Recurrent Abdominal Pain in a 61-Year-Old Woman

Question: The patient is a 61-year-old woman who underwent hysterectomy 8 years ago. She presented with paroxysmal abdominal pain and distension with no apparent cause 4 days ago, and the pain was tolerable without special treatment. The symptoms worsened 10 hours ago with nausea and vomiting of stomach contents. Physical examination showed that the abdomen was soft, with tenderness of the whole abdomen and no rebound pain. Surprisingly, she had been taking Zhizi Jinhua Wan (ZZJHW) for 8 years. ZZJHW is composed of 8 Chinese herbs: Gardenia Fruit, Radix Scutellariae, Coptis Chinensis, Cortex Phellodendri, Honeysuckle, Rhubarb, Anemarrhenae, and Radix Trichosanthis, which have the effect of clearing heat and fire, cooling the blood, and detoxifying it.