[2] The river flows through the Kamikōchi (上高地, Upper Highlands) valley - designated as one of Japan's National Cultural Assets, on the list of Special Natural Monuments and Special Places of Scenic Beauty.

[3] Water from the upper reaches of Karasawa Cirque flows through Hontani and joins the Azusa River near Yokō.

From here the river continues through Kamikōchi, under Kappa Bridge (河童橋, Kappa bashi), and then flows through Taisho Pond (大正池, Taishō ike), formed in 1915 following the eruption of Mount Yake, an active volcano in the Hida Mountains.

In his 1896 book, Mountaineering and Exploration in the Japanese Alps, the English missionary and mountaineer Walter Weston wrote that the Azusa River was used to power machinery used in sericulture, "The simple machinery for winding off the silk from the cocoons is water powered and gives employment to a score of bright-faced girls, varying from twelve to twenty years of age.

[10] Several weirs, canals, and underground channels draw water from the Azusa River that are used for irrigation, including for wasabi farming in Azumino.