Zhang, a 51-year-old male, was admitted to the hospital with “recurrent dry mouth and excessive drinking for five months and numbness and pain in the lower extremities for one month”. The patient developed dry mouth and wasting with no obvious cause before May, and then drank a lot of sweet drinks. He was diagnosed with “type 2 diabetes mellitus” and given glimepiride 2mg bid orally. In the past month, the patient felt numbness in the lower limbs, followed by pins and needles sensation in the soles of the feet and soreness and tenderness in the gastrocnemius muscle, especially at night, affecting sleep. The patient was admitted to the hospital with a random blood glucose of 7.8 mmol/L. Diagnosis: fatigue, dry mouth, numbness in the toes, tingling in the soles of the feet, tenderness in the gastrocnemius muscle of the lower extremities, bowel movement, nasal function, poor sleep. Physical examination: BMI: 19.1 kg/m2, BP: 120/70 mmHg, clear mind, thin body, normal skin temperature of lower extremities, dorsal foot artery pulsation exists, pinprick sensation and vibration sensation at the back of the big toe exist, knee reflex exists, ankle reflex is diminished on the left side and not elicited on the right side, 10g filament tactile sensation is normal on the left side and diminished on the right side. The tongue is red, the coating is white and greasy, and the pulse is fine. Electromyography: peripheral nerve damage. Vascular ultrasound: bilateral lower limb atherosclerosis with localized small plaque formation. Fundus examination: diabetic retinopathy DR grade I. Diabetic peripheral neuropathy (DPN), the most common neuropathy caused by diabetes, has an incidence of 30% to 90%. Epidemiological studies and numerous clinical observations have confirmed that the prevalence of DPN is not significantly related to the duration of the disease, nor is it significantly related to the severity of the diabetic condition. This explains why the neuropathic symptoms in this patient were particularly prominent despite the relatively short duration of the disease and the fact that the assessment of the disease was not yet severe. However, this patient posed another problem for our clinicians: while a prolonged period of elevated blood glucose can undoubtedly lead directly to the development of DPN, the painful symptoms caused by DPN were increasing while the patient’s fasting glucose remained 7-8 mmol/L since the onset of the disease and glycated hemoglobin was 7.2% upon admission. After admission, the patient was given Vasopin to control blood glucose, Mobic to relieve pain, Valium to help sleep, Dexin to relieve anxiety and pain, adenosine cobalamin to nourish the nerves by inotropic injection, and the Chinese herbal medicine Sangzhi, Haosetong and Ginkgo Damo to benefit qi and nourish yin, activate blood circulation and remove blood stasis; at the same time, the patient was given a self-formulated formula to tonify the liver and kidney and clear heat and dampness. Mulberry leaf, mulberry bark, atractylodes, zedoary, deer grass, whole worm powder, ground dragon powder, ground h worm powder. In addition, we gave our own preparation of Ginseng Scorpion Pain Capsules orally to invigorate blood circulation and eliminate blood stasis, quench wind and relieve pain. Chinese herbal foot bath is used to invigorate blood circulation and promote the circulation of blood, with the following formula: safflower, sumac, myrrh, frankincense, hemipterocarpus, and yellow essence. DPN can have different clinical manifestations depending on the diameter of the involved nerve fibers. The present case is a painful diabetic peripheral neuropathy with mainly fine fiber involvement, which is often accompanied by sensory hypersensitivity, manifested as fear of cold, numbness, burning sensation, and pain mostly obvious at night, which seriously affects the patient’s quality of life. In this regard, Western medicine believes that the long-term elevated blood glucose leads to increased intracellular sorbitol, decreased inositol, increased glycated protein products and abnormal lipid metabolism, which cause axonal atrophy or even disappearance of peripheral nerves, stage or diffuse myelin sheath wrinkling or demyelination pathological changes. In the treatment, we advocate nerve nutrition and improvement of microcirculation. For those with severe pain, tricyclic antidepressants can be used to improve symptoms by increasing the pain threshold. According to Chinese medicine, DPN is caused by diabetes mellitus over a long period of time, depletion of qi and yin, deficiency of yin and yang, stagnation of blood flow, and paralysis of the arteries and veins. The disease is located in the vasculature and internal organs such as liver, kidney and spleen, with deficiency of qi and blood as the root cause and stasis of blood blocking the vasculature as the symptom. Therefore, under the premise of tonifying the essence and blood of liver and kidney, we add Chinese herbal medicines to invigorate blood circulation and eliminate stasis, extinguish wind and open the ligaments for external use. Such as worm medicine, to take its function of running away, in order to pass through the meridians. On the tenth day of admission, the patient’s toe numbness and plantar tingling improved, but the pain in the lower extremities increased, especially at night, and could not even tolerate the rubbing of the clothes and blankets, and could not sleep throughout the night, and the patient’s mood fluctuated, and the fasting blood sugar level also increased. As the fifth vital sign after temperature, pulse, respiration and blood pressure, pain is gaining attention. Pain is not only a concomitant symptom, but also a disease. Pain-induced insomnia makes the patient tired and anxious, for which we made a series of medication adjustments, giving the patient clonidine as a sleep aid and topical analgesia with fentanyl transdermal patches. At the same time, we combined with Chinese medicine acupuncture point injection therapy, because the acupuncture point is the part of the body where the qi from the internal organs and meridians is infused on the surface of the body, and the “Ling Shu” says that “it is the place where the qi of the gods marches in and out”, which can adjust the balance of the body’s yin and yang qi and blood, and can treat not only local diseases, but also diseases in the distant parts of the circulation of the meridians, and even has the effect of affecting the whole body. It can even affect the whole body. Foot San Li is a joint point of Foot Yang Ming Stomach meridian, which has the function of strengthening, activating blood circulation and resolving blood stasis, and is the main point for treating impotence and paralysis. Therefore, we selected foot San Li with Chengshan acupuncture point to inject adenosine cobalamin and lidocaine. On the fifteenth day of admission, the patient’s pain in the lower limbs improved, the duration and quality of night sleep improved, and the blood sugar stabilized. The patient complained of dry mouth, red tongue, thin and greasy coating, and fine and small pulse. Considering that the patient still had heat in the Wei branch, the prescription was adjusted to clear the heat in the Wei branch, nourish Yin and Blood, and extinguish the wind and open the ligaments. Herbs such as: ginseng, gypsum, Zhi Mu, Leu Lu, Di Long, smallpox powder, lily of the valley, raw earth, ground bones, asparagus, yu zhu, cocoon, cicada, scorpion, silkworm, Shou Wu, Cyperus rotundus, Chuan Huai Niu Knee, Ling Xiao Hua, ghostly feather, comfrey, Chuan Lian, lady’s maidenhair, dry lotus grass. Foot bath formula fumigated for external use (same formula as before). The patient was admitted to the hospital on the twenty-first day, no obvious dry mouth, plantar tingling, toe numbness significantly improved, lower limb gastrocnemius pain reduced, sleep in more than four hours, nasal can, two stool regulation. After treatment, the patient’s condition improved and blood sugar stabilized, so he was discharged from the hospital for care. The patient was discharged from the hospital for care, followed by internal administration of Chinese herbal medicine and external application of foot bath (all prescriptions were the same as before). At the follow-up visit ten days after discharge, the patient’s spirit improved, the pain in the lower limbs improved significantly, with occasional numbness in the toes, and he was still sleeping peacefully at night, and his blood sugar was stable. Intractable painful diabetic peripheral neuropathy is a difficult disease to treat clinically. Through the diagnosis and treatment of this patient, we found that the combination of Chinese and Western medicine and comprehensive treatment has good clinical efficacy. Chinese medicine and meridian acupuncture points are playing an increasingly important role in the treatment of chronic complications of diabetes mellitus. Clinically, under the guidance of correct dialectical analysis and rational use of relevant tools of traditional medicine, it may bring the patient and the practitioner a harvest of darkness and light.