Introduction: This retrospective comparative effectiveness cohort study aimed to investigate the association between warm needle acupuncture (electrothermal acupuncture) combined with conventional rehabilitation training and clinical symptoms, functional recovery, and quality of life (QoL) in patients with lumbar disc herniation (LDH), compared with conventional rehabilitation training alone. Material and Method: This study was a retrospective, non-randomized, preference-based controlled retrospective cohort. A total of 200 patients diagnosed with LDH and undergoing microdiscectomy were included. Patients were assigned to groups based on their treatment preferences and clinical treatment plans (non-random allocation). The observation group (warming acupuncture group, n = 125) received warming acupuncture combined with conventional rehabilitation training, whereas the control group (conventional rehabilitation training alone, n = 75) received conventional rehabilitation training alone. There was no difference in the surgical procedure between the two groups. This study adopted a blinded outcome assessment and statistical analysis (outcome assessors and statisticians were blinded). The Japanese Orthopaedic Association (JOA) scores, visual analog scale (VAS), Generic QoL Inventory-74 (GQOLI-74), and clinical response before and after treatment were assessed. Result: After treatment, the JOA scores of patients in both groups were significantly improved, and the increase in the observation group was significantly greater than that in the control group. The VAS scores of patients in both groups were significantly reduced, and the VAS score of the observation group was significantly lower than that of the control group. The scores of all items in the observation group (especially in terms of improvement in physiological and psychological functions) were significantly higher than those in the control group. The treatment response rate in the observation group was 96.8%, significantly higher than the 84% in the control group (P < 0.05). Conclusion: Warming acupuncture combined with conventional rehabilitation training demonstrated more significant improvements in alleviating clinical symptoms, reducing pain, promoting functional recovery, and enhancing quality of life in patients with LDH, suggesting it may be superior to conventional rehabilitation training alone. However, this study has a limitation: The non-randomized allocation based on patient treatment preferences or clinical policies may introduce selection bias and indication bias, which should be considered when interpreting the results.