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BACKGROUND: This novel study provides a time series analysis of tongue features extracted from a diabetic patient with pyogenic liver abscess (PLA), treated with the integration of western medicine and traditional Chinese medicine (TCM). The features, namely, tongue color, tongue fur thickness and fur color, identified from a series of tongue images taken every two days, exhibit significant transitions matching closely with the progression of disease. These tongue features could serve as effective, non-intrusive indices for different progression stages of diabetes with PLA. CASE PRESENTATION: A 76-year-old male diabetic patient was admitted for hyperglycemic hyperosmolar state. Intermittent fever and abdominal discomfort were noted. After performing abdominal computed tomography and laboratory studies, the results indicated pyeogenic liver abscess, Klebsiella pneumoniae ssp. pneumoniae related. As PLA progressed, the patient suffered spiking fever and right upper abdominal pain. Tongue examination revealed features with red tongue, white-yellow and thick fur. After receiving pigtail catheter drainage, the fever subsided and the pus-like fluid was drained smoothly. During the course of this process, gradually dwindled tongue fur witnessed through periodic tongue examination coincides consistently with laboratory data, namely, body temperature, fasting plasma glucose and plasma glucose level gathered. CONCLUSION: This is the first time series analysis of applying tongue examination to the progression of a specific disease. Through a series of tongue images taken periodically, tongue color, tongue fur thickness and fur color are identified to closely linked to the progression of diabetes with PLA, as indicated by data gathered through means of plasma glucose and abdominal sonographic follow-ups. Based on this promising finding, our future study will further extend the application of tongue assessment to evaluate the tongue characteristics of diabetic patients. [ABSTRACT FROM AUTHOR]