The upstream area of the Yellow River Basin in Qinghai Province is an important component of the national ecological barrier and the “water tower” of China, and a priority area for ecological protection. In this article, a set of relevant studies on land use pattern and process in this area over the past 40 years were reviewed, and the article comprehensively analyzed the current status, changes, and effects of land use and made policy recommendations. We found that: (1) There is a relatively stable land use pattern with grassland as the absolute dominant land-use type in the upstream area of the Yellow River Basin. An important turning point in land use occurred around 2000. Before then, ecological land such as grasslands, woodlands, and wetlands decreased and resulted in adverse effects such as land degradation, soil erosion, and desertification in the region. After 2000, ecological land and vegetation index increased, the ecosystem gradually changed to a healthier direction, and the carbon sink function is enhanced. (2) The implementation of a series of ecological projects and climate change make land use and its effects extremely complex. On the whole, the total area and degree of land degradation decreased to some extent, with grazing resources and livestock population largely balanced. The cultivated land area of the Yellow River-Huangshui River valley in the east has been decreasing, and agricultural intensification has increased significantly with the planting structure gradually optimized. Local deterioration is still severe, especially that soil erosion intensified in the freezing-thawing zone in alpine regions. (3) In the future, it is necessary to further research on the mechanism of ecological effects of land use, the contribution of environmental effects of ecological engineering and natural factors, and ecological service value to better understand the human-environment relationship in this study area.