A Spin on Crataegus: East vs. West View on the Quintessential Heart Health Herb

By Heather Tynan, ND

If you know herbs and heart health, you know hawthorn (Crataegus spp).

This plant is well known for its gentle yet powerful tonification effects on the heart and the entire cardiovascular system, notably its ability to moderately lower blood pressure.

This is how we Western herbalists tend to know Crataegus, anyway.

If we look toward Eastern medicine, we find this herb being used similarly, but with the addition of some significant therapeutic applications. 

In this article, we take a deep dive into Crataegus. From reviewing medicinal actions from both an Eastern and Western perspective to discussing history and constituents to discovering the most popular Chinese herbal formula featuring this herb and more, you will walk away with no other option but to make this plant an intimate medical ally – if you haven’t already!

The Rich History of Hawthorn

Hawthorn is one of those conveniently well-studied, widely used, and historically rich herbs on which we have much ancient text and current data. The wealth of knowledge on its traditional uses, constituents, and modern applications makes it one of the rare plant medicines that have even been incorporated, at least to some extent, into Western biomedicine. Many cardiologists, in particular, have become more and more aware of its heart-related uses because approximately one in three heart failure patients purported to seek out complementary and alternative remedies for their condition, landing them on this popular herb.¹²

Historically, hawthorn was used for a wide variety of ailments. Writings from Pietro Andrea Mattioli (1501-1578), who translated and commented on the treatise of Dioscorides, name fever, thirst, “bilious pestilent exhaustion,” colic, vomiting of food, dysentery, bile regurgitation, excessive menstruation, hematorrhea, loose teeth, and diseased gums, “stomach worms,” pharyngitis, wounds both recent and aged, cardiac pain due to cold or shortness of breath, liver inflammation, and excessive tearing of the eyes as conditions for which hawthorn could be effectively applied.⁶ Many of these are likely to be attributed to hawthorn’s astringency. In contrast, others intimate other physiological actions of this herb, some of which will be discussed below to modern and traditional Western and Eastern applications.

Amongst the numerous Crataegus species found worldwide, many are used medicinally. C. monogyna and C. laevigata are the primary hawthorn species historically found and utilized for food and medicine in Central Europe, C. pentagyna, C. nigra, and C. azarolus are used in southern and southeastern Europe, and C. pinnatifida and C. scabrifolia in China.¹⁴

Scientific Research on Hawthorn’s Cardiovascular Benefits

Research elucidating the chemical composition and repeatedly demonstrating the effectiveness of hawthorn in treating cardiovascular conditions has shed much light on current understandings of this herb and paved the way for confident clinical use. 

The major areas of research around this herb focus on its cardiovascular properties. Hawthorn preparations have shown both research-based and clinical empirical benefits for the early stages of congestive heart failure, angina, elevated blood pressure, and minor arrhythmia. Studies examining these actions have demonstrated hawthorn’s effectiveness in heart rate reduction, exercise tolerance improvements, and decreases in serum lipid levels and blood pressure.²

Key Constituents and Parts Used in Hawthorne 

Amongst hawthorn’s primary components are flavonoids (0.1%-1% in fruits, 1%-2% in leaves and flowers),¹⁰ oligomeric proanthocyanidins (OPCs, 1%-3% in fruits or leaves with flowers)¹, triterpene acids (0.5%-1.4% in fruits), organic acids (2%-6%), sterols, and trace amounts of cardioactive amines.⁴ Flavonoids and OPCs are considered the two main types of bioactive constituents responsible for hawthorn’s therapeutic effects; many hawthorn preparations are thus standardized based on their content of both flavonoids and OPCs.² Berries, seeds, flowers, and leaves are all used for medicine, with similar active molecular component profiles.¹²

Western Herbal Applications of Hawthorn

Hawthorn’s berries, flowers, leaves, or any combination of these traditionally have been used for their astringent, cardiotonic, hypotensive, diuretic, antispasmodic, and antiatherosclerotic effects.¹⁴ Cardiovascular conditions for which hawthorn is used include heart failure, hypertension with insufficiency of the heart muscle, mild arrhythmias, angina, and atherosclerosis.² 

Other functions of hawthorn include acting as a CNS sedative, antioxidant, adaptogen, cardiac trophorestorative, cardioprotective, coronary vasodilator, and peripheral vasodilator, as well as stabilizing collagen and reducing myocardial oxygen demand. Preparations used include teas, tinctures, powders, extracts, and syrups.⁹

Formal and empirical evidence for the traditional use of hawthorn in Western herbal practice reinforces its traditional use in cardiology. Can we expand our view of this herb and discover newfound perspectives and applications gleaned from our herbalist counterparts in the East?

Hawthorn in Traditional Chinese Medicine 

The hawthorn tree is cultivated primarily in northeast China, Beijing, Tianjin, Liaoning, Hebei, Taihang Mountains, and Shandong. Leaves and berries are harvested in summer and autumn. According to the 2020 Chinese Pharmacopoeia, hawthorn’s therapeutic effects include activation of blood circulation and elimination of blood stasis, invigoration of Qi, which better moves the blood and helps eliminate turbidity, and consequent reduction in serum lipid levels.⁵

Shan Zha, 山楂, specifically the hawthorn berry, is the main plant part used in the millennia-old practice of Chinese herbal medicine. It falls under the category “herbs that relieve food stagnation (digestives),” emphasizing stagnation caused by excessive intake of meats and greasy foods. It is also mainly quoted for its use in cases of abdominal distention and pain, hernia, and hypertension. Its taste is sour and sweet, its temperature is slightly warm, and the entering channels are the Liver, Spleen, and Stomach. The Chinese Materia Medica expands upon what is discussed above from the Pharmacopoeia and lists four main actions of Shan Zha. The first is reducing and guiding out food stagnation and transforming accumulations, particularly when there is an accumulation of meats and fats with abdominal distention, pain, or diarrhea. The second is transforming blood stasis, invigorating blood circulation, and dissipating clumps, with major indications for this comprising postpartum abdominal pain and clumping due to blood stasis and hernial disorders. Next, Shan Zha stops diarrhea in “chronic dysentery-like disorders;” it works best in its toasted form for this function. Finally, its fourth use looks familiar: treating hypertension, high serum cholesterol, angina, and coronary artery disease.¹¹

In Eastern medical traditions, it is common to find medical recommendations that fall under “food therapy.” Natural foods, like herbs, are determined to have properties (temperature, flavor, entering channels, etc.) that can help or hinder healing depending on the presenting imbalance. Shan Zha is consumed in China and Europe as medicine and food (jam or jelly, wine, canned fruit, and so on).² It is rich in amino acids, choline, pectin, minerals, vitamin C, chlorogenic acid, and epicatechol, providing therapeutic value.¹⁴

Research Studies: Eastern Perspective on Hawthorn

Uncovering clinical studies and research reviews on the digestive action of hawthorn is more complex than sifting through the abundance of articles related to cardiovascular health, particularly when filtering by studies involving human cohorts. A study by Wei et al. noted that raw and charred hawthorn effectively reduced functional dyspepsia, perhaps by helping regulate the intestinal microbiome in rats.¹³ A human study measuring the effects of hawthorn syrup versus a placebo syrup on gastroesophageal reflux disease demonstrated a significant reduction in both heartburn and regurgitation.⁸ While empirical evidence gathered through hundreds to thousands of years of Chinese herbal history supports the use of hawthorn in cases of indigestion and “food stagnation,” formal investigations via randomized, double-blind, placebo-controlled type studies are lacking. 

Popular Chinese Herbal Formulas featuring Hawthorn 

In Chinese medical tradition, herbs are rarely used singly. The preferred form of herbal intake is typically as part of an artfully blended formula, which is balanced and synergized. It often works more effectively and harmoniously in the body than single herbs can. The most widely used formula featuring Shan Zha is the common food stagnation formula, Bao He Wan.

Bao He Wan’s chief herb is, no surprise, hawthorn; it also features six other herbs that help reduce food accumulation, strengthen the Spleen, transform Damp/Phlegm, and move Qi, especially in the Middle Jiao. Taking hawthorn as a single herb or Bao He Wan as a formula, stagnation looks slightly different for food than it does when it is taken for cardiovascular health; dosing is acute, and the herb(s) act quickly on the digestive system.

Bao He Wan is not the only Chinese herbal preparation containing hawthorn as an integral component. Two other examples are Yi Xin Tong and Xin’an capsules, both employed for their medicinal effects on the cardiovascular system.⁵

Therapeutic Dosages of Hawthorn

The therapeutic dosage of hawthorn depends on the preparation type. Western herbalism most commonly acknowledges 120-240 mg TID of standardized extract, 2-4 mL TID of 1:5 tincture, or 1-2 tsp of berry steeped for 15 minutes in one cup of water as therapeutic hawthorn doses. In Eastern tradition, the equivalent of 9-12 g of dried berry taken BID-TID in various forms (tea, tincture, or pill) is considered the medicinal dose. Measuring the therapeutic effects of hawthorn takes time; one must continue taking this herb for at least 4-8 weeks before full actions are seen.² 

Safety, Side Effects, and Interactions

Adverse effects of hawthorn are infrequent and mild when they do occur; this is considered a safe herb with a wide therapeutic range, and there are no known incidents of serious events due to its use.³ In Western herbalism, this herb is generally considered safe during pregnancy, although consultation with a qualified professional is always advised.⁷ In the Chinese medical tradition, which, like Western herbalism, categorizes herbs as safe, cautioned, or contraindicated in pregnancy, hawthorn is strictly contraindicated. Most herbs in the contraindicated category live there because of their ability to stimulate the uterus and cause contractions, but not so of hawthorn, which instead is traditionally considered to possess the ability to cause fetal death when taken in large doses during pregnancy.¹¹

While studies have not confirmed the following interactions, due to overlapping activity, hawthorn may potentiate cardiovascular herbs such as digitalis, beta-blockers, and other hypotensive agents. Adjustments in dosages of these drugs taken may be required alongside hawthorn use.²

CONCLUSION: Hawthorn as a Global Herbal Ally

Hawthorn is a safe, accessible, formally researched, and multi-use herb implemented for many types of healing by both Eastern and Western practitioners across nations and time. From heart to stomach, China to Europe to the Americas and beyond, it is a tried and true member of the worldwide herbal repertoire.

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References

1. Blumenthal M, Goldberg A, Brinckmann J, et al. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications, 2000.
2. Chang Q, Zuo Z, Harrison F, Chow M. Hawthorn. The Journal of Clinical Pharmacology. 2002;42(6): 605-612.
3. Daniele C, Mazzanti M, Pittler M, Ernstet E. Adverse-event profile of Crataegus spp. A systematic review. Drug safety. 2006;29: 523-535. 
4. Gao GY, Feng YX, Qin XQ. Analysis of the chemical constituents of hawthorn fruits and their quality evaluation. Yaoxue Xuebao. 1995;30: 138-143.
5. Guo W, Shao T, Peng Y, Yang H, et al. Chemical composition, biological activities, and quality standards of hawthorn leaves used in traditional Chinese medicine: a comprehensive review. Frontiers in Pharmacology. 2023;14: 1275244.
6. Herbs in History: Hawthorn. [Web Page}. https://www.ahpa.org/herbs_in_history_hawthorn. Accessed January 5, 2025.
7. Mills S, Bone K. Principles and Practice of Phytotherapy. London: Churchill Livingstone, 2000. 
8. Moeini F, Jafarian A, Aletaha N, Naderi N, et al. The Effect of Common Hawthorn (Crataegus monogyna Jacq.) Syrup on Gastroesophageal Reflux Disease Symptoms: The effects of hawthorn syrup on gastroesophageal reflux symptoms. Iranian Journal of Pharmaceutical Sciences 2016;12(4): 69-76.
9. The Naturopathic Herbalist: Crataegus oxycantha. [Web page]. https://thenaturopathicherbalist.com/herbs/c-2/crataegus-oxycantha-hawthorne/. Accessed January 4, 2025.
10. Rehwald A, Meier B, Sticher O. Qualitative and quantitative reversed-phase high-performance liquid chromatography of flavonoids in Crataegus leaves and flowers. J Chromatogr. 1994;677: 25-33.
11. American Dragon: Shan Zha. [Web page]. https://www.americandragon.com/Individualherbsupdate/ShanZha.html. Accessed January 2, 2025.
12. Tassell M, Kingston R, Gilroy D, Lehane M, et al. Hawthorn (Crataegus spp.) in the treatment of cardiovascular disease. Pharmacognosy reviews. 2010;4(7): 32.
13. Wei A, Ai L, Chen X, Li L, et al. Comparative studies on the regulatory effects of raw and charred hawthorn on functional dyspepsia and intestinal flora. Tropical Journal of Pharmaceutical Research. 2019;18(2): 333-339.
14. Zhang J, Chai X, Zhao F, Hou G, et al. Food applications and potential health benefits of hawthorn. Foods. 2022;11(18): 2861.