Abstract: The combined effects of cold, arid, and ionic erosion accelerate concrete damage and degradation in the complex environments of western China. Dry–wet cycles increase the rate of ion transport. Under the combined action of freeze–thaw cycles and corrosive ions, weak internal regions such as pores rapidly develop into interconnected cracks. As a result, concrete durability deteriorates sharply, and the damage rate far exceeds that caused by any single factor. Conventional techniques such as grouting and surface repair provide only passive maintenance. They cannot restore the original material performance or fundamentally eliminate the effect of cracking damage on concrete serviceability. In contrast, concrete can be endowed with active, intelligent crack repair capabilities through the use of self-healing materials. These capabilities are realized through physical filling, chemical reactions, or biomineralization, thereby inhibiting damage propagation. Concrete damage arises from the combined effects of inherent material defects and environmental factors. As a multiphase heterogeneous composite, concrete contains weak internal regions such as interfacial transition zones, cement paste, and pores. These regions often exhibit inadequate mechanical properties and bond strength, which act as intrinsic triggers for microcrack initiation. During service, concrete is simultaneously subjected to multiple physicochemical actions, including freeze–thaw cycles, wetting–drying alternations, and aggressive ions. Water, as a transport medium, drives chloride and sulfate ions inward through capillary action under dry–wet cycles, inducing drying-shrinkage and wetting-expansion stresses while accelerating chemical attack. Freeze–thaw cycles enlarge microcracks through repeated frost-heaving stresses generated by phase changes of pore water. Aggressive ions not only chemically decompose the cementitious matrix and destroy the steel passivation film, but also strongly couple with physical processes, forming a positive feedback mechanism in which permeation promotes freeze–thaw damage and cracking accelerates erosion. This multifactor coupling is far more than a simple superposition of individual effects. Instead, nonlinear interactions lead to accelerated material degradation, ultimately causing rapid structural failure and a significant loss of durability. Self-healing materials give concrete the autonomous ability to repair cracks. When cracking occurs, preset healing agents inside the concrete are triggered to react with the hydration products, thereby sealing the cracks, restoring performance, and prolonging structural service life. Self-healing materials are classified into three categories based on their healing mechanisms: physical, chemical, and biological. Physical healing relies mainly on changes in physical state to fill cracks. Fibers restrain crack propagation through bridging effects and provide nucleation sites for hydration products. Shape memory alloys use recovery stresses generated by phase transformations to close cracks, but their high cost limits widespread use. Superabsorbent polymers block cracks by swelling when they absorb water; however, their swelling capacity decreases significantly in arid and saline environments. Chemical healing depends on water-based reactions that generate healing products. Permeable crystalline materials can be repeatedly activated to provide sustained healing, whereas expansive polymer-based healing agents typically enable only a single repair event and lack long-term durability. Biological healing involves microbial metabolism that induces calcium carbonate precipitation. The precipitates bond tightly to the concrete matrix and are environmentally friendly; however, the healing efficiency is constrained by multiple factors, including bacterial activity, carrier performance, mineralization substrates, and environmental conditions. Overall, different self-healing materials exhibit distinct characteristics in triggering conditions, action mechanisms, and environmental adaptability. However, synergistic healing mechanisms and long-term performance in complex environments require further investigation. The focus of this study was on the healing performance of different self-healing materials under various curing environments. Comparative analyses were conducted on their ability to repair cracks of different scales and to adapt to complex environments, thereby providing a basis for material selection under specific service conditions. Because conventional self-healing materials can hardly meet practical engineering requirements under the coupled effects of cold, drought, and ionic erosion, future efforts should concentrate on the following aspects: interaction mechanisms between self-healing materials and concrete, the development of self-healing materials resistant to cold, drought, and ionic erosion, and the construction of composite repair technology systems. Through these endeavors, concrete self-healing materials and technologies suitable for the cold, drought, and ion-erosion environments of western China are expected to be developed.