# Whole lotus rhizome or defined lotus-root juice × Reduction of menstrual blood loss in heavy menstrual bleeding Verdict 3080 · Evidence Check Stored-material review date: 2026-10-05 Original evidence review date: 2026-09-08 Review-criteria version: 1.0 Public page/material preparation date: 2026-10-28 Clinical papers were not read directly; existing review summaries were checked. No new clinical-literature search was performed. Unverified does not mean that research is absent or that there is no effect. ## Assessment scope - Population: Adults with heavy menstrual bleeding. Diagnosis, baseline and selection criteria in an eligible direct trial are unverified - Ingredient, formulation and route: Oral whole edible Nelumbo nucifera rhizome or defined lotus-root juice. Distinguish nodes, carbonized products, other parts and combination prescriptions; actual direct-trial formulation is unverified - Dose: Actual intake, frequency and adherence linked to an eligible direct heavy-menstrual-bleeding trial are unverified - Comparator: Actual direct heavy-menstrual-bleeding trial comparator and background treatment are unverified. S01’s cucumber comparator concerns a different antioxidant endpoint - Measured outcome: Intended endpoints are PBAC or objective menstrual blood loss. Actual direct measurements, between-group results, denominators and intervals are unverified - Duration: Actual direct-trial administration duration, baseline/follow-up menstrual cycles and measurement times are unverified - Questions outside this scope: Do not transfer S01’s antioxidant and DNA-damage markers from an older-adult randomized food-comparison pilot to menstrual-blood-loss results. Exact randomized/completed denominators and actual funding/conflicts are unverified.; S02’s traditional/preclinical review is not a direct comparative heavy-menstrual-bleeding trial. No participant recruitment by the review itself does not mean no participants in all included human research. Do not transfer records for leaves, nodes, carbonized products or combination prescriptions to clinical efficacy of whole lotus rhizome or juice.; S03’s 1 reported anaphylaxis case after lotus-root ingestion is a separate safety signal. Actual intake, cooking/juice status, timeline, diagnosis, co-exposures, total exposed denominator and incidence are unverified. No new frequency or causality is calculated or adjudicated.; Retain the original ?, unrecorded score and Caution. Distinguish food-use experience from therapeutic-amount juice safety; pregnancy, lactation, liver/kidney disease, anticoagulants/antiplatelets and long-term safety are unverified. Do not extend to optimal dose, persistence after stopping, anemia treatment or replacement of standard care. ## Checklist items ### N01 · Which independent claim does this table address? Verification status: Met Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The original claim concerns reduced menstrual blood loss in adults with heavy menstrual bleeding who orally consume whole edible lotus rhizome or defined lotus-root juice. Hemostatic claims for leaves, plumule, rhizome nodes, carbonized products and combination prescriptions are excluded. - Why unverified: The original claim identity and exclusion boundaries are linked to retained material. This does not verify a direct clinical effect. - Reason for missing information: The claim boundary is verified. Actual trial formulation, amount, comparator and duration remain unverified in subsequent conditions. - Required materials and conditions: Identification records for the original claim, plant part, formulation, route, population and endpoint. - Materials to obtain first: Identification records for the original claim, plant part, formulation, route, population and endpoint. - Further research: Classify new material by original-claim eligibility and consider a separate table only for an actually different question. - Conditions for verification: Link the current original menstrual-blood-loss claim to its population, plant part and route, distinguishing other effects. - Why this condition is needed: This prevents different parts and effects of one plant from being merged into the menstrual-blood-loss question. - Application exceptions: If actual trial formulations of defined juice and food become known, retain their differences without inventing new claims from currently unverified combinations. - Remaining uncertainty: Whether the same boundaries can be maintained when direct-trial material is added. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N02 · Is the trial intervention whole edible rhizome, distinguished from nodes and carbonized products? Verification status: Partly verified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The intended part is explicitly the whole edible underground rhizome, but actual part and processing records for an eligible heavy-menstrual-bleeding trial product are not retained. - Why unverified: The intended and excluded parts are known, but actual direct-trial intervention identity is unverified. - Reason for missing information: Raw-material and processing information for a heavy-menstrual-bleeding trial product is missing. This does not mean other parts are ineffective. - Required materials and conditions: Trial-product botanical identity, plant part, processing and manufacturing records. - Materials to obtain first: Trial-product botanical identity, plant part, processing and manufacturing records. - Further research: Compare acquired product documents with trial methods, classifying whole rhizome, nodes and carbonized products separately. - Conditions for verification: Verify from actual trial part and processing records that the intervention is whole edible Nelumbo nucifera rhizome. - Why this condition is needed: Hemostatic contexts for nodes or carbonized products can otherwise become claims of therapeutic efficacy for whole lotus rhizome. - Application exceptions: Retain traditional records as context; they do not replace identification of the trial-product plant part. - Remaining uncertainty: Agreement between the current definition and actual trial products. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S02 ### N03 · Are the direct trial's food or juice formulation and inclusion of other active ingredients verified? Verification status: Partly verified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The retained material poses whole food or defined lotus-root juice as the question and states that an eligible trial formulation is unverified. Combination prescriptions are excluded. - Why unverified: Permitted formulations in the question are known, but actual product specifications and single-intervention status are unverified. - Reason for missing information: Manufacturing, content and combination-product information for a direct trial is not retained. - Required materials and conditions: Trial-formulation manufacturing, raw-material amount, extraction or juicing conditions, other active ingredients and product-supply records. - Materials to obtain first: Trial-formulation manufacturing, raw-material amount, extraction or juicing conditions, other active ingredients and product-supply records. - Further research: Build trial-specific product specifications distinguishing food, defined juice, other-part extracts and combination prescriptions. - Conditions for verification: Verify manufacturing, content and combination status of the actual administered food or defined juice from original trial material. - Why this condition is needed: Results for undefined lotus-root juice or combination prescriptions cannot be attributed to the contribution of whole lotus rhizome alone. - Application exceptions: Do not automatically treat food and juice as equivalent; reconsider applicability when actual specification differences are identified. - Remaining uncertainty: Food/juice equivalence and the specific contribution of lotus rhizome. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N04 · Are direct-comparison participants adults with heavy menstrual bleeding, with diagnosis and baseline status verified? Verification status: Partly verified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The intended population is adults with heavy menstrual bleeding. S01 concerns antioxidant outcomes in older adults; diagnosis and baseline characteristics in a direct heavy-menstrual-bleeding trial are unverified. - Why unverified: Only the intended population name is known; actual eligible-population diagnosis, baseline and selection information are unverified. - Reason for missing information: Diagnostic criteria and baseline bleeding information for the direct population are missing. - Required materials and conditions: Heavy-menstrual-bleeding diagnostic criteria, participant characteristics, bleeding causes and baseline PBAC or objective blood-loss records. - Materials to obtain first: Heavy-menstrual-bleeding diagnostic criteria, participant characteristics, bleeding causes and baseline PBAC or objective blood-loss records. - Further research: Compare participant characteristics with the adult heavy-menstrual-bleeding population; retain separate results or applicability limits for mixed populations. - Conditions for verification: Verify the actual heavy-menstrual-bleeding definition, age, bleeding causes, baseline menstrual blood loss and inclusion/exclusion criteria. - Why this condition is needed: Older antioxidant-trial participants and adults with heavy menstrual bleeding are different populations. - Application exceptions: Retain populations with different diagnoses or bleeding causes as indirect rather than deleting them or declaring no effect. - Remaining uncertainty: Applicability to particular causes and severities of heavy menstrual bleeding. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01 ### N05 · Is there a comparison of added lotus rhizome against an appropriate control on the same background treatment? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The direct heavy-menstrual-bleeding trial comparator is unverified in retained material. S01's cucumber comparator addresses a different antioxidant-marker question. - Why unverified: Material verifying the direct menstrual-blood-loss comparator and balance of treatments is missing. - Reason for missing information: An actual between-group contrast is unavailable, so S01's food comparator cannot serve as a heavy-menstrual-bleeding comparator. - Required materials and conditions: Direct-trial group interventions and controls, standard treatment, co-treatment and rescue-treatment records. - Materials to obtain first: Direct-trial group interventions and controls, standard treatment, co-treatment and rescue-treatment records. - Further research: Compare group interventions to define the contrast for adding lotus rhizome and examine other treatment differences separately. - Conditions for verification: Verify actual comparators, common treatments and the contrast of interest in a heavy-menstrual-bleeding trial. - Why this condition is needed: The contribution of lotus rhizome cannot be determined without actual comparators and background treatments. - Application exceptions: Do not require placebo as the only eligible control; specify control conditions and the actual effect of interest. - Remaining uncertainty: The comparative effect of added lotus rhizome and the contribution of other treatments. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01 ### N06 · Are actual lotus-rhizome or juice intake and adherence linked to menstrual-blood-loss material verified? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The dose in an eligible human heavy-menstrual-bleeding trial is unverified. Safety considerations for food use and repeated therapeutic-amount juice consumption are distinguished. - Why unverified: Actual intake, frequency and adherence linked to direct bleeding results are unverified. - Reason for missing information: Original material establishing exposure to the therapeutic formulation is missing. - Required materials and conditions: Group-specific raw-material amount, juice concentration, intake frequency, actual consumption and adherence records. - Materials to obtain first: Group-specific raw-material amount, juice concentration, intake frequency, actual consumption and adherence records. - Further research: Link product specifications and consumption records to examine exposure corresponding to the direct endpoint. - Conditions for verification: Verify nominal and actual intake, frequency and adherence in a direct trial. - Why this condition is needed: Food-use experience or amounts from other studies cannot establish actual exposure to therapeutic juice. - Application exceptions: Do not invent a therapeutic or minimum amount; keep doses for other endpoints separate. - Remaining uncertainty: Dose-related effects, harms and applicability. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N07 · Are administration duration, menstrual-blood measurement cycles and visit times verified? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: Eligible-trial duration and bleeding-measurement cycles are unverified in retained material. - Why unverified: Without a direct-trial administration and measurement schedule, effects within matching menstrual cycles cannot be assessed. - Reason for missing information: Administration duration, measurement cycles and follow-up material are missing. - Required materials and conditions: Administration and follow-up schedules, with baseline and follow-up cycle bleeding measurements. - Materials to obtain first: Administration and follow-up schedules, with baseline and follow-up cycle bleeding measurements. - Further research: Link visits and menstrual-cycle timelines to assess whether contrasts concern matching times. - Conditions for verification: Verify direct-trial administration duration, baseline and follow-up menstrual cycles and measurement times. - Why this condition is needed: Menstrual-blood-loss results cannot be compared as the same outcome without measurement cycles and exposure duration. - Application exceptions: Do not invent an appropriate minimum duration or required cycle count. Long-term persistence is a separate extension. - Remaining uncertainty: Matching duration and persistence after stopping. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N08 · Are the direct heavy-menstrual-bleeding trial design, allocation, concealment and baseline balance verified? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: S01 is recorded as a randomized food-comparison pilot in older adults. The design of an eligible direct comparative menstrual-blood-loss trial is unverified. - Why unverified: A randomized-trial label for another endpoint cannot provide allocation evidence for the direct efficacy question. - Reason for missing information: Direct-trial design, allocation, concealment and baseline tables are missing. - Required materials and conditions: Direct-trial methods, allocation procedures, group baseline tables and design documents. - Materials to obtain first: Direct-trial methods, allocation procedures, group baseline tables and design documents. - Further research: Compare actual allocation and group baseline information for the endpoint of interest, retaining unverified procedures. - Conditions for verification: Verify the actual comparative design, allocation procedures, concealment and baseline balance for the direct endpoint. - Why this condition is needed: Randomization in a related antioxidant RCT does not establish a comparative menstrual-blood-loss design. - Application exceptions: Retain nonrandomized material with design limits; do not replace unverified design with non-applicability of crossover or cluster designs. - Remaining uncertainty: The scope for assessing confounding or allocation problems. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01 ### N09 · Are actual PBAC or objective menstrual-blood-loss tools, units and assessment procedures verified? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: Retained material specifies PBAC or objective menstrual blood loss as intended endpoints, but actual tools, units and measurement procedures are unverified. - Why unverified: Only candidate endpoints are identified; actual measured results and assessment procedures are unverified. - Reason for missing information: Direct-outcome measurement methods, scales, units and assessment conditions are missing. - Required materials and conditions: Bleeding-measurement tools and units, assessor procedures, group collection within matching cycles and blinding records. - Materials to obtain first: Bleeding-measurement tools and units, assessor procedures, group collection within matching cycles and blinding records. - Further research: Link PBAC scores and objective blood loss as separate measures and examine measurement-condition differences. - Conditions for verification: Verify direct-outcome methods, tools, units, scale direction, assessor blinding and collection procedures. - Why this condition is needed: This prevents confusion between an intended endpoint specification and actual measured results. - Application exceptions: Do not automatically convert PBAC to objective loss or judge failure solely because blinding is impossible. - Remaining uncertainty: Distinguishing measurement differences from actual bleeding changes. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S02 ### N10 · Are co-medication, standard treatment, rescue treatment and group-specific changes verified in direct material? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: Retained material states that lotus rhizome cannot be advertised as a replacement for standard gynecological treatments such as hormonal therapy. Direct-trial common-treatment and rescue-treatment records are missing. - Why unverified: Advertising boundaries do not replace group co-treatment, change and analysis information. - Reason for missing information: Actual concurrent treatments and group-specific changes are missing. - Required materials and conditions: Group gynecological treatments, other interventions, rescue treatment, adherence and analytical handling records. - Materials to obtain first: Group gynecological treatments, other interventions, rescue treatment, adherence and analytical handling records. - Further research: Link treatment changes and lotus-rhizome exposure over time to examine factors mixed into the actual contrast of interest. - Conditions for verification: Verify concurrent treatments, changes, rescue treatment and their handling by group in a menstrual-blood-loss trial. - Why this condition is needed: Bleeding changes caused by other treatments could otherwise be attributed to lotus-rhizome efficacy. - Application exceptions: There is no need to prohibit all co-treatment; assess it according to the actual effect of interest and group-specific handling. - Remaining uncertainty: The sole contribution of lotus rhizome to bleeding changes. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N11 · Are randomized, completed and analyzed denominators verified for direct heavy-menstrual-bleeding results? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: Group denominators for menstrual-blood-loss results are unverified. S01's randomized and completed counts are also unverified, and S03's 1 person is a safety case report. - Why unverified: Actual analysis counts in an eligible direct trial are missing, preventing assessment of power, precision or total participants. - Reason for missing information: Direct recruitment, allocation, completion and analysis counts are missing. - Required materials and conditions: Direct-trial participant flow and analysis counts by group and endpoint. - Materials to obtain first: Direct-trial participant flow and analysis counts by group and endpoint. - Further research: Link recruitment to analysis of the relevant bleeding endpoint without adding participant counts from other reports. - Conditions for verification: Distinguish and verify recruited, allocated, completed, measured and analyzed denominators by group for direct results. - Why this condition is needed: Retained report counts and participants in other human studies are not direct-analysis denominators. - Application exceptions: Do not use the absence of participants recruited by a review or the 1 allergy case as an efficacy denominator for heavy menstrual bleeding. - Remaining uncertainty: Denominator attribution and the selected analysis-population scope. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01, S02, S03 ### N12 · Are missing direct bleeding results, dropout reasons and handling methods verified? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: An eligible direct trial is unverified, so missing bleeding measurements, loss to follow-up, exclusions and handling methods cannot be verified. - Why unverified: Direct-trial participant flow and results needed to assess missingness are missing. - Reason for missing information: Group dropout, missingness and handling information are missing. - Required materials and conditions: Direct-trial group dropout reasons, cycle-specific missing measurements, missing-data handling and sensitivity-analysis records. - Materials to obtain first: Direct-trial group dropout reasons, cycle-specific missing measurements, missing-data handling and sensitivity-analysis records. - Further research: Link flow and result tables to examine the direction of missing measurements and actual handling scope. - Conditions for verification: Verify missing menstrual-blood-loss measurements, loss to follow-up, exclusion reasons and group missing-data handling. - Why this condition is needed: Actual participant flow and missing-data material are needed to assess whether only completer results remain. - Application exceptions: Do not interpret missing dropout information in related research as no dropout in a direct trial. - Remaining uncertainty: The influence of missingness on the contrast of interest. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N13 · Is it verified whether bleeding results estimate between-group final values or changes? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: Actual between-group analysis and effect definitions for PBAC or objective menstrual blood loss are unverified. - Why unverified: Without direct values and models, a reduction direction cannot serve as a between-group effect estimate. - Reason for missing information: Group order, original values, final values or changes, analysis populations and adjustment information are missing. - Required materials and conditions: Group bleeding values, between-group analysis tables and models, and ITT or adherence-effect definitions. - Materials to obtain first: Group bleeding values, between-group analysis tables and models, and ITT or adherence-effect definitions. - Further research: Compare the question's contrast of interest with actual analyses, separating within-group change from between-group effects. - Conditions for verification: Verify group order, final-value or change analyses, between-group analysis, adjustment and analysis populations for direct results. - Why this condition is needed: The direction of reduced bleeding alone cannot establish the comparative effect measure or analysis. - Application exceptions: Do not assign ITT, PP or adjusted effects to material that does not specify its analysis. - Remaining uncertainty: Which comparative effect can be estimated. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S02 ### N14 · Are direct menstrual-blood-loss effect estimates, variability and confidence intervals verified? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: Retained material lacks effect estimates, variability and confidence intervals for an eligible direct bleeding comparison. S02 is also summarized as not providing clinical PBAC or objective-loss results. - Why unverified: Direct numerical information needed to assess effect size and precision is missing. - Reason for missing information: The relevant values are unverified in retained summaries. Whole-paper nonreporting has not been newly established. - Required materials and conditions: Endpoint-specific group result tables, variability types, denominators and between-group estimates and intervals. - Materials to obtain first: Endpoint-specific group result tables, variability types, denominators and between-group estimates and intervals. - Further research: Link estimates to measures, times and denominators, leaving unverified intervals without new calculation. - Conditions for verification: Verify direct-comparison measures, units, estimates, denominators, SD or SE and confidence intervals in original material. - Why this condition is needed: Significance or a trial label alone cannot establish effect size and precision. - Application exceptions: Do not calculate bleeding effects or intervals from other markers, or infer SD and SE. - Remaining uncertainty: The range and precision of possible effects. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01, S02 ### N15 · Are important differences and patient-related criteria needed to interpret bleeding changes verified? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: Direct bleeding estimates, intervals and important-difference criteria are unverified in retained material. - Why unverified: Both effects and importance criteria are missing, preventing comparison of clinical meaning. - Reason for missing information: Justification of measure-specific important differences and intervals for direct results is missing. - Required materials and conditions: Evidence for important PBAC or objective-blood-loss differences, with the trial's estimates and intervals. - Materials to obtain first: Evidence for important PBAC or objective-blood-loss differences, with the trial's estimates and intervals. - Further research: If justified importance criteria become available, compare them with actual intervals without adopting arbitrary minimum effects or sample sizes. - Conditions for verification: Verify the relationship between justified important differences for the chosen measure and actual estimated intervals. - Why this condition is needed: Whether bleeding decreases and whether its magnitude matters to patients are different judgments. - Application exceptions: Leave currently undetermined importance criteria as such; do not turn unverified information into a clinically negligible effect. - Remaining uncertainty: Whether bleeding changes are meaningful to patients. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N16 · Can direct-trial registration, protocol, planned endpoints and actual results be compared? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The registration fields of the three retained evidence records say unverified. An eligible direct trial and its registration and plans are unidentified. - Why unverified: Missing direct-trial identity and original plans prevent comparison of planned endpoints and analyses with results. - Reason for missing information: Direct-trial identifiers, registration, protocol and analysis plans have not been acquired. - Required materials and conditions: Direct-trial identifiers, original registration, protocol, analysis plan, amendments and actual results. - Materials to obtain first: Direct-trial identifiers, original registration, protocol, analysis plan, amendments and actual results. - Further research: Link trial identity first, then compare planned and actual endpoints, times and analyses, distinguishing unacquired material. - Conditions for verification: Verify an eligible direct trial's identity, registration and plans against actual bleeding endpoints, times and analyses. - Why this condition is needed: Related bibliographies do not establish a direct trial's advance plan or a selective-reporting comparison. - Application exceptions: Do not turn unacquired registration into confirmed nonregistration or selective reporting, or uniformly require trial registration for reviews and case reports. - Remaining uncertainty: Agreement between advance plans and selected analyses. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01, S02, S03 ### N17 · Can unique families, duplication and independent replication of direct menstrual-blood-loss trials be verified? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: S01 is a human pilot for another endpoint, S02 a review and S03 a safety case report. Eligible direct bleeding-trial identity is unverified, so unique direct-trial and independent-replication counts remain unrecorded. - Why unverified: Report roles are distinguished, but material establishing direct-trial families is missing. - Reason for missing information: Direct trials, families, replication and total unique participants are unverified. - Required materials and conditions: Direct-trial identifiers and report links, review included-study lists, recruitment and institution information. - Materials to obtain first: Direct-trial identifiers and report links, review included-study lists, recruitment and institution information. - Further research: Link reports and study families, distinguishing re-citation of the same population or results from independent replication. - Conditions for verification: Verify eligible direct-trial identifiers, associated reports, recruited populations and endpoint/time family relationships. - Why this condition is needed: This prevents the three related reports from being counted as three independent heavy-menstrual-bleeding trials. - Application exceptions: Retain reviews and cases in their respective roles without estimating unique direct trials or participant totals. H07 informs only the boundary against re-citing the safety case as replication. - Remaining uncertainty: Unverified direct replication and duplication through re-citation. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01, S02, S03 ### N18 · Can favorable, no-difference and unfavorable results for the same direct bleeding question be verified? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: Retained records describe unidentified direct bleeding trials. The absence of clinical bleeding results in S02 is not evidence of a null effect, and S03's allergy event is safety context. - Why unverified: Without direct results for the same question, favorable, no-difference and unfavorable between-group outcomes cannot be compared. - Reason for missing information: Directions, magnitudes and opposing reports for direct bleeding results are unverified. - Required materials and conditions: All relevant direct-trial bleeding result tables, analyses, corrections and opposing reports. - Materials to obtain first: All relevant direct-trial bleeding result tables, analyses, corrections and opposing reports. - Further research: Compare results at matching contrasts and times without turning numerical differences for other questions into conflicts. - Conditions for verification: Verify actual results regardless of direction for matching intervention, population, bleeding endpoint and time. - Why this condition is needed: A summary lacking clinical results is not an observation of a null effect or equivalence. - Application exceptions: Safety signals differ from null direct-bleeding results; do not extend an unidentified direct trial to a worldwide absence of effect. - Remaining uncertainty: Possible confusion between absence of effect and absence of material. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S02, S03 ### N19 · Can S01's oxidative and DNA-damage results apply directly to menstrual blood loss? Verification status: Not applicable Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: S01 concerns oxidative and DNA-damage markers in a randomized food-comparison pilot in older adults. Its retained summary records no menstrual-blood-loss result. - Why unverified: S01's observed endpoint and population do not match the bleeding question, so direct application of that result is not applicable. - Reason for missing information: Direct application is not applicable. Separate direct menstrual-blood-loss material remains unverified. - Required materials and conditions: S01 original-trial population, measurements and result tables, with separate direct bleeding material. - Materials to obtain first: S01 original-trial population, measurements and result tables, with separate direct bleeding material. - Further research: Code antioxidant and DNA-damage markers separately from menstrual blood loss to compare directness. - Conditions for verification: Verify S01's actual population, endpoints and result role, explaining differences from direct bleeding results. - Why this condition is needed: The existence of human lotus-rhizome research differs from direct heavy-menstrual-bleeding efficacy. - Application exceptions: Older-adult oxidative and DNA-damage markers are not directly applied to the current bleeding question. Not applicable concerns only direct application of this result. - Remaining uncertainty: Extrapolation from antioxidant-marker changes to menstrual blood loss. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01 ### N20 · Are S01's population, design, actual randomized and completed denominators, funding and conflicts verified? Verification status: Partly verified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: S01 records older adults, but exact randomized and completed denominators and actual funding and COI are unverified in existing records. - Why unverified: Reported design and population context are verified, but actual denominators and conflict information are not. - Reason for missing information: S01's flow, actual funding and disclosure documents are absent from retained summaries. - Required materials and conditions: S01 participant flow, original result tables, funding, product supply and author disclosures. - Materials to obtain first: S01 participant flow, original result tables, funding, product supply and author disclosures. - Further research: Compare the related report's actual denominators and funding without transferring them to direct heavy-menstrual-bleeding denominators or independence. - Conditions for verification: Verify S01's population, design, randomized and completed denominators and actual funding and conflict disclosures. - Why this condition is needed: An academic-research classification alone cannot establish denominators and independent funding. - Application exceptions: This is not direct-efficacy material, so verifying its denominators does not replace direct-effect conditions. - Remaining uncertainty: The size and independence of the reported recruited population. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01 ### N21 · Can S02's traditional and preclinical review serve as a direct heavy-menstrual-bleeding comparative trial? Verification status: Not applicable Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: S02 is a traditional-use and preclinical narrative review. Its summary states that the review itself recruited no clinical participants and provides no clinical PBAC or objective menstrual-blood-loss results. - Why unverified: Using this review itself as a direct comparative bleeding trial does not meet design and result applicability conditions. - Reason for missing information: Direct-trial application of the review itself is not applicable. Individual directness and family information for included material were not newly verified. - Required materials and conditions: Review text, included-material list and original material from a separate eligible direct comparative trial. - Materials to obtain first: Review text, included-material list and original material from a separate eligible direct comparative trial. - Further research: Distinguish traditional and preclinical review records from clinical-trial reports and link identified included studies to families. - Conditions for verification: Verify S02's design and provision of clinical results, distinguishing it from a direct comparative trial. - Why this condition is needed: A traditional metrorrhagia record does not become a modern PBAC comparison. - Application exceptions: The narrative review itself is not a trial recruiting clinical participants. Actual identities of included studies need separate comparison. - Remaining uncertainty: The risk of transferring traditional narratives to comparative effects. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S02 ### N22 · Do traditional hemostatic records concern the same part, processing and disease as whole edible lotus rhizome or juice? Verification status: Partly verified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: Retained material distinguishes classical hemostatic use, lotus-leaf uterine-bleeding records, nodes, carbonized products and combination prescriptions from the current intervention. Exact part and processing mappings for individual S02 traditional records are unverified. - Why unverified: Major stated differences are verified, but comparisons of individual traditional-record identity, part and processing are missing. - Reason for missing information: Exact mappings of individual traditional originals to their forms of use are missing. - Required materials and conditions: Traditional records and relevant review sections, actual parts, processing, prescription composition and disease definitions. - Materials to obtain first: Traditional records and relevant review sections, actual parts, processing, prescription composition and disease definitions. - Further research: Classify records by part, processing and disease, marking matches and differences from the whole-lotus-root-juice question. - Conditions for verification: Compare traditional parts, processing and diseases with whole edible underground rhizome and the current bleeding endpoint. - Why this condition is needed: Lotus-leaf uterine-bleeding records, nodes, carbonized products and combination prescriptions could otherwise be merged into one intervention. - Application exceptions: Retain other-part records as background without adopting them as clinical results for the current intervention. - Remaining uncertainty: Similarity between traditional records and defined juice. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S02 ### N23 · Are S03's anaphylaxis event definition, diagnosis and collection context verified? Verification status: Partly verified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: S03 records 1 human case of anaphylaxis after lotus-root ingestion. Detailed diagnostic and collection procedures are unverified in this retained summary. - Why unverified: The original event description and case existence are verified, but actual diagnostic and collection details remain unverified. - Reason for missing information: Diagnostic evidence and detailed original case material remain unread. - Required materials and conditions: S03 diagnostic evidence, medical history, event timeline, reporting methods and original text. - Materials to obtain first: S03 diagnostic evidence, medical history, event timeline, reporting methods and original text. - Further research: Link actual case-event descriptions to identification procedures, distinguishing signals, comparative risks and causality. - Conditions for verification: Verify original event definitions, diagnosis and collection level for the reported post-ingestion anaphylaxis. - Why this condition is needed: Retain the human allergy signal while maintaining the verified level of diagnosis and causality. - Application exceptions: Do not require a case report to provide incidence data; retain it as safety context. This condition adds no mandatory efficacy-trial count. - Remaining uncertainty: Event-identification level and the scope of causal interpretation. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S03 ### N24 · Are S03's actual intake, preparation and event timeline verified? Verification status: Partly verified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The context of an event after lotus-root ingestion is retained, but exact dose, preparation, onset, recovery, withdrawal and re-exposure timelines are unverified. - Why unverified: Only the broad direction of ingestion followed by the event is known; formulation, amount and detailed temporal relations are unverified. - Reason for missing information: Original S03 exposure amount, preparation and detailed timeline material is missing. - Required materials and conditions: Case intake, product or food form, timeline, withdrawal and re-exposure records. - Materials to obtain first: Case intake, product or food form, timeline, withdrawal and re-exposure records. - Further research: Compare actual exposure and event timelines without determining causality from temporal order alone. - Conditions for verification: Verify case exposure amount, cooking or juice form, ingestion, onset, recovery, withdrawal and re-exposure times. - Why this condition is needed: A food-ingestion case cannot automatically serve as direct harm material for defined therapeutic-amount juice. - Application exceptions: Do not infer missing dose, preparation or latency, or invent improvement after withdrawal or re-exposure. - Remaining uncertainty: Whether direct application to harm from defined juice is possible. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S03 ### N25 · Are exposed-person denominators, observation periods and comparisons available to interpret anaphylaxis frequency? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: S03 concerns 1 person, but total lotus-root-exposure denominators, duration and background comparisons are missing. The manuscript also explicitly states that incidence is unverified. - Why unverified: Event counts alone cannot establish occurrence frequency or comparative risk. - Reason for missing information: Exposed-person denominators, duration, event-collection systems and comparisons are missing. - Required materials and conditions: Total exposed and affected counts, exposure and follow-up durations, collection systems and comparison conditions. - Materials to obtain first: Total exposed and affected counts, exposure and follow-up durations, collection systems and comparison conditions. - Further research: Assess only reported frequencies linked to denominators and time; do not convert case counts into incidence. - Conditions for verification: Verify frequency information linking people with events to exposed-person denominators, duration, collection systems and comparators. - Why this condition is needed: A report of 1 person does not establish the exposed-population denominator or incidence magnitude. - Application exceptions: Retain cases without controls or exposed denominators as signals. Do not require numerical harm-incidence certainty for the current efficacy question. - Remaining uncertainty: Harm frequency and the influence of selective reporting. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S03 ### N26 · Are the case's other foods, medications, allergy status and alternative explanations verified? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: S03 is summarized as lotus-root-associated anaphylaxis; details of concurrent foods, medication, baseline allergies and assessment of alternative causes are not retained. - Why unverified: Missing alternative-exposure and diagnostic material prevents assessment of sole causal contribution. - Reason for missing information: Original co-exposure, baseline-status and alternative-cause assessment material is missing. - Required materials and conditions: Case food and medication co-exposures, baseline allergies and diseases, and alternative-cause assessment records. - Materials to obtain first: Case food and medication co-exposures, baseline allergies and diseases, and alternative-cause assessment records. - Further research: Compare exposure, baseline status and diagnostic evidence, distinguishing assessed alternatives from unverified candidates. - Conditions for verification: Verify concurrent exposures, baseline allergies, other causes and assessment methods for the reported event. - Why this condition is needed: A report of an association with lotus root alone cannot establish a sole cause or confirmed causality. - Application exceptions: Without alternative-cause information, do not state that no other causes existed. - Remaining uncertainty: The sole contribution of lotus root and the extent of established causality. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S03 ### N27 · Is material available on therapeutic-amount juice in pregnancy, lactation, liver or kidney disease and drug interactions? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: Retained material distinguishes food-use experience from therapeutic-amount juice safety. Pregnancy, lactation, kidney and liver disease, and anticoagulant or antiplatelet interactions are unverified. - Why unverified: Direct safety material for the relevant vulnerable populations, drugs and therapeutic formulation is unverified. - Reason for missing information: Material matching the stated vulnerable-population and interaction scopes is missing. - Required materials and conditions: Population-specific exposure and harm collection for therapeutic-amount juice, long-term observation and anticoagulant or antiplatelet interaction material. - Materials to obtain first: Population-specific exposure and harm collection for therapeutic-amount juice, long-term observation and anticoagulant or antiplatelet interaction material. - Further research: If existing safety material becomes available, compare applicability by food versus therapeutic juice, vulnerable populations and concurrent drugs. - Conditions for verification: Verify direct safety information for relevant special populations, long-term use and drug interactions at matching formulation and exposure levels. - Why this condition is needed: Food experience or a case involving 1 person cannot establish safety in all populations and long-term exposure. - Application exceptions: Do not require all rare-harm studies for the narrow efficacy claim or create personal intake instructions. - Remaining uncertainty: Long-term and population-specific safety of therapeutic juice. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S03 ### N28 · Are actual funding, product supply and author interests verified for the three reports? Verification status: Unverified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: S01 and S02 are classified as academic research or review, but actual funding and COI are unverified. S03 funding and COI details are also unverified. - Why unverified: Beyond manuscript type classifications, material verifying actual funding, supply, employment and disclosures is missing. - Reason for missing information: Actual report-specific funding and conflict disclosures have not been acquired. - Required materials and conditions: Original S01, S02 and S03 funding, product-supply, author-affiliation, patent and COI disclosures. - Materials to obtain first: Original S01, S02 and S03 funding, product-supply, author-affiliation, patent and COI disclosures. - Further research: Link funding and disclosure levels to each report without turning missing information into independent funding or absence of bias. - Conditions for verification: Verify actual funding, product supply, employment, patents and disclosure levels for each report. - Why this condition is needed: Academic-research or review classifications do not prove actual independence. - Application exceptions: Do not automatically exclude material with identified conflicts or automatically treat no conflicts as no bias. - Remaining uncertainty: Independent funding, institutions and the scope of result attribution. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01, S02, S03 ### N29 · Were actually read material, external papers and abstracts, and individual historical access dates distinguished? Verification status: Met Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The retained summary's Korean, English and full structure were read. No new external access or reading occurred. The three citations lack individual access-level and access-date fields; the original review date 2026-09-08 is separate. - Why unverified: Actual actions and material-specific reading scopes are distinguished without inferring individual historical dates. - Reason for missing information: Separation of reading records is verified. Current verification of external full texts and abstracts and individual historical access levels remain unverified. - Required materials and conditions: Original retained input, citation locations, material types, actual access and reading events, and report-specific historical access records. - Materials to obtain first: Original retained input, citation locations, material types, actual access and reading events, and report-specific historical access records. - Further research: For newly acquired material, link identity, type, read locations and dates without promoting summary reading to full-text reading. - Conditions for verification: Separate current retained-summary reading from unattempted external access and unread material by item; leave absent historical access dates unrecorded. - Why this condition is needed: A bibliographic URL and original verdict review date do not prove current full-text reading or individual historical access dates. - Application exceptions: Access not attempted is not inaccessibility, and a PubMed URL is not a publisher full-text URL. - Remaining uncertainty: Current external-material content and actual historical access levels. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: S01, S02, S03 ### N30 · Can actual original search queries, execution dates, results and selection scope be verified? Verification status: Partly verified Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The manuscript reports PubMed and ClinicalTrials.gov searches combining plant parts, bleeding and PBAC. Evidence scope is limited to retained sources and the absence-proven flag is false. No new search occurred in this work. - Why unverified: Retained search context and absence limits are known, but original date-specific results, selection logs and completeness are unverified. - Reason for missing information: Detailed historical queries, execution dates and selection logs are missing. Worldwide absence is not claimed. - Required materials and conditions: Historical search queries, dates, results and selection records, with an explanation of the retained scope. - Materials to obtain first: Historical search queries, dates, results and selection records, with an explanation of the retained scope. - Further research: If search records are acquired, compare historical selection scope; distinguish additional searches as separately authorized events. - Conditions for verification: Verify actual date-specific queries, results and selection records as well as original sources and terms, limiting absence language to that scope. - Why this condition is needed: Failure to identify a study in a search differs from the absence of all clinical research or effects. - Application exceptions: No new search is performed in the current conversion, and original-search completeness is not certified. - Remaining uncertainty: Possible omissions in the retained search and the current literature state. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N31 · Are the original ?, unrecorded score, pre/post-correction human-study flags and review status preserved? Verification status: Met Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The current grade is ?, score is unrecorded and the no-human-study flag is false. Editorial records retain the historical true value and specify legacy-grade review with grade revalidation false. Evidence status records related human studies as true, direct efficacy and eligible comparisons as false, and proven absence as false. - Why unverified: Original values, types and pre/post-correction differences are preserved exactly without certification as a new final grade. - Reason for missing information: Historical preservation is verified. Clinical re-review of the original grade is incomplete. - Required materials and conditions: Original current grade, score, axes, evidence status, correction and editorial-review material, with change history. - Materials to obtain first: Original current grade, score, axes, evidence status, correction and editorial-review material, with change history. - Further research: For change events, compare version-specific originals and separately record display corrections, new clinical evidence and regrading. - Conditions for verification: Preserve actual types of original verdict, score and axes, with correction and review history, without certifying a new verdict. - Why this condition is needed: Current versus historical no-human-study flags could be mistaken for changed efficacy evidence or a new verdict. - Application exceptions: The original grade is a historical citation, not an inherited condition status, efficacy probability or new score. - Remaining uncertainty: Interpretation of the existing grade and flags and future review. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N32 · Was ID1965's cough and sputum question distinguished from the current menstrual-blood-loss claim? Verification status: Met Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The manuscript explains that ID1965 concerns bronchitis-related cough and sputum for the same whole lotus rhizome or juice, so it is not a duplicate. That individual original was not read in this work. - Why unverified: The other-effect boundary described in the current manuscript is preserved, with original-material nonreading explicit. - Reason for missing information: The current table's question separation is verified. Individual ID1965 evidence and content verification were not performed. - Required materials and conditions: Manuscript adjacent-claim identifiers and endpoint boundaries; actual material for that question in future separately scoped work. - Materials to obtain first: Manuscript adjacent-claim identifiers and endpoint boundaries; actual material for that question in future separately scoped work. - Further research: If authorized to address the adjacent question, review its original and material independently without automatically inheriting efficacy evidence from this table. - Conditions for verification: Distinguish the other effect of the same intervention explicitly described in the current manuscript as an independent question. - Why this condition is needed: Bronchitis-related cough and sputum and menstrual blood loss are different endpoints even for the same lotus rhizome or juice. - Application exceptions: Do not open ID1965's individual file in this work; record only the current manuscript's mention. - Remaining uncertainty: The actual scope of a separate adjacent-manuscript review. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N33 · Are optimal dose and persistence after stopping required as additional conditions for this narrow bleeding question? Verification status: Not applicable Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The current main question concerns direct comparison of menstrual blood loss. Actual eligible dose and duration are unverified, and direct material establishing optimal dose or persistence is also unavailable. - Why unverified: Optimal-dose and post-withdrawal persistence extensions are not additional mandatory conditions for the selected narrow main question. - Reason for missing information: Additional mandatory application of those extensions is not applicable. Direct material on actual dose and duration remains unverified. - Required materials and conditions: Actual direct-trial dose and duration material; direct dose comparisons and post-withdrawal follow-up only when addressing extensions. - Materials to obtain first: Actual direct-trial dose and duration material; direct dose comparisons and post-withdrawal follow-up only when addressing extensions. - Further research: If direct comparisons become available, examine original effects, dose comparisons and persistence as separate contrasts of interest. - Conditions for verification: Distinguish verification of actual original-claim dose and duration from extensions concerning optimal dose and persistence after stopping. - Why this condition is needed: This prevents unverified direct bleeding material from becoming judgments about optimal dose or long-term effects. - Application exceptions: Optimal dose and post-withdrawal persistence are not additional mandatory conditions for the current main question. Actual exposure and measurement duration remain addressed in N06 and N07. - Remaining uncertainty: Direct material needed for future extensions. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ### N34 · Are blood-loss results being extended to verified anemia treatment or replacement of standard care? Verification status: Not applicable Reading scope: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. - Current findings: The manuscript states that lotus root cannot be advertised as a hemostatic food, menstrual-loss reducer, anemia treatment or replacement for standard gynecological care. This table is limited to the menstrual-blood-loss question. - Why unverified: Independent efficacy judgments for anemia treatment and treatment replacement are outside the current main question's applicability. - Reason for missing information: Extension of the current endpoint is not applicable. Preserving original boundaries does not mean anemia or treatment-replacement material has been verified. - Required materials and conditions: Original bleeding result tables and separate anemia or standard-treatment comparisons, with original advertising boundaries. - Materials to obtain first: Original bleeding result tables and separate anemia or standard-treatment comparisons, with original advertising boundaries. - Further research: Even if direct results become available, assess other anemia and treatment-replacement endpoints and comparators as separate eligible questions. - Conditions for verification: Distinguish the selected menstrual-blood-loss endpoint from separate clinical questions about anemia treatment and treatment replacement. - Why this condition is needed: Blood-loss results would not automatically prove anemia correction or replacement of standard care. - Application exceptions: Do not require anemia or standard-treatment-replacement studies as additional mandatory conditions for the current bleeding endpoint. - Remaining uncertainty: Directness for future separate clinical questions. - Referenced methods: Existing method principles distinguish population, plant part, processing, formulation, dose, duration, comparator, denominators, missingness, bleeding measurement, between-group analysis, intervals, plans, study families, funding and harms. Detailed conditions are Chamgap’s own application. - Related sources: ## Evidence and sources ### S01 Ji 2015 older-adult lotus-rhizome/cucumber antioxidant pilot [PubMed](https://pubmed.ncbi.nlm.nih.gov/26193861/) Materials actually read: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. Findings recorded in the summary: Retained summary: a randomized pilot comparing lotus rhizome with cucumber in older adults, addressing oxidative and DNA-damage markers. The retained summary contains no menstrual-blood-loss result. Exact randomized/completed counts and actual funding/COI are unverified. PMID 26193861, PMCID PMC12878895 and DOI 10.1007/s12603-015-0524-x are retained identifiers. Record level: Distinguish the record of related human research from direct bleeding efficacy. Do not transfer another endpoint’s randomization or cucumber control to direct heavy-menstrual-bleeding design or results. Whole-paper nonreporting was not newly established. Independent replication: S01’s related human antioxidant pilot, S02’s narrative review and S03’s safety case report have different roles. Do not count 3 reports as 3 independent comparative heavy-menstrual-bleeding trials or sum participants. Unique trial, participant and direct-efficacy-trial counts are unrecorded. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | PubMed bibliography/abstract entry; actual current availability scope unverified | Current public availability unverified | External access not attempted; not acquired | Not read | This is the retained original PubMed URL. Current access, acquisition and reading were not attempted. A bibliographic link does not establish full-text reading. Past manuscript review descriptions are historical records. They do not establish actual external paper, abstract or registration reading or independent clinical certification in this work. The original review date is 2026-09-08, the historical correction date is 2026-09-14 and the case-record review date is 2026-10-05. Historical access level and access date for individual external materials are not recorded; current access was not attempted. | | Paper full text; actual full-text URL unrecorded | Current public availability unverified | External access not attempted; not acquired | Not read | The actual full-text URL is unrecorded and distinct from the bibliographic URL. No new full-text link was constructed from identifiers; current access, acquisition and reading were not attempted. Past manuscript review descriptions are historical records. They do not establish actual external paper, abstract or registration reading or independent clinical certification in this work. The original review date is 2026-09-08, the historical correction date is 2026-09-14 and the case-record review date is 2026-10-05. Historical access level and access date for individual external materials are not recorded; current access was not attempted. | ### S02 Paudel and Panth 2015 lotus traditional/preclinical narrative review [PubMed](https://pubmed.ncbi.nlm.nih.gov/27057194/) Materials actually read: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. Findings recorded in the summary: Retained summary: a narrative review of traditional hemostatic use, metrorrhagia and preclinical contexts. The review itself recruited no clinical participants and is summarized as providing no clinical PBAC or objective menstrual-blood-loss results. Individual traditional-record part, processing and disease mappings and actual funding/COI are unverified. PMCID PMC4710907 and DOI 10.1155/2015/789124 are retained identifiers. Record level: Retain as traditional/preclinical background. Non-applicability of the review itself as a direct trial means neither no participants in all included human research nor a null effect. Independent replication: S01’s related human antioxidant pilot, S02’s narrative review and S03’s safety case report have different roles. Do not count 3 reports as 3 independent comparative heavy-menstrual-bleeding trials or sum participants. Unique trial, participant and direct-efficacy-trial counts are unrecorded. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | PubMed bibliography/abstract entry; actual current availability scope unverified | Current public availability unverified | External access not attempted; not acquired | Not read | This is the retained original PubMed URL. Current access, acquisition and reading were not attempted. A bibliographic link does not establish full-text reading. Past manuscript review descriptions are historical records. They do not establish actual external paper, abstract or registration reading or independent clinical certification in this work. The original review date is 2026-09-08, the historical correction date is 2026-09-14 and the case-record review date is 2026-10-05. Historical access level and access date for individual external materials are not recorded; current access was not attempted. | | Paper full text; actual full-text URL unrecorded | Current public availability unverified | External access not attempted; not acquired | Not read | The actual full-text URL is unrecorded and distinct from the bibliographic URL. No new full-text link was constructed from identifiers; current access, acquisition and reading were not attempted. Past manuscript review descriptions are historical records. They do not establish actual external paper, abstract or registration reading or independent clinical certification in this work. The original review date is 2026-09-08, the historical correction date is 2026-09-14 and the case-record review date is 2026-10-05. Historical access level and access date for individual external materials are not recorded; current access was not attempted. | ### S03 Nishimura-Tagui 2020 anaphylaxis case after lotus-root ingestion [PubMed](https://pubmed.ncbi.nlm.nih.gov/32232879/) Materials actually read: The retained Korean/English summaries and case-specific condition/application records were read. External abstracts, full texts, registration, protocols and analysis plans remain unread; access was not attempted. Findings recorded in the summary: Retained summary: 1 reported anaphylaxis case after lotus-root ingestion. Intake, cooking/juice status, onset/recovery/withdrawal/re-exposure timeline, diagnosis, concurrent foods/drugs, alternative causes, total exposed denominator, incidence, funding and COI are unverified. PMID 32232879 and DOI 10.1111/1346-8138.15329 are retained identifiers. Record level: Retain as a safety signal without converting it to direct heavy-menstrual-bleeding efficacy, a null result, established causality or incidence. Do not newly determine harm from defined therapeutic-amount juice or personal risk. Independent replication: S01’s related human antioxidant pilot, S02’s narrative review and S03’s safety case report have different roles. Do not count 3 reports as 3 independent comparative heavy-menstrual-bleeding trials or sum participants. Unique trial, participant and direct-efficacy-trial counts are unrecorded. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | PubMed bibliography/abstract entry; actual current availability scope unverified | Current public availability unverified | External access not attempted; not acquired | Not read | This is the retained original PubMed URL. Current access, acquisition and reading were not attempted. A bibliographic link does not establish full-text reading. Past manuscript review descriptions are historical records. They do not establish actual external paper, abstract or registration reading or independent clinical certification in this work. The original review date is 2026-09-08, the historical correction date is 2026-09-14 and the case-record review date is 2026-10-05. Historical access level and access date for individual external materials are not recorded; current access was not attempted. | | Paper full text; actual full-text URL unrecorded | Current public availability unverified | External access not attempted; not acquired | Not read | The actual full-text URL is unrecorded and distinct from the bibliographic URL. No new full-text link was constructed from identifiers; current access, acquisition and reading were not attempted. Past manuscript review descriptions are historical records. They do not establish actual external paper, abstract or registration reading or independent clinical certification in this work. The original review date is 2026-09-08, the historical correction date is 2026-09-14 and the case-record review date is 2026-10-05. Historical access level and access date for individual external materials are not recorded; current access was not attempted. | ## Review criteria and methods These are Chamgap's own application conditions, informed by the relevant sections of official methodological guidance. They do not constitute official assessment-tool certification or a new efficacy score. - M03 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03) · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13 · Clearly record the question, eligibility conditions and reasons for changes; distinguish intervention variants. · Retained method-application records were reused. External originals were not reread and method content was not reassessed. - M04 [Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04) · §4.5, §4.6.1–4.6.3, MECIR C42 · Link studies and reports separately; do not omit studies solely because results are unreported. · Retained method-application records were reused. External originals were not reread and method content was not reassessed. - M08 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08) · §8.1–8.2.3, Table 8.2.a · Fix the result and effect of interest when examining randomization, deviations, missingness, measurement and selective reporting. · Retained method-application records were reused. External originals were not reread and method content was not reassessed. - M15 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15) · §15.2.4, §15.3.1–15.3.3 · Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision. · Retained method-application records were reused. External originals were not reread and method content was not reassessed. - M19 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19) · §19.1.2, §19.2.1–19.2.4 · Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence. · Retained method-application records were reused. External originals were not reread and method content was not reassessed. ## What the statuses mean - Met: The item’s boundary or record is verified from retained material; this does not verify a clinical effect. - Partly verified: Only some required information is verified; actual remaining evidence gaps are distinguished. - Unverified: Required information is unverified within the retained material read. This does not mean no studies or an effect of 0. - Not applicable: Only the specified applicability exception applies; this does not replace unread or insufficient material. - Not read: External material content was not read in this work; this differs from access failure or paper nonreporting. ## Change history 2026-10-28 · Public page/materials 1.0. The public view and materials were prepared from the existing 34 items. No new clinical search, verification-state change or scoring was performed.