Herbal Showcase: Hawthorn

It has been my goal for the last year, to offer a monthly series in which I showcase some of my favorite herbs/botanicals. I hope that I can continue this series, so you can familiarize yourselves with not only the traditional uses of these powerful botanicals, but also get an idea of what you need to watch out for in terms of health contraindications and misinformation.

Since February is Heart Month, we’re going to kick off this series with one of the most widely utilized botanicals for cardiovascular health, Hawthorn (Crataegus spp.). ​
Crataegus is one of my favorite botanicals, because 1) it is used in both Chinese and Western herbalism, 2) it is relatively easy to source, and 3) it is effective. As part of the Rose family, Hawthorn has been used in many cardiovascular conditions, including congestive heart failure (CHF), circulatory problems, high blood pressure and high cholesterol to name a few. You have to be pretty cautious, however, when reading about this botanical on the Internet, as there are multiple species of Crataegus, and they don’t all have the same effects. Here is the run down on this Cardiovascular botanical:

The Basics

Common Name: Hawthorn
Parts most commonly used: Leaves and flowers are considered to be the most pharmacologically active; berries can also be used in some cases.
Most common species used:

  • Crataegus oxyacantha/Crataegus monogyna: coronary heart disease, atherosclerosis, high blood pressure, elevated cholesterol, congestive heart failure
  • Crataegus laevigata: coronary heart disease, high LDL
  • Crataegus pinnatifida (Shan Zha in Chinese Herbalism): angina, arteriosclerosis, high blood pressure, respiratory symptoms

What does the research say?

  • Many of the most cited research studies are from the 1990s, with a few follow up studies in the late 2000s and early 2010s.
  • Crataegus monogyna may improve ejection fraction, exercise tolerance and decrease subjective symptoms such as fatigue and shortness of breath (NMCD, accessed Jan, 2020).
  • A 2008 meta-analysis reviewed the use of hawthorn as an adjunctive therapy to conventional treatment, and found that the group using combination therapy had increased max workload, exercise tolerance, cardiac oxygen consumption, and improvements in shortness of breath and fatigability (Herbalgram, 2012).
  • A study published in 2009 found that Crataegus monogyna did not improve quality of life scores in CHF, or functional capacity, risk of mortality and neurohormone profiles. These results were not consistent with the previous studies from the 1990s, so the authors suggested various reasons why that might be, including sample size, participants with milder NYHA scores, less rigorous tests, or overlap of hawthorn mechanism of action with that of drugs being taken by participants in this study.
  • There was a study showing that Shan Zha may help with angina and with ECG findings, helping the study population reduce their nitroglycerin dosing compared to placebo (Weng, et al, 1984)
  • A 2011 study suggested that Crataegus laevigata improved coronary heart disease biomarkers and lowered LDL (Dalli E, Colomer E, Tormos MC, et al)
  • One retrospective study from 2008 suggested that heart failure progression, rate of death and heart failure related hospitalizations in patients taking hawthorn was increased compared to placebo (reviewed by NMCD, accessed Jan 2020).

What does Chinese herbalism say?

  • Properties: sour, sweet, slightly warm
  • Channels impacted: Large Intestine, Spleen, Stomach, Heart
  • Actions/Indications: reduces food stagnation and transforms accumulation; transforms blood stasis and dissipates clumps; stops diarrhea

What does Traditional herbalism say?

Crataegus restores balance to those that are out of body or out of balance. One’s spirit is not grounded, as indicated by brain fog, weakness, sense of overburden and being weighed down by the material world. Chinese medicine sometimes describes this as the Heart and Kidney not communicating, but since these symptoms are related to Crataegus monogyna uses in Western herbalism (rather than Shan zha), I did not include this indication in the Chinese herbalism section.

Contraindictions

  • Use with caution or not at all if you have the following conditions: low blood pressure
  • Use with caution or not at all if you are taking the following:
  • Nitrates (i.e. Nitroglycerin): Crataegus has blood pressure lowering and vasodilatory effects, so this may result in an additive effect and cause low blood pressure and possible vaso-vagal results.
  • Phosphodiesterase 5 inhibitors (i.e. Viagra, Cialis, etc): Similar mechanisms of action with this class of meds, and therefore may have additive effects
  • Blood pressure meds (beta blockers, calcium channel blockers): Similar mechanisms of action with this class of meds, and therefore may have additive effects
  • Digoxin: Crataegus may improve cardiac output, so it may have additive effects with digoxin, requiring dose reductions.
  • Herbs to use with caution if taking Crataegus: andrographis, casein peptides, cat’s claw, CoQ10, fish oil, L-arginine, nettles, theanine, lyceum (there may be others)

There you have a basic spotlight for Crataegus spp. (Hawthorn) from the Western and Chinese herbal perspectives. To find out if herbal interventions are right for you, call MCHM for your consultation with Dr. Abigail.