Horizontal drilling of boreholes using complex-strata drilling and multi-stage reaming technologies has gained greater significance in water investigations, as vertical drilling often fails to fully characterise laterally distributed seepage pathways, weak interlayers, fractures, karst formations, and structurally controlled defects. The review explores the geology, drilling principles, major equipment systems, fluid and cuttings transport systems, borehole stability problems, and multi-stage reaming techniques for constructing horizontal boreholes in complex strata. Close consideration is given to the interplay among lithological heterogeneity, structural discontinuities, groundwater conditions, and operational parameters on drilling performance and borehole quality. The discussion demonstrates that multi-stage reaming is not merely a borehole enlargement process but a formation-adaptive design process to enhance the ultimate usability of the borehole and minimise the risk of instability throughout construction. Common engineering uses in the foundations of dams, reservoir banks, underground hydraulic structures, and post-treatment checking are also covered, along with evaluation criteria that include trajectory control, wall integrity, process stability, and reliability of the investigation. The review also lists existing constraints, such as a lack of standardisation, a lack of integration between geology and drilling control, and excessive reliance on experience-based design in heterogeneous formations. The further development should focus on intelligent drilling, real-time interpretation of responses, process optimisation using digital twins, and integrated investigation systems. The article is systematically presented as a source for the development of horizontal-borehole construction and staged-enlargement technologies in more challenging landscapes in water-conservancy engineering.