Abstract: Background　Early diagnosis and treatment of herpes zoster（HZ）are crucial in reducing post-herpetic neuralgia complications. However，research on prevention and treatment at the primary healthcare level remains insufficient. Objective　Based on the hierarchical diagnosis and treatment system between community health service centers and general hospitals，this study aims to establish a comprehensive community-based clinical pathway for HZ，providing guidelines for standardized management in community settings. Methods　Through a systematic review spanning from 2003 to 2023， international and domestic literature on HZ prevention，diagnosis，pain assessment tools，and treatment measures were collated. Utilizing focus group discussions，12 experts engaged in HZ-related work or research from Shanghai，Beijing，including representatives from disease control centers，health commissions，comprehensive hospitals，and community health centers，refined and constructed the clinical pathway and operational protocols for community HZ diagnosis and treatment. Results　Within the hierarchical medical system，the community-based pathway for HZ diagnosis and treatment encompasses stages of prevention，diagnosis and differential diagnosis，treatment，and follow-up. The established pathway assigns initial HZ diagnosis，graded treatment，and follow-up responsibilities to community health service centers while general hospitals handle specialized differential diagnoses and non-basic services. This pathway is anchored by community general practitioners as its central axis. Conclusion　The community-based pathway for diagnosing and treating herpes zoster（HZ）developed in this study，within the framework of a hierarchical medical system，can effectively enhance the standardization of HZ diagnosis and treatment in primary healthcare institutions. Moreover，it establishes a solid clinical and theoretical foundation for promoting a two-way referral model of HZ under nationwide hierarchical diagnosis and treatment.

Key words: Herpes zoster, Bidirectional referral, Clinical pathway, Community health services

摘要： 背景　带状疱疹（HZ）的及早诊断和治疗对降低HZ后并发症具有重要意义，然而其在基层医疗卫生机构开展的防治研究相对匮乏。目的　以社区卫生服务机构-综合医院的分级诊疗背景为基础，构建一套完整的HZ社区全科诊疗路径，为规范化开展社区HZ诊疗提供参考。方法　通过文献回顾法整理2003—2023年国内外HZ预防、诊断和相关性疼痛评估工具集合及治疗措施；通过焦点小组会议法，邀请来自上海和北京疾控、卫健委、综合医院和社区卫生服务中心的从事HZ相关工作或研究的12名专家，梳理并构建社区HZ诊疗路径流程和操作细则。结果　分级诊疗背景下社区HZ诊疗路径包括预防环节、诊断与鉴别诊断环节、治疗环节和随访环节；构建了由社区卫生服务中心承担HZ首诊诊断、分级治疗与随访工作，由综合医院承担特殊鉴别诊断和非基本服务项目，以社区全科医生为路径中轴线的社区HZ诊疗路径。结论　本研究构建的分级诊疗背景下社区HZ诊疗路径，能够提高基层医疗卫生机构开展HZ的诊疗规范，为在全国推广HZ分级诊疗的基层双向转诊模式提供了临床和理论基础。

关键词: 带状疱疹, 双向转诊, 诊疗路径, 社区卫生服务