Engineering sediment design is a common technical challenge faced by the water conservancy hubs in sediment-laden rivers worldwide. As a typical reservoir in the sediment-laden river, the Guxian Water Conservancy Project is a milestone project in improving the Yellow River water and sediment regulation system and implementing the national strategy of ecological protection and high-quality development of the Yellow River Basin. Proper handling of engineering sediment issues is crucial for the project development. On the basis of in-depth analysis of the design and regulation experiences from existing water conservancy projects in sediment-laden rivers such as Sanmenxia and Xiaolangdi Reservoir, this study focuses on the characteristics and changing trend of the incoming water and sediment of the Guxian Water Conservancy. In response to the design requirements in engineering sediment design, including the coupling design of long-term water and sediment series, active control of sedimentation morphology, and dynamic resilience maintenance of effective reservoir capacities, dynamic regulation is used as the guide of engineering sediment design. And several key technologies are developed, including the design of sediment-discharge bottom holes with ultra-deep and ultra-large discharge capacities, design of dynamic sediment erosion base level and capacity, coupling design between three sediment deposition patterns and dynamic storage capacity, and operation mode of storing clean water and regulating muddy flow. A water-sediment co-treatment technology system for sediment-laden rivers that features morphology control, process regulation, and dynamic response is formed. Moreover, the adaptability of Guxian Water Conservancy is improved to the extreme incoming water and sediment combinations, which is of great significance for enhancing the water-sediment regulation and water resource storage capacities of the Yellow River, and achieving the long-term stability in the lower reach of the Yellow River. Meanwhile, it provides a new technological paradigm for the treatment of engineering sediment problems in reservoirs of sediment-laden river.