The Yellow River Basin is an important food production area and an ecological challenge for China, where environmental protection and water scarcity are the major constraints. For the upper reaches of the Yellow River Basin, optimizing the adoption of chemicals in agricultural production and integrating crops with livestock are the key strategies for protecting the eco-environment. For dryland agriculture in the middle and upper reaches, this study summarizes four aspects of efficient precipitation techniques in terms of collection, storage, conservation, and use, which have greatly improved crop yields and supported dryland crop production. Irrigated agriculture in the middle and lower reaches is the core area of China’s grain production, where the area under water-saving irrigation reached 13.0 Mha in 2018, greatly improving water use. Compared with 1998, cereal production in 2018 increased by 62.2 Mt under similar total water withdrawals (49.7 billion to 51.6 billion m³), and the annual soil erosion at the Tongguan Hydrological Observatory reduced by 584 million m³ in 2018, achieving great success in environmental protection and efficient water use. The Chinese government has set a goal for the Yellow River Basin to become the national leader in environmental protection and efficient water use by 2035. Such a high demand requires the combined efforts of the whole community, as well as the adoption of new technologies, coordinated basin-wide development, and adequate policy support.