Hydromorphology is a major component of riverine ecosystems. Therefore, proper assessments of the status quo, as well as the detection of pressures in river basins, are of high relevance. Process-based morphological methods have been developed, relying on a broad data basis and resulting in suitable instruments, such as the Morphological Quality Index (MQI). In this study, the hydromorphological status of the Nanxi river system in Eastern China was assessed by an adapted application of the MQI. Adaptations and amendments in the methodical approach were developed in cycles and carried out to transfer the well-approved method for European river systems to another geographical setting. The strengths of the tested approach are the few data requirements, the applicability for modified river basins, and the decoupling of historical information. The assessment of 161 river kilometers resulted in a hydromorphological status quo with the focus being a relative comparison of different sections ranging from “moderate” to “bad”, with an average classification of a “poor” state. On the one hand, the results build the basis for future restoration and river management planning, specifically, and on the other hand, they create a foundation for the development of an assessment method fitted for modified river systems conditions.