North China is one of the major breadbaskets in China and is critical in ensuring food security of the nation. It sustained 18% of national total arable land, and 23% of national total grain crop output using only 6% of national total water resources. However, such impressive accomplishments were achieved at huge costs incurred in resources, environment, and ecosystem. We first presented accomplishments, current situations, and main challenges facing agriculture and water use in North China. Then, using an integrated framework in agricultural water management widely adopted by international water research communities, we reviewed the trajectory of agricultural development and its associated water withdrawal, water use efficiencies, and productivities in North China from 1998 to 2015, from which some major experiences and lessons were derived. We then tentatively proposed policy and strategy pathways to ensure food security in North China in the future.