China is one of a few countries in the world where karst is intensively developed and karst water is heavily utilized as water supply sources. Shanxi is such a Province with the largest karst distribution in places in Northern China, where 19 large karst springs and their catchments are identified to provide important sources of the water supply and ecosystem functioning in Shanxi. Over the years, many problems associated with utilization of karst springs in Shanxi cropped out, including the decrease in spring flow, decline of groundwater level, groundwater contamination and pollution, etc., which severely restrict the sustainable utilization of karst water resources in Shanxi. Through the retrieval and analysis of some 200 local and international publications, this paper critically reviews the research results of karst springs in the region from the perspective of spring flow trend, precipitation recharge and time-lag, evaluation of karst water resources, water chemistry and environmental isotopes with purposing assession, and further evaluates the integrity of the aquifer system including vulnerability, impacts of coal mining and engineering activities on karst groundwater, delineation of spring catchment sub-systems, protection and management measures. It is concluded that human activities and climate change are the primary and secondary factors negatively affecting karst springs, respectively. The impacts of human activities on karst springs are mainly facilitated by intensive development of karst water, mining drainage, engineering construction and other activities. While karst water in parts of Shanxi spring catchments is polluted to various degrees, hence it is recommended to mainstream the protection of karst spring water in the areas of strategic importance. This paper will contribute towards the establishment of sustainable development and utilization of karst water in Shanxi and even in Northern China.