Abstract: Under the national strategy of integrating mountains, rivers, forests, fields, lakes, grasslands, and sand with ecological civilization construction, the health of urban river systems is of great significance for improving the quality of the living environment and realizing a healthy China. Taking the urban river system in Nanning City, Guangxi Zhuang Autonomous Region as the research object, based on field research and river and lake health evaluation guidelines, a river health evaluation model, which comprises four major criteria layers and twelve indicator layers, was constructed to evaluate the health of the Nakao River, Liangqing River, and Shajiang River. The results showed significant differences in the health status of the three rivers: the Nakao River scored 94.57, indicating a very healthy state; the Shajiang River scored 83.18, suggesting a healthy state, yet with loopholes in shoreline management and risks of riverbank instability; and the Liangqing River scored 70.12, indicating a sub-optimal health state, primarily attributable to shoreline ecological degradation, water pollution, and habitat destruction. Based on the health status of the three rivers, a micro-renewal strategy is proposed to provide a solution for ecological protection and functional improvement of urban river systems.