Hawthorn

Botanical Name: Crataegus oxycanthoides, Rosaceae

Botanical synonyms: C. laevigata (Mills and Bone 2000, 439).

Common names: Hawthorn, Mayblossom, Whitethorn, Haw

Similar species: Crataegus monogyna, C. douglasii, C. columbiana, C. viridis, C. phaenopyrum, C. cuneata, C. pinnatifida, etc.

Plant description: Hawthorn is a thorny deciduous shrub or small tree, but occasionally reaching a height up to 10 m, found throughout the most temperate regions of the world. C. oxycanthoides leaves are 3-5 lobed, with stipules; C. monogyna leaves are deeply lobed, almost like an oak-leaf; C. douglasii has 5-9 lobed leaves; all leaves of the various species are quite thick and leathery, dark-green above and paler below. Among wild or naturalized species the flowers are generally white, with 5 petals and 10-20 stamens, borne in terminal clusters or in the leaf axils; the odor in some species quite ‘stinky.’ The pink or red-flowered cultivars are generally not used medicinally. The fruit is brilliant red, almost looking like a tiny apple, but beneath the skin the fruit is comprised of a bland white to yellow fleshy meal that surrounds one or more large seeds. In some species (e.g. C. pinnatifida) the fruit is quite large, fleshy, sweet and sour.

Habitat, ecology and distribution: Crataegus species are typically found in moist, open places, at the edge of forests, in thickets, and along shorelines, steam banks, roadsides and coastal bluffs, at low to mid elevation.

Part used: Flowers, leaves, fruit.

History: Hawthorn has a long history of use, and was considered sacred by many traditions. The flowering branches of the Hawthorn tree heralded the beginning of the ancient Celtic festival of Beltane, and for this reason was called the ‘Mayflower.’ According to Celtic tradition, the Hawthorn tree represented the Goddess, and was inhabited or surrounded by faeries and elemental spirits. Villagers would gather the blossoms on Beltane to decorate their homes, or tie pieces of cloth or ribbon onto the branches to honor the nature spirits. Later, under Christian influence, the significance of Hawthorn changed considerably, and rather than being associated with fertility and abundance, became thought of as an unlucky tree, representative of purity, chastity and cleansing. Despite this gradual change in how it was perceived Hawthorn continued to be used as a protective remedy, the flowers and leaves kept as in a sachet or a small piece of the wood inscribed and kept as a talisman to ward off evil influences – probably this is where the idea of using a Hawthorn stake to kill a vampire evolved. Hawthorn is also said to be the same plant from which Crown of Thorns was fashioned. Its common name ‘Haw’ or ‘hedge’ suggests that is was at one time used by landowners to distinguish individual plots of land. In Western herbal medicine, the use of Hawthorn as an important remedy is figured to be relatively recent, first mentioned as an ingredient of Sirupus Senelorum, a remedy prepared for Henry IV of France (1533-1610). It was adopted into the material medica relatively late by the physiomedical and eclectic physicians. The botanical name comes from the Greek word kratos, meaning ‘hard,’ and oxus (sharp) akantha (thorn). Some of the larger, sweeter and sour species of fruit are consumed as a food and prepared as a preserve.

Constituents: Hawthorn is noted for its flavonoid glycosides, which include flavonols (e.g. quercitin, hyperoside, kaempferol) and flavones (e.g. vitexin, apigenin, luteloin), as well the oligomeric procyanidins (e.g. epicatechin, catechin) and proanthocyanidins. Hawthorn also contains cyanogenetic, phenolic, saponin and triterpenoid glycosides, as well as various amines, carboxylic acid, condensed tannins (e.g. phlobaphene) and sugars (Duke 1992; Newall et al. 1996, 157; Mills and Bone 2000, 440; Mills 1991, 403). In general, the flowers contain the highest level of flavonoids (Mills and Bone 2000, 440).

Medical Research: Hawthorn has undergone a considerable degree of scientific investigation. In experimental models, Hawthorn has demonstrated positively inotropic (increasing myocardial tone), negatively chronotropic (normalizing the heart rhythm), cardioprotective, vasodilatory, antioxidant, hypocholesterolemic, anti-inflammatory, antitumor and collagen stabilizing activities (Mills and Bone 2000, 440-43). According to Mills and Bone the flavonoid glycosides demonstrate a vasodilatory and mildly stimulant property on both peripheral and coronary circulation, some fractions having a positively inotropic activity, whereas others and sometimes in the same fraction, have a negatively chronotropic property (2000, 441). The flavonoids have also been shown to exert a cardioprotective activity in cardiac cells deprived of oxygen and glucose, in vivo (Newall et al 1996, 157). The oligomer procyanidins specifically been shown to exert a positive intropic and beta-adrenoceptor blocking activities, but have either a mild or little effect upon heart rhythm. The amines have also been shown to exhibit a positive inotropic property, as well peripheral vasoconstrictor effects (Newall et al. 1996, 157; Mills 1991, 403). The small amounts of cyanogenetic glycosides are thought to exert a sedative activity upon cardiac function, increasing vagal tone and slowing heart rhythm, countering any stimulant property of the flavonoid fractions (Mills 1991, 403). In summary, Hawthorn has a sympathetic property upon peripheral circulation and a parasympathetic effect upon the myocardium, enhancing oxygen utilization and energy metabolism in the heart. Hawthorn has also been shown to potentiate the activity of cardiac glycosides such as digoxin.

Heart disease: In a placebo-controlled clinical trial an extract of Hawthorn was shown to enhance the exercise capacity of patients with heart failure and reduce the number of heart failure-related clinical signs and symptoms (Tauchert 2002). A three-month randomized, placebo-controlled, double-blind clinical trial investigated the efficacy of a Hawthorn extract, standardized to 18.75% oligomeric procyanidins, in outpatients suffering from congestive heart failure. The results showed that the difference of the double product (heart rate x systolic blood pressure x 10(-2)) decreased by 26.8% in the group taking Hawthorn, and by only 2.7% in the placebo group (Zapfe 2001). In a placebo-controlled study of 190 patients with functional cardiovascular disorders, a herbal combination therapy comprising Hawthorn and Camphor significantly reduced heart-related symptom scores, as well as scores for exhaustion, joint pain, and pain on pressure, compared with placebo (Schmidt et al 2000). In a multicenter, placebo-controlled double-blind study, the efficacy of a Hawthorn extract was investigated in 1442 in-patients with cardiac insufficiency. The Hawthorn extract clearly demonstrated a clear improvement in the performance of heart function, when compared to placebo, in the reduction of such parameters as shortness of breath and ankle edema (Weikl et al 1996).

Hypertension: In a randomized, double-blind, placebo-controlled study Hawthorn was shown to lower the resting diastolic blood pressure in participants, and displayed an additional anxiolytic property (Walker et al 2002).

Anxiety: The effect of a polyherbal combination of Crataegus, Ballota, Passiflora, Valeriana, Cola and Paullinia was investigated for its effect upon mood in a double-blind, placebo-controlled study, over a period of 28 days. The researchers found that the herbal formula had statistically significant effect upon mood disorders such as anxiety, when compared to placebo (Bourin et al 1997).

Connective tissue disorders: The oligomeric procyanidins in Hawthorn have demonstrated a collagen-stabilizing activity in vitro, enhancing the cross-linking of collagen fibers, and thereby strengthening connective tissue (Masquellier 1981).

Toxicity: Newall et al report that the oral LD₅₀ for the isolated flavonoids is upwards of 6 g/kg (1996, 158). Although most clinical trials report that Hawthorn extracts are well-tolerated, Newall et al report nausea, fatigue and dermatitis as possible side-effects (1996, 158); Mills and Bone however indicate that no significant side-effects have been observed in clinical trials (2000, 446). Symptoms of acute toxicity in experimental research include bradycardia and respiratory depression (Newal et al 1996, 158).

Herbal action: cardiotonic, cardioprotective, antioxidant, astringent, hypotensive, antiarrhythmic

Indications: cardiac failure, myocardial weakness, paroxysmal tachycardia, extrasystole, cardiac angina, hypertension, atherosclerosis, chronic nephritis

Contraindications and cautions: Newall et al report an uteroactive effect in vitro and in vivo, and thus suggest that Hawthorn should not be used in pregnancy (1996, 158); Mills and Bone however indicate that no adverse effects in pregnancy or lactation should be expected (2000, 446). Hawthorn is well known to potentiate the effect of cardiac glycosides, and should be used in such cases under proper supervision.

Medicinal uses: Rudolf Weiss states that Hawthorn is used to improve coronary circulation, increasing blood flow and relieving the angina associated with ischemic conditions (1988, 165). It is long-term remedy however, and rather than exerting the rapid inotropic effect of the digitaloides, Hawthorn gradually improves degenerative changes to the heart muscle. Weiss states that Hawthorn also has a beneficial effect upon cardiac arrhythmia, tachycardia and extrasystole, used as a more or less symptomatic remedy that should begin to exert its effects with 20-30 minutes after oral administration (1988, 164). Based on these observations, Weiss reserves Hawthorn for use in aged, “senile hearts,” in any weakness of the myocardium after infectious diseases (e.g. pneumonia, influenza), in cardiac arrhythmia, and in the prevention and treatment of coronary artery disease and atherosclerosis (1988, 165). Eclectic physician H.W. Felter came to similar conclusions about the clinical indications of Hawthorn, adding shortness of breath, mitral regurgitation, and anemia as indications, as well as “…heart-strain, due to over-exertion or accompanying nervous explosions” (1922). More recently, Hawthorn has been used by herbalists to treat anxiety and panic disorders, with many considering Hawthorn to be a specific for a ‘broken heart,’ feelings of resentment and anger, as well as a sense of spiritual disconnection. In regard to dose, Felter states that “...smaller doses are suggested as more likely to succeed than full doses” (1922). In traditional Chinese medicine, the rather sour Crataegus pinnatifida fruit (Shan zha) is used to enhance digestive function.

Pharmacy and dosage:

• Fresh Plant Tincture: flowering tips, with leaves; 1:2, 95% alcohol, 1-5 mL
• Dry Plant Tincture: flower, leaf, berry; 1:5, 50% alcohol, 1-5 mL
• Hot Infusion: flowering tips, with leaves; 1:20, 60-120 mL
• Tablets: flowers and leaves; standardized to 20 mg oligomeric procyanidins, 1 g