IntroductionModified Yaotong Tang (MYT) is used as an adjunctive postoperative herbal decoction in traditional Chinese medicine practice for lumbar disorders, but its association with early recovery after unilateral biportal endoscopy (UBE) and the reproducibility of its clinical preparation remain insufficiently characterized.MethodsThis single-center retrospective comparative cohort study screened 235 patients with symptomatic single-level lumbar disc herniation (LDH) who underwent surgical treatment between September 2022 and September 2025. Of these, 182 met the eligibility criteria, including 122 patients in the primary UBE analytic cohort (62 UBE + MYT and 60 UBE alone) and 60 patients in a transforaminal lumbar interbody fusion cohort retained only as a descriptive external benchmark. The primary UBE comparison was adjusted using inverse probability of treatment weighting (IPTW).ResultsCompared with UBE alone, the UBE + MYT cohort showed lower IPTW-adjusted Visual Analog Scale scores at postoperative day (POD) 3 (3.88 vs. 4.67; mean difference, −0.79; 95% CI, −1.06 to −0.53; P < 0.001) and POD7 (2.85 vs. 3.73; mean difference, −0.88; 95% CI, −1.14 to −0.62; P < 0.001). IPTW-adjusted IL-6 and CRP levels were lower during the first postoperative week, and follow-up Japanese Orthopaedic Association scores were higher in the UBE + MYT cohort. MYT administration was verified using de-identified medical, pharmacy/decoction-room, nursing, and follow-up records. No Clavien-Dindo grade III or higher adverse events were observed.DiscussionPostoperative MYT use was associated with lower early postoperative pain scores, lower inflammatory biomarker levels, and better subsequent functional recovery after UBE for LDH. No severe safety signal was observed, but causality and rare herb-related safety events require prospective validation.