Objective <p>To observe changes in intestinal flora in children with anorexia and the effects of pediatric Tuina (Chinese therapeutic massage) on their intestinal flora, and to explore the relationship between alterations in intestinal flora and anorexia, as well as the therapeutic mechanisms of pediatric Tuina in treating children with anorexia.</p> Methods <p>A total of 60 healthy children who underwent physical examinations were recruited as the blank group. One hundred and twenty children with anorexia were randomly divided into a Tuina group and a medication group, with 60 children in each group, according to the random number table method. The blank group received no intervention; the Tuina group was treated with pediatric Tuina therapy; the medication group was treated with Jian Wei Xiao Shi (stomach-invigorating and digestion-promoting) tablets. Both groups underwent continuous treatment for 7 d as one course, with a 1-day rest period between courses, for a total of 4 courses. Fecal samples were collected from the three groups. The intestinal flora was detected using the 16S rDNA method.</p> Results <p>Before treatment, compared to the blank group, the abundance of <i>Firmicutes</i> in the Tuina and medication groups was significantly lower (<i>P</i>&lt;0.05). After treatment, the abundance of <i>Firmicutes</i> in the Tuina group was significantly increased compared to before treatment (<i>P</i>&lt;0.05), with no significant difference compared to the blank group (<i>P</i>&gt;0.05); in the medication group, there was a trend of increased abundance of <i>Firmicutes</i>, but there was no significant difference compared to that before treatment in the same group (<i>P</i>&gt;0.05), and the difference compared to the blank group remained significant (<i>P</i>&lt;0.05). Before treatment, compared to the blank group, the abundance of <i>Faecalibacterium prausnitzii</i> (<i>F. prausnitzii</i>) in the Tuina and medication groups was significantly lower (<i>P</i>&lt;0.05). After treatment, the abundance of <i>F. prausnitzii</i> in the Tuina group was significantly increased compared to before treatment (<i>P</i>&lt;0.05), with no significant difference compared to the blank group (<i>P</i>&gt;0.05); in the medication group, there was a trend of increased abundance of <i>F. prausnitzii</i>, but no significant difference was showed compared to before treatment in the same group (<i>P</i>&gt;0.05), and the differences compared to the blank and Tuina groups were significant (<i>P</i>&lt;0.05). Before treatment, compared to the blank group, the abundance of <i>Eubacterium</i> in the Tuina and medication groups was significantly lower (<i>P</i>&lt;0.05); after treatment, the abundance of <i>Eubacterium</i> in both Tuina and medication groups was significantly increased compared to that before treatment (<i>P</i>&lt;0.05), with no significant difference compared to the blank group (<i>P</i>&gt;0.05). Before treatment, compared to the blank group, the abundance of <i>Roseburia</i> in the Tuina and medication groups was significantly lower (<i>P</i>&lt;0.05); after treatment, the abundance of <i>Roseburia</i> in both Tuina and medication groups was significantly increased compared to that before treatment (<i>P</i>&lt;0.05), with no significant difference compared to the blank group (<i>P</i>&gt;0.05).</p> Conclusion <p>The reduction of beneficial intestinal flora may be involved in the pathogenesis of pediatric anorexia. Pediatric Tuina can promote the recovery of intestinal flora balance by increasing the abundance of beneficial flora.</p>