The fresh groundwater in the Loess Plateau serves as a major source of water required for the production and livelihood of local residents and is greatly significant for regional economic and social development and ecological protection. This paper analyzes the hydrogeological conditions and groundwater characteristics in the Loess Plateau, expatiates on the types and distribution characteristics of the fresh groundwater in the plateau, and analyzes the influencing factors and mechanisms in the formation of the fresh groundwater in the plateau as a priority. Based on this, it summarizes the impacts of human activities and climatic change on the regional fresh groundwater. The groundwater in Loess Plateau features uneven temporal-spatial distribution, with the distribution space of the fresh groundwater closely relating to precipitation. The groundwater shows a distinct zoning pattern of hydrochemical types. It is fresh water in shallow parts and is salt water in deep parts overall, while the fresh water of exploration value is distributed only in a small range. The storage space and migration pathways of fresh groundwater in the loess area feature dual voids, vertical multilayers, variable structure, poor renewability, complex recharge processes, and distinct spatial differences. In general, the total dissolved solids (TDS) of the same type of groundwater tends to gradually increase from recharge areas to discharge areas. Conditions favorable for the formation of fresh groundwater in loess tablelands include the low content of soluble salts in strata, weak evaporation, and special hydrodynamic conditions. Owing to climate change and human activities, the resource quantity of regional fresh water tends to decrease overall, and the groundwater dynamic field and the recharge-discharge relationships between groundwater and surface water have changed in local areas. Human activities have a small impact on the water quality but slightly affect the water quantity of the groundwater in loess.