching, TCM syndrome score, and quality of life were compared in both groups. Results In the total effective rate, in comparison of the control group 80.49%, the study group 97.56% was higher (P<0.05). After treatment, in comparison of the control group, the number of wheals and itching severity scores in the study group were lower (P<0.05). After treatment, in comparison of the control group, the scores of unbearable itching, pale complexion, shortness of breath and fatigue in the study group were lower (P<0.05). After treatment, in comparison of the control group, the impact scores of symptoms and conditions, daily activities, interaction with others, work and study, sleep, and treatment in the study group were lower (P<0.05). Conclusion The combination treatment of Modified Ma Huang Decoction and autologous blood therapy can improve the clinical efficacy of patients with cold type urticaria, alleviate TCM symptoms, improve wheals and itching, and enhance their quality of life.