Objective To observe the effect of modified Pifu Jiedu decoction in patients with chronic urticaria. Methods A total of 40 patients with chronic urticaria diagnosed and treated in the Department of Dermatology, Suzhou 100 Hospital from April 2024 to March 2025 were selected as the research subjects. According to the random number table method, they were divided into the control group and the study group, with 20 patients in each group. The control group was given oral ebastine tablets, and the study group was given oral modified Pifu Jiedu decoction. The Urticaria Activity Score (UAS), Urticaria Control Test (UCT) and clinical efficacy were compared between the two groups. Results The UAS score in the two groups after treatment was lower than that before treatment, and that in the study group was lower than that in the control group, and the difference was statistically significant (P <0.05). The UCT score in the two groups after treatment was higher than that before treatment, and that in the study group was higher than that in the control group, and the difference was statistically significant (P <0.05). The total effective rate of treatment in the study group was 85.00%, which was higher than 70.00% in the control group, and the difference was statistically significant (P <0.05). Conclusion The oral administration of modified Pifu Jiedu decoction has a definite effect in the treatment of chronic urticaria. It can improve the clinical symptoms of patients, effectively control the condition of urticaria, and is beneficial to promoting the early recovery of patients.