This 76-year-old male patient with the past history of diabetes mellitus, was admitted due to shortness of breathing. He was diagnosed as pyogenic liver abscess, Klebsiella pneumoniae ssp. pneumoniae related, companied with hyperglycemia and right upper abdominal pain in hospital course. Then he received transcutaneous needle aspiration and antibiotic therapy. As disease progressed, he had spiking fever for 3 days and persistent right upper abdominal pain with red tongue, white-thick fur, slippery, floating and rapid pulse. Therefore we prescribed Huo-pu-xia-ling decoction based on dampness-heat assailing the exterior, the fever subsided. Interestingly, the tongue appearance had obviously changed, like tongue fur reduced, as symptoms improved. We examined the quality and size of liver abscesses using abdominal sonography and found the liver abscesses reduced under treatment. Through this case report, we provide more evidence about diabetes with pyogenic liver abscess treated with combination of traditional Chinese medicine and western medicine.