The rash is often preceded by systemic manifestations such as mild fever, lethargy, and loss of appetite, with prodromal symptoms such as sensory allergy, pins and needles, itching, burning, pain, and local lymph node swelling and pain, lasting about 1 to 3 days. Some patients do not have any prodromal symptoms. The rash can occur on any part of the body, mostly on one side of the body, usually not exceeding the midline of the body, and occasionally on both sides. The rash is commonly seen on the chest, followed by the face, neck, abdominal skin, and also on the eyes, nose, oral mucosa and ears. The rash starts with localized irregular or oval erythema, and within a few hours clusters of corn to green bean sized papules appear, which rapidly turn into hemispherical blisters with clear and transparent contents, tense walls, and a red halo at the base, the lesions can be one or several groups of blisters, which are distributed in a band along the peripheral nerves in turn, gradually increasing, each group of blisters varies from several to dozens, often in 1 to 2 groups, 3 to 5 groups or more. Some of them fuse with each other to form a diffuse swath of damage, with normal skin between the blister groups. After a few days, the clear blister fluid can gradually cloud into pus, and then gradually absorbed, some rupture to reveal the moist surface, if no secondary infection, the surface dries and crusts, about 10 days or so scab off, leaving a temporary light red spot or pigmentation spots, generally do not leave a scar. In the elderly and frail patients, necrosis at the base of the blister is often seen, with a slightly depressed center and significant surrounding inflammation, often leaving a scar after healing. Neuralgia is one of the distinctive features of the disease and has diagnostic value. It is often accompanied by varying degrees of pain before or at the onset of the rash, often paroxysmal, pins and needles, burning or tenderness, and can gradually increase. In children, the pain is mild or absent, while in older patients it is paroxysmal, often unbearable, and remains severe for months or longer after the rash disappears. Enlarged lymph nodes near the rash are common, and very few patients have temporary motor nerve disorders. A small percentage of patients have atypical clinical manifestations, such as neuralgia without a rash. The herpes zoster virus is most likely to invade the intercostal nerves. Except for the thoracic nerve, which forms the intercostal nerve to innervate the skin of the thorax and abdomen, the other spinal nerves mostly unite with several adjacent spinal nerves to form the cervical, brachial, lumbar, and sacroiliac plexuses, and then many peripheral nerves are divided from each plexus and distributed to the skin of the neck, upper limbs, lower limbs, and perineum. Therefore, after the onset of the thoracic nerve, the lesioned segment can often be clearly reflected by the intercostal nerve; while after the onset of the cervical and lumbosacral nerves, only the area of the spinal nerve lesion can be understood from the skin lesion. The cerebral nerves have their own specific distribution areas, and the more frequently involved nerves are the trigeminal nerve and the facial and auditory nerves. In the elderly, the trigeminal nerve is most commonly involved, with the ophthalmic branch being the most common, often with severe pain and lesions distributed on one side of the frontal face. In the case of maxillary branch involvement, blisters may appear on the suspensory and tonsils, and in the case of mandibular branch involvement, blisters may appear on the anterior tongue and buccal mucosa. When the facial and auditory nerves are invaded by the virus, blisters appear in the external auditory canal or tympanic membrane, and there may be tinnitus, deafness, vertigo, nausea, vomiting, nystagmus, facial paresis, and loss of taste sensation in the anterior 2/3 of the tongue, which also becomes ear herpes zoster. If the virus invades the visceral nerve fibers of the autonomic nerve by the posterior spinal root nerve, it may produce symptoms of the corresponding system, such as gastroenteritis, cystitis, peritonitis, pleurisy, and other manifestations. During the onset of the disease, patients may experience a variety of uncomfortable symptoms, with nerve pain being the most pronounced, making it difficult to sleep and eat. If improper treatment or weakness is caused by many factors, it will turn into “postherpetic neuralgia”, which may take less than a year or more than a few years, and the patient will suffer for a long time, affecting the quality of life. Atypical herpes zoster: 1. rashless herpes zoster: only neuralgia without rash. 2, incomplete or strophic herpes zoster: no lesions, or only red papules without forming blisters that are absorbed. 3, hemorrhagic herpes zoster: the fluid in the blisters is bloody. 4, gangrenous herpes zoster: the center of the rash is gangrenous, forming a dark brown crust that does not peel easily, leaving a scar after healing. 5, generalized herpes zoster: widespread lesions due to hematogenous spread of the virus, even to the whole body skin and mucous membranes, severe symptoms of systemic toxicity, as well as large blisters, hemorrhagic blisters, gangrene and other lesions, mostly seen in elderly frail or tumor patients. 6. Herpes zoster meningoencephalitis: it is caused by the upward spread of viral invasion of cerebral nerves or cervical ganglia, which can cause headache, vomiting, convulsions and other symptoms and should be alerted. 7. Herpes zoster pneumonia and hepatitis: when internal organs such as lungs and liver are involved. 8. Herpes zoster: if large blisters between cherry and egg size are formed.