Objective To investigate the effects of Baduanjin combined with Five-Element Music Therapy on gastric motility in patients with chronic gastritis of spleen-stomach deficiency cold type, and to construct an influencing factors model. Methods A total of 80 patients with spleen-stomach deficiency cold type chronic gastritis admitted in the past three years were randomly assigned to the control group (n=40) and the observation group (n=40). The control group received conventional medication and health education, while the observation group additionally underwent standardized Baduanjin and Five-Element Music Therapy for 12 weeks. Clinical symptom scores, gastric motility parameters, TCM syndrome scores, psychological status, and quality of life were compared between the two groups. Multivariate Logistic regression was used to identify key influencing factors, and a mediation analysis (partial least squares–based path modeling) was conducted to explore the pathway linking psychological status, TCM syndrome improvement, and gastric motility recovery. Results After intervention, the observation group showed greater reductions in symptom scores compared with the control group (P<0.05). Gastric emptying time was significantly shortened, gastric electrical rhythm and antral contraction frequency were improved (All P <0.05). TCM syndrome scores decreased markedly, self-rating anxiety scale(SAS) and self-rating depression scale(SDS) scores declined, and 36-item short form health survey(SF-36) scores increased in the observation group, all with significant differences (All P <0.05). The total effective rate was 92.50% in the observation group versus 75.00% in the control group (P<0.05). No significant difference in adverse events was observed between groups (P>0.05). Logistic regression identified disease duration, compliance, and psychological status as major influencing factors. Mediation analysis revealed that psychological status exerted a significant indirect effect on gastric motility recovery through TCM syndrome improvement, forming a stable “psychological status → TCM syndrome improvement → gastric motility recovery” pathway. Conclusion Baduanjin combined with Five-Element Music Therapy effectively improves clinical symptoms, promotes gastric motility, and enhances psychological status and quality of life in patients with chronic gastritis of spleen-stomach deficiency cold type. Treatment efficacy is strongly influenced by compliance and psychological status.