As China’s economy booms, increasing water use has significantly affected hydro-geomorphic processes and thus the ecology of surface waters. A large variety of hydrological changes arising from human activities such as reservoir construction and management, water abstraction, water diversion and agricultural land expansion have been sustained throughout China. Using the global scale hydrological and water use model WaterGAP, natural and anthropogenically altered flow conditions are calculated, taking into account flow alterations due to human water consumption and 580 large reservoirs. The impacts resulting from water consumption and reservoirs have been analyzed separately. A modified “Indicators of Hydrologic Alteration” approach is used to describe the human pressures on aquatic ecosystems due to anthropogenic alterations in river flow regimes. The changes in long-term average river discharge, average monthly mean discharge and coefficients of variation of monthly river discharges under natural and impacted conditions are compared and analyzed. The indicators show very significant alterations of natural river flow regimes in a large part of northern China and only minor alterations in most of southern China. The detected large alterations in long-term average river discharge, the seasonality of flows and the inter-annual variability in the northern half of China are very likely to have caused significant ecological impacts.