Herpes zoster scabs seem to be crawling because the virus damages the patient’s sensory nerve endings, resulting in peripheral nerve sensory sensitization. 1. Crawling sensation is a neuropathic change caused by herpes zoster, which occurs mainly by nerve sensitization and afferent nerve block. 2. When nerve endings are locally damaged, injury receptors (sensory nerve-mediated pain) become more sensitive, resulting in ongoing nerve impulse episodes and hyperexcitability called peripheral sensory sensitization. 3. When the injury receptor issues impulses for a prolonged period of time, it increases afferent stimulation of the spinal cord dorsal horn neurons and enlarges the receiving area of the dorsal horn neurons, resulting in central sensitization, which manifests itself as sensory abnormalities and sensitivity. 4. In addition, herpes zoster is often associated with persistent insect bite pain, because in the presence of afferent nerve block, there is spontaneous activity of the central nerves, resulting in persistent pain in the patient. Central sensitization is usually self-limiting, but can be permanent. The presence of insect crawling sensation after the scabbing of herpes zoster should be treated in a timely manner at a regular hospital to avoid delays.