Hawthorn (Crataegus oxycantha)

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What is Hawthorn?

Hawthorn is a handsome tree, growing to just a few meters in height and sporting small white flowers and bright red berries. It's popular in gardens across North America and in parts of Europe and Australia.

The flowers and berries of the tree are used in Western herbal medicine to treat a range of cardiovascular conditions and can be used as a preventative measure against heart disease.

Today, cardiovascular disease remains the number one killer in developed parts of the world. The benefits hawthorn offers towards cardiovascular function, and the plant's prevalence worldwide making it an outstanding candidate for future medicines against heart disease.

Aside from cardiovascular disease, hawthorn is commonly used to treat anxiety conditions and topically to treat acne and dry skin.

The berries are high in vitamin C.

 

+ Indications

  • Hyperlipidemia
  • As a preventative treatment for coronary artery disease
  • Cardiac arrhythmias
  • heart palpitations
  • Age related heart disease
  • Angina pectoris
  • Tachycardia
  • Mild congestive heart failure
  • Recovery from myocardial infarction
  • Infections of diptheria and pneumonia
  • Atherosclerosis
  • Anxiety
  • As a cofactor for vitamin C

Topical Uses

  • Acne
  • To improve hydration of the skin and hair

+ Contraindications

  • Caution advised with cardiovascular patients

Herbal Actions:

  • Cardiotonic
  • Diuretic
  • Astringent
  • Hypotensive
  • Antioxidant
  • Collagen Stabilizer
  • Hypocholesterolemic
  • Anti-Arrhythmic
 

What is Hawthorn Used For?

The main use of hawthorn is for treating cardiovascular disease. The flowers and berries contain a slurry of chemicals with well-studied effects on the cardiovascular system. Hawthorn dilates the coronary arteries, provides arteriole protection through antioxidant activity, regulates abnormal heart rhythms, and improves microcirculation.

All of these effects from a single plant make hawthorn an important herb for treating and preventing a range of cardiovascular conditions. Hawthorn is used to lower cholesterol and triglycerides, treat heart palpitations and other forms of arrhythmia, improve the contractibility of the heart for congestive heart failure and improve diminished blood flow with COPD.

 

Traditional Uses of Hawthorn

Western Herbal Medicine

There is a lot of reference to hawthorn in older texts, and much of the indications are towards cardiac diseases and circulation. It was used in the past to treat conditions including tachycardia, hypertention, angina pectoris, and myocardial weakness. The berries were also used as an astringent for sore throats, and as a diuretic. [3].

Traditionally the berry was mainly used, however more recent findings suggest the leaves to have a stronger action medicinally [3].

Hawthorn has also been extensively used as a source of wood, and the berries as a flavouring of liquor. [3].

The British herbal pharmacopoeia lists crataegus as cardiotonic, coronary vasodilator, and hypotensive specific for cardiac failure, myocardial weakness, hypertension, arteriosclerosis, Buergers disease, and paroxysmal tachycardia [13].

Traditional Chinese Medicine

In Chinese medicine, the fruit was often used to improve digestion, stimulate circulation, and treat blood stasis. [3].

 

Herb Details: Hawthorn

Weekly Dose

Part Used

  • Berries, flowers, leaves

Family Name

  • Rosaceae

Distribution

  • North America
    Europe

Constituents of Interest

  • Vitexin
  • Quercetin
  • Hyperoside
  • Crataegolic acids

Common Names

  • Hawthorn
  • Crataegus
  • Aubépine (France)
  • Biancospino (Italy)

CYP450

  • Unknown

Quality

  • Slightly Warm

Pregnancy

  • Unknown

Taste

  • Sweet and Sour

Duration of Use

  • Long-term use acceptable.
 

Botanical Information

Hawthorn is a member of the Rosaceae family of plants, which comprises some 91 genera and 4828 different species. The Crataegus genus contains 260 different species, several of which are used medicinally.

Crataegus is a deciduous, thorny shrub or small tree that can grow up to 10m tall. [3].

The leaves are broad and have 3-5 lobes. [3].

The flowers are white, have red anthers, and arranged in groups of 5 or 10 [3].

The fruit is contained within a larger, dark red colored false fruit [3].

There is extensive hybridization of Crataegus in general, which has led to some confusion with the classification of many species contained in the genus [3].

 

Harvesting Collection, and Preparation:

Although traditionally the berries were preferred, in general it has been found that the leaves offer the most benefit towards cardiovascular disease [3].

 

Pharmacology & Medical Research

Cardiovascular System

The German Federal Ministry of Health conducted a four year study on Crataegus and its activity on the cardiovascular system, which resulted with the inclusion of Crataegus as a recognized cardiac medication in Europe. [1].

Much of the research on hawthorn has been aimed at its activity on the cardiovascular system.

To date, evidence towards crataegus benefits on the entirety of the cardiovascular system includes:

  • Coronary artery dilation [3, 4]
  • Antioxidant activity [24]
  • Positively inotropic [3, 4]
    • improves the availability and utilization of energy in the myocardium rather than directly impacting contractile fibers like cardiac glycosides [1].

Coronary artery dilation

The coronary artery dilation has been found to be through the crataegolic acid and ursolic acid content, and various flavonoids (such as vitexin-2"-)'rhamnoside, luteolin-7-glucoside, hyperoside, rutin, and vitexin), and the oligomeric procyanidins (OPCs) [4].

the ability for hawthorn to improve coronary blood flow was reproduced in dogs (with oral administration) [8].

Antioxidant activity

The antioxidant activity of Crataegus is suggested to be mainly due to the flavonoids present in the leaves, flowers, and berries. These chemicals are strong antioxidant chemicals and have also been shown to produce the ability to increase collagen cross-linkiung in the walls of vascular tissue. This strengthens the blood vessels and dcan significantly reduce the risk of cardiovascular disease. [1].

Positively Inotropic

The inotropic activity was found to be due to the cratagolic acid, ursolic acid, and vitexin-2"-O-rhamnoside (flavonoid) content in an older study [4]. The action was found in another study to be through an increase in the contraction amplitude of the cardiac myocytes in an in vitro study [5].

This activity has been reproduced in several studies using standardized leaf and flower extracts [7].

Antiarrhythmic

The antiarrhithmic activity of Crataegus was explored through in vitro testing of caridac tissue. The mechanism was suggested to be likely through a prolonged refractory period brought on by the beta-adrenergic agonist activity of crataegus constituents [6].

Microcirculation

The OPC content of Crataegus was shown in several studies to promote bloodflow in both the aorta and microcirculation, through nitric-oxide mediated relaxation and inhibitory action on angiotensin converting enzyme (ACE) both in-vitro and in vivo [9, 10, 11, 12].

 

Phytochemistry

Hawthorn Berries

The berries of the hawthorn tree contain flavonoids, amines, catechols, carboxylic acid, and triterpene acids [3].

Hawthorn Leaves & Flowers

The leaves contain flavonoids (up to 1.78%) (including vitexin, quercetin, hyperoside, rutin), oligomeric procyanidins (1-2.4%), triterpene acids (up to 0.6%) (ursolic acid, oleanic acid, crataegolic acids), phenolic acids (caffeic, chlorogenic, and related phenocarboxyl acids), [1-3].

A Note on Concentrated Extracts of Hawthorn

There have been multiple reports of studies using isolated constituents showing very little or no significant activity when compared to the whole herb extract. The whole extract has been found to consistently produce noticeable, and broad actions, especially on the cardiovascular system [1]. For this reason, only the whole herb extract should be used.

 

Clinical Applications Of Hawthorn:

The coronary artery dilating activity of hawthorn makes it useful for treating coronary artery disease and angina. The high level of safety with this herb and a broad range of other cardiovascular effects have made this a staple in those at risk for cardiovascular disease or those who have suffered a myocardial infarct in the past. Hawthorn is also useful for lowering high cholesterol levels, high triglyceride levels, treating atherosclerosis, heart palpitations, arrhythmias, and congestive heart failure.

 

Cautions:

Due to the action around heart function, crataegus may enhance the activity of cardiac glycosides such as digitalis, or Convellaria majalis. This may improve the effectiveness of these drugs/herbs, and allow for smaller, more effective doses. Caution is advised when using these medications. [1]. 

 

Toxicity

There are no reported long term adverse effects with using hawthorn in the therapeutic dosage range, and long term use is recommended for cardiovascular disease with this herb [3]. 

 

Synergy

Often used in conjunction with Tilia platyphyllos, Allium sativum, or Viburnum opulus for arteriosclerosis [1]. There may be possible synergy here.

Combines well with Tilia and Scutellaria for hypertension [1].

Crataegus has been reported to have synergy with digitalis glycosides and beta-blockers. No adverse interactions have been reported with digoxin. [3].

The British herbal pharmacopeia suggests crataegus has possible synergy with Selenicereus grandiflorus, Tilia, Viscum, or Scutellaria [13].

 

Author:

Justin Cooke, BHSc

The Sunlight Experiment

(Updated May 2019)

 

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References:

  1. Hoffmann, D. (2003). Medical herbalism: The science and practice of herbal medicine. Rochester, VT: Healing Arts Press

  2. Blumenthal, M., Brinckmann, J., & Wollschlaeger, B. (2003). The ABC clinical guide to herbs. Austin, TX: American Botanical Council.

  3. Bone K, Mills S. (2013). Principles and Practice of Phytotherapy. Elsevier health. China. (Pg. 392-398).

  4. Occhiuto, F., Circosta, C., Costa, R., Briguglio, F., & Tommasini, A. (1986). Comparative study of the cardiovascular activity of shoots, leaves and flowers of Crataegus oxyacantha: 2. Action of extracts and isolated pure active principles on the isolated rabbit heart. Plantes medicinales et phytotherapie, 20, 52-63.

  5. Petkov, E., Nikolov, N., & Uzunov, P. (1981). Inhibitory effect of some flavonoids and flavonoid mixtures on cyclic AMP phosphodiesterase activity of rat heart. Planta Medica, 43(10), 183-186.

  6. Pöpping, S., Rose, H., Ionescu, I., Fischer, Y., & Kammermeier, H. (1995). Effect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomyocytes. Arzneimittel-Forschung, 45(11), 1157-1161.

  7. Trunzler, G., & Schuler, E. (1962). [Comparative studies on the effect of a Crataegus extract, of digitoxin, digoxin and gstrophanthin on the isolated mammalian heart.]. Arzneimittel-Forschung, 12, 198-202.

  8. Roddewig, C., & Hensel, H. (1977). [Reaction of local myocardial blood flow in non-anesthetized dogs and anesthetized cats to the oral and parenteral administration of a Crateagus fraction (oligomere procyanidines)]. Arzneimittel-Forschung, 27(7), 1407-1410.

  9. Kim, S. H., Kang, K. W., Kim, K. W., & Kim, N. D. (2000). Procyanidins in crataegus extract evoke endothelium-dependent vasorelaxation in rat aorta. Life sciences, 67(2), 121-131.

  10. Brixius, K., Willms, S., Napp, A., Tossios, P., Ladage, D., Bloch, W., ... & Schwinger, R. H. (2006). Crataegus special extract WS® 1442 induces an endothelium-dependent, NO-mediated vasorelaxation via eNOS-phosphorylation at serine 1177. Cardiovascular drugs and therapy, 20(3), 177-184.

  11. Anselm, E., Socorro, V. F. M., Dal-Ros, S., Schott, C., Bronner, C., & Schini-Kerth, V. B. (2009). Crataegus special extract WS 1442 causes endothelium-dependent relaxation via a redox-sensitive Src-and Akt-dependent activation of endothelial NO synthase but not via activation of estrogen receptors. Journal of cardiovascular pharmacology, 53(3), 253-260.

  12. Lacaille-Dubois, M. A., Franck, U., & Wagner, H. (2001). Search for potential angiotensin converting enzyme (ACE)-inhibitors from plants. Phytomedicine, 8(1), 47-52.

  13. British Herbal Medicine Association. (1983). British Herbal Pharmacopoeia. Bournemouth, UK: Author.

  14. Bone, K. (2003). A clinical guide to blending liquid herbs: Herbal formulations for the individual patient. Edinburgh [u.a., MO: Churchill Livingstone.

  15. Broken source

  16. Pittler, M. H., Schmidt, K., & Ernst, E. (2003). Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. The American journal of medicine, 114(8), 665-674.

  17. Veveris, M., Koch, E., & Chatterjee, S. S. (2004). Crataegus special extract WS® 1442 improves cardiac function and reduces infarct size in a rat model of prolonged coronary ischemia and reperfusion. Life Sciences, 74(15), 1945-1955.

  18. Krzeminski, T., & Chatterjee, S. S. (1993). Ischemia and early reperfusion induced arrhythmias: beneficial effects of an extract of Crataegus oxyacantha L. Pharm Pharmacol Lett, 3, 45-48.

  19. Al Makdessi, S., Sweidan, H., Dietz, K., & Jacob, R. (1999). Protective effect of Crataegus oxyacantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart. Basic research in cardiology, 94(2), 71-77.

  20. Holubarsch, C. J., Colucci, W. S., Meinertz, T., Gaus, W., & Tendera, M. (2008). The efficacy and safety of Crataegus extract WS® 1442 in patients with heart failure: The SPICE trial. European journal of heart failure, 10(12), 1255-1263.

  21. Daniele, C., Mazzanti, G., Pittler, M. H., & Ernst, E. (2006). Adverse-Event Profile of Crataegus Spp. Drug safety, 29(6), 523-535.

  22. Taskov, M. (1977). On the coronary and cardiotonic action of crataemon. Acta physiologica et pharmacologica Bulgarica, 3(4), 53-57.

  23. Schüssler, M., Hölzl, J., & Fricke, U. (1995). Myocardial effects of flavonoids from Crataegus species. Arzneimittel-Forschung, 45(8), 842-845.