Huaijiao Wan (Sophora Fruit Pill) huái jiǎo wán · 槐角丸

Safety. Huaijiao Wan comes from Taiping Huimin Hejiju Fang, the formulary issued under the Song dynasty office responsible for public pharmacy. That provenance shapes how the entry reads: its indications are written for a counter, not for a lineage of teacher-to-student cases. It is part of the reason this formula is still stocked in ordinary Chinese pharmacies today — and availability of that kind is exactly why what follows matters more here than it does for a rarer formula. Six ingredients, and the indication is haemorrhoids and blood in the stool. That second clause is the sentence to slow down on. Haemorrhoids and anal fissure really are the commonest causes, and they are the benign ones — but they are diagnoses made after the area has been looked at, not before. The list that cannot be deferred includes colorectal cancer, inflammatory bowel disease, infectious colitis, angiodysplasia, diverticular bleeding, and upper gastrointestinal bleeding moving fast enough to present as bright red blood. Two things people reliably get wrong about this: the colour of the blood does not reliably identify its source, and a person can have haemorrhoids and a proximal bleeding lesion at the same time. Iron-deficiency anaemia is often the first objective sign. Visible rectal bleeding warrants endoscopy, and its being available without prescription says nothing about what the bleeding is. Three of the six ingredients carry specific cautions that are worth keeping separate rather than lumped together. Sophora fruit is not 槐花 or 槐米 — the flower and the flower bud of Sophora japonica — and rutin content differs substantially between fruit, flower and bud; the venotonic claims made for rutin and quercetin are not established. Sanguisorba is a heavy tannin load, and liver injury has been reported after heavy intake. Scutellaria has reported cases of liver injury, most of them in combination products where attribution is genuinely hard to establish; this library records that uncertainty rather than resolving it. Bitter orange contains synephrine, has cardiovascular adverse-event reports from the supplement literature, and shows CYP3A4 inhibition in vitro. Angelica sinensis has warfarin-interaction case reports. As with every formula in this library, no quantity and no schedule is given. A formula that survived seven centuries on pharmacy shelves is a genuine piece of the tradition. Being easy to buy is not the same as being the right thing to take before anyone has looked.