Patients with tuberculous pleurisy should first be sent for routine, biochemical, and anti-tuberculosis antibodies after the pleural fluid is withdrawn to determine whether it is exudate or leaky fluid. Pleural fluid smears are used to look for pathogens and culture. At present, there are also molecular biology tests, which have a high positive rate and do not require a long waiting time, and a positive result can also clarify the diagnosis. At the same time, pleural fluid needs to be perfected with tumor tests, such as pleural fluid CEA and pleural fluid for cancer cells, to avoid misdiagnosis. The diagnosis of tuberculous pleurisy is further supported by the presence of typical tuberculosis manifestations when the chest fluid is drained. If there are large foci of lung infection, reactive pleural fluid caused by common infection needs to be considered, and if there are suspected tumor manifestations in the lung, malignant pleural fluid needs to be considered as a possibility. In addition to pleural fluid aspiration examination can also be performed pleural biopsy with ultrasound, CT-guided pleural biopsy, and thoracoscopic pleural biopsy. Pathological examination is easier to find the pathological diagnosis of typical tuberculosis, while cases without tuberculosis pathological changes need to find tuberculosis bacteria with the help of antacid staining for a clear diagnosis.