We often encounter patients with or without tuberculosis symptoms (afternoon or night fever, night sweats), but with tuberculosis-like shadows in the lungs, who refuse to undergo anti-tuberculosis treatment when the clinical diagnosis of “tuberculosis” has been made after ineffective antibiotic treatment. Their reasons were very good: several hospitals suspected that it was tuberculosis, and they went to the tuberculosis hospital to check the sputum for tuberculosis bacteria, but no tuberculosis bacteria were found, so it was impossible to determine that it was tuberculosis. Other patients and their families don’t understand: I have no symptoms whatsoever, and you say I have tuberculosis just based on the X-ray, how is that possible? Dear patients and their families, in fact, I would like to say the following to you: 1. If there are 100,000 Mycobacterium tuberculosis bacilli in 1 ml of sputum, only conventional sputum smear will be detected; that is, even if there are as many as 100,000 Mycobacterium tuberculosis bacilli in 1 ml of sputum, the result of positive Mycobacterium tuberculosis bacilli is usually not obtained. Therefore, a negative result of sputum smear for Mycobacterium tuberculosis does not mean that it is not tuberculosis. Of course, if a positive result is found, it often means that the patient is highly infectious; 4. If anti-TB trial therapy is effective, it supports that it is TB; if it is ineffective, it suggests that it may not be TB.