Presentation
A 69-year-old male, a chronic smoker with a 15-year history of type II diabetes mellitus, presented with persistent left ankle inflammation, pain, and neuropathy four months after surgical repair of a left ankle fracture from a car accident. His prior surgical history included three ankle fracture surgeries. His symptoms persisted even after four months of antibiotic therapy.

Examination
Upon physical examination, dorsalis pedis pulse was 1/4 and posterior tibial pulse was 2/4 bilaterally. Capillary refill was brisk in both feet. Epicritic sensation was intact and symmetric, with no protective sensory loss in either foot confirmed using a Semmes-Weinstein monofilament. Muscle strength was symmetric and intact. Ophthalmologic evaluation revealed mild nonproliferative diabetic retinopathy in both eyes with no progression over a five-year acupuncture treatment period.

Diagnosis
He was diagnosed with chronic diabetic neuropathy and persistent post-traumatic ankle inflammation. Laboratory findings confirmed poor glycemic control. The patients had a family history of diabetes, heart disease, and hypertension. His condition was classified in Traditional Chinese Medicine (TCM) as a "heat" type with dampness in the middle Jiao and meridian dysfunctions involving the kidney, bladder, spleen, and stomach.

Management
The patient began acupuncture treatment to improve kidney, bladder, and spleen function and suppress stomach overactivity. Within six months, his ankle inflammation fully resolved, and regular foot function returned. Initially, the patient discontinued his diabetic medication (Metformin 1000 mg) due to discomfort, leading to a spike in his HbA1c to 8.4% and fasting glucose to 173 mg/dL. Acupuncture was resumed, and over the next year, gradual improvements in glycemic markers were noted: HbA1c dropped from 8.4% to 6.7%, cholesterol from 225 to 201 mg/dL, LDL from 165 to 135 mg/dL, and fasting glucose from 157 to 133 mg/dL. On discontinuation of acupuncture, his levels worsened again, with HbA1c rising to 9.1%.Upon resuming therapy, markers gradually improved. The glucose levels reduced from 145 to 220 mg/dL (pre-treatment levels) to 127–165 mg/dL after acupuncture. Qualitative improvements included better sleep, reduced overeating, and decreased fatigue.

Follow-Up
Over five years, the patient remained free of diabetic neuropathy symptoms and experienced no recurrence of ankle pain or inflammation. His retinal condition remained stable. The patient had no cardiac or renal complications. He remained physically active and resumed daily functions without restriction.