Herpes zoster is known in Chinese medicine as “tangled waist fire dragon” and “tangled waist fire dan”. It is also commonly known as “snake sores” and “spider sores”. It is a long string of blisters on the skin, like a long snake coiled around the body, so Chinese medicine calls it “snake-tan”. Because it often occurs on the back of the chest, distributed along the course of the intercostal nerve, around the waist, tired as pearls, the appearance of a dragon coiled body, so folk also called it “waist wrapped dragon”. The skin of the lesion has a burning, stinging sensation, and after a few days, dense small blisters will appear, the blisters are transparent and clear, crystal clear, the walls of the blisters are tense and shiny, the surrounding skin is red, and the lesion is as painful as a fire burn, so it is commonly known as “fire Dan”. Because of the rapid onset of herpes zoster, the pain is more intense, and at the beginning of the onset of new rash, really like a dragon and snake crawl, some patients will feel afraid. It is also a popular saying that if the “waist wrapping dragon” is wrapped around the waist, it will kill the person, which is not based on science. This disease is caused by the herpes zoster virus, the lesions are often distributed unilaterally along a peripheral nerve, generally not exceeding the midline of the body surface, much less in a circle. In addition to commonly occurring on the lower back and abdomen, they can also occur on the chest, extremities, neck, ears, nose, eyes, and mouth. In a few severe cases, herpes zoster meningoencephalitis and herpes zoster of the gastrointestinal or urinary tract may occur. Moreover, about 30% to 50% of middle-aged and elderly patients may have intractable neuralgia that lasts for several months or longer after the damage has subsided. Herpes zoster neuralgia has similar symptoms to some clinical diseases, how can we make an early and correct diagnosis? A friend once asked me a question about an elderly patient who came in for consultation with unilateral facial pain, and the doctor suspected trigeminal neuralgia, but could not confirm the diagnosis because the patient had shingles. Trigeminal neuralgia occurs in the area of the trigeminal nerve distribution on the head and face, with sudden onset, sudden stop, lightning-like, slash-and-burn, intractable and severe pain, without the appearance of herpes before the onset. Herpes zoster neuralgia, on the other hand, has a clear history of pain that occurs after herpes. The ophthalmic branch of the trigeminal nerve is the most susceptible and can be accompanied by herpes of the cornea. Here I would like to share my experience with you: first of all, atypical clinical symptoms in the early stage of herpes zoster are the most important reason for misdiagnosis, the incubation period of herpes zoster is 5-12 days, during the incubation period there are often prodromal symptoms such as skin itching, sensory allergy, pins and needles sensation or burning pain. In this case, we should pay enough attention to the fact that we should consult the relevant departments as soon as possible to make a clear diagnosis and provide timely treatment for cases that cannot be diagnosed but are highly suspected. In this case, we should ask for detailed medical history, whether herpes has been born or not, and examine the body carefully to make judgment. In clinical practice, we have encountered a patient who complained of neck pain and discomfort for 8 years, and carefully questioned the history of herpes in the neck 8 years ago. Without a detailed history it is likely to be misdiagnosed as cervical spondylosis. Herpes zoster also needs to be differentiated from herpes simplex, which usually has a history of multiple recurrences in the same location, whereas this does not occur in patients with herpes zoster without significant immunodeficiency. Isolation of the virus from the blister fluid or testing for VZV, HSV antigen or DNA is the only reliable method for differential diagnosis.