Abstract: The key problem in the management of the Yellow River stems from its distinct characteristic, namely the insufficient runoff and excessive sediment loads lacking sufficient coordination, which causes complexity and difficulty in management. This paper examines the changes in runoff and sediment loads of this river and its characteristics of fluvial process in recent decades, based on a review of its management history. Then, we describe a strategic thinking of river management that would be effective in the existing water and sediment condition of the river to cope with its various new features, such as sharp decline in runoff and sediment loads, river channel shrinkage, intensified ‘secondary suspended river’, and increasingly prominent contradiction between floodplain reclamation and river harnessing. Our strategy in managing the Yellow River is to regulate its relation between water and sediment and improve the lower channel, under which several engineering measures should be adopted: construct a river regulation system for water and sediment control, reconstruct and maintain the primary channel with sufficient water and sediment transport capacity, lower the Tongguan elevation in the middle reach, improve the river channel in the lower reach, and stabilize the flow paths in the river mouth. The strategy and measures would provide a useful support for comprehensive management of the Yellow River.