Objective To observe the efficacy of oral Houpo Tongbi decoction combined with pirarubicin intravesical chemotherapy in the treatment of postoperative patients with non-muscle-invasive bladder cancer (NMIBC). Methods Ninety-five NMIBC patients who underwent transurethral resection of bladder tumor (TURBT) in Shanghai General Hospital of Shanghai Jiao Tong University from Jan. 2018 to Dec. 2019 were randomly divided into observation group (n=49) and control group (n=46). The control group only received pirarubicin intravesical chemotherapy, while the observation group received oral Houpo Tongbi decoction combined with pirarubicin intravesical chemotherapy. The total course of treatment was 1 year. All patients were followed up for 1 year. The recurrence, improvement of traditional Chinese medicine (TCM) symptoms, quality of life, urine routine, blood routine, liver and kidney function and adverse events were compared between the 2 groups. Results After 1 year of adjuvant treatment, the recurrence rate in the observation group (18.37%, 9/49) was significantly lower than that in the control group (36.96%, 17/46) (P<0.05). The overall improvement rate of TCM symptoms was significantly higher in the observation group (79.59%, 39/49) than in the control group (41.30%, 19/46) (P<0.05). The quality of life results showed that the emotional function, fatigue, pain, general health status and urinary tract symptom were significantly better in the observation group compared with the control group (all P<0.05). The peripheral white blood cell count and alanine aminotransferase level in the observation group were significantly lower than those in the control group (both P<0.05), and there were no significant differences in other blood routine or liver and kidney function indexes between the 2 groups (all P>0.05). There were no significant differences in the levels of white blood cell or red blood cell in urine (both P>0.05), while the urine protein level of the observation group was significantly lower than that of the control group (P<0.05). During the treatment period, the total incidence of adverse events in the observation group (36.73%, 18/49) was significantly lower than that in the control group (60.87%, 28/46) (P<0.05). Conclusion Houpo Tongbi decoction combined with pirarubicin intravesical chemotherapy can reduce the postoperative recurrence of NMIBC, alleviate TCM symptoms caused by tumor, improve quality of life, and reduce chemotherapy-related adverse events.