Exactely what is does is hard to determine. It gives a random result on each use which includes boss spawning. Buff adding, gifting and killing the player. It is perhaps one of the best items added in 1.4 and will give a different result on each use. It is crafted from 1 Odd Acorn,1 Cursed Acorn, 1 Crocodile Scales and 10 Soul of Death.