Encyclopedia/Botanical/TEM · Folk medicine/encyclopedia-hawthorn

Hawthorn

Crataegus spp.

Sources

6 listed

Best forAdults looking for a traditional herbal aid to mild stress and the evening wind down. Not a substitute for medical treatment of any heart symptom.

Clinical evidence

Clinical

Real World Significance

53Established historical significance

Breadth 54 Depth 30 Density 77 Convergence 50 Continuity 65

SafetyUsually well toleratedStudied preparations are often well tolerated; gastrointestinal complaints or dizziness can occur. HERB CHF reported more adverse events with hawthorn than placebo, mostly non-cardiac. Cardiac complaints and combinations with heart medicines require medical assessment. Use in pregnancy and breastfeeding is not recommended because data are insufficient.

Tradition

TEMFolk medicine

Common preparations

Fresh FlowersFresh LeavesTeaTinctureStandardised extractBerry

In short

Summary of findings for quick reference

Hawthorn is a familiar European hedgerow shrub. This entry covers Crataegus, focusing on leaf and flower of C. monogyna and C. laevigata and their hybrids. An unbroken cardiac tradition since antiquity is not established; modern use developed particularly from the late nineteenth century. Chinese hawthorn, including C. pinnatifida, has its own tradition: its fruits are used for digestive complaints, among other purposes. This is distinct from research on European leaf-with-flower preparations.

Particular leaf-with-flower extracts have been studied most extensively as additions to medical treatment for heart failure. The 2008 Cochrane review found benefits for some symptoms and exercise measures. Later trials qualify that picture: SPICE found no significant benefit for its primary major cardiac event endpoint, and HERB CHF found none for walking distance or quality of life. For mild stress and sleep support, the EMA classification relies on long-standing use rather than sufficiently established clinical benefit.

Hawthorn is not a self-treatment for heart failure. New or persistent cardiac symptoms require medical assessment. Pain in the heart region, breathlessness or newly swollen legs require immediate medical advice. Even during traditional use, symptoms lasting longer than two weeks or worsening should be assessed. If you take cardiovascular medication, discuss adding hawthorn with your doctor first.

Clinical evidence ↔ Historical significance

We display two separate evidence categories: clinical evidence from modern trials and historical significance from documented healing tradition. Both are valuable, but they answer different questions.

In every encyclopedia entry we evaluate two distinct categories of evidence. Clinical evidence as used in trials meets a narrower but scientifically essential bar. At the same time, the hundreds of thousands of plant species worldwide have only partially been captured and tested in modern studies.

Alongside the trial picture our researchers compile a comprehensive overview of where and since when a plant has been used across different traditions of natural medicine. When a plant has been used as a medicinal plant in many cultures across many generations, that historical significance deserves to be visible too.

Our position: a truly informative overview emerges only when both categories sit side by side. We communicate transparently what counts as what.

Overview

Hawthorn is a thorny shrub or small tree of the rose family with white spring flowers and red autumn fruits. This entry focuses on the European species Crataegus monogyna and Crataegus laevigata. European phytotherapy mainly uses leaf with flower. The fruits have their own traditional and culinary uses. Characteristic constituents include oligomeric procyanidins (OPCs) and flavonoids such as vitexin, hyperoside and rutin. In Austria hawthorn grows in hedges and at woodland edges.

Older monographs from Commission E, WHO and ESCOP describe hawthorn preparations for declining cardiac performance. The EMA leaf-with-flower monograph covers traditional uses only: temporary nervous cardiac complaints after a doctor has excluded serious disease, and mild stress and sleep support. Trials of particular extracts in heart failure have mixed results. These do not establish self-treatment or equivalent effects for arbitrary food supplements.

History

Hawthorn has a long European medicinal history, but the earliest mentions concern uses other than modern cardiac treatment. Historical scholarship describes a cardiac-pain passage in Mattioli’s sixteenth-century commentary on Dioscorides. This does not establish continuous cardiac use since antiquity. Late nineteenth-century North American Eclectic physicians described hawthorn in heart disease. In 1919 Ellingwood reproduced a report by Jennings from 1896 while also expressing reservations about the high expectations for the remedy.

Commission E positively assessed leaf with flower for declining cardiac performance corresponding to NYHA II; WHO and ESCOP also discuss this use. The later 2016 EMA HMPC monograph concerns traditional use only. It covers temporary nervous cardiac complaints, such as palpitations, after medical exclusion of serious conditions, and mild stress and sleep support. Clinical research has investigated standardised extracts including WS 1442 and LI 132. Results apply to the preparation studied.

Mechanism

Characteristic constituents of hawthorn leaf with flower include oligomeric procyanidins and flavonoids such as vitexin, vitexin rhamnoside, hyperoside and rutin. Standardised extracts are characterised in part by their content of these groups. WS 1442 is standardised to oligomeric procyanidins and LI 132 to flavonoids. Fruits and leaf with flower differ in composition; this does not justify a blanket ranking of stronger and weaker plant parts.

Laboratory and animal studies describe changes in cardiac muscle contraction, vasodilation and antioxidant effects. These findings may help explain possible mechanisms, but do not establish clinical symptom benefit. They also do not establish an onset of action for stress or sleep. Multiweek heart-failure trials are not instructions to self-treat cardiac symptoms for weeks.

The 2008 Cochrane review by Pittler, Guo and Ernst included 14 randomised trials; ten with 855 participants provided data for meta-analysis. Particular leaf-with-flower extracts improved some exercise measures and symptoms compared with placebo, mostly alongside usual treatment. The later SPICE trial in 2,681 people with heart failure found no significant benefit for its primary cardiac event endpoint with 900 mg WS 1442 daily over two years. HERB CHF, involving 120 participants, also found no benefit for walking distance or quality of life with 900 mg daily over six months. Clinical results are therefore mixed; heart failure requires medical treatment.

For relief of mild stress symptoms and sleep support, the EMA classifies the use as traditional. Sufficient clinical evidence for hawthorn alone is lacking for these purposes. Findings from combination products do not establish hawthorn’s contribution to an observed effect. The traditional classification therefore does not prove an effect for any arbitrary hawthorn tea or food supplement.

Evidence

4 Outcomes evaluated. Sorted by grade.

Outcome	Class	Grade	Effect	Refs
Chronic heart failure, alongside medical treatmentAdults with mild to moderate chronic heart failure on conventional therapy	Clinical	C	Mixed findings	[1][2][3]
Mild mental stress symptoms (traditional use)Adults with mild symptoms of mental stress	Traditional	D	Traditional Use	[4]
Sleep aid (traditional use)Adults seeking a traditional herbal aid to sleep	Traditional	D	Traditional Use	[4]
Antioxidant and vascular wall effects (in vitro)In vitro and animal models	Traditional	D	Preclinical findings	[6]

Usage

Forms and preparation

Hawthorn tea uses dried leaf with flower. Pour boiling water over the weighed herb, infuse according to the package instructions and strain. See Dosage for the amount. Fruits can be processed separately, for example into syrup; statements about leaf with flower do not transfer to them. Tincture dose and frequency depend on extraction ratio and alcohol content, so a universal drop count is inappropriate. An extract should specify plant part, extraction ratio, extraction solvent and any standardisation. The same number of milligrams does not mean the same composition across different extracts. Follow the medicine’s package leaflet; a study dose is not a general dosage recommendation for supplements.

Dosage

For tea used for temporary nervous cardiac complaints, the EMA gives an adult dose of 1 to 2 g comminuted leaf with flower in 150 ml boiling water, up to four times daily and no more than 6 g per day. A doctor must first exclude serious disease. The monograph does not list this tea dose for stress or sleep difficulties. Powders, tinctures and extracts have separate preparation-specific doses. SPICE and HERB CHF studied 900 mg WS 1442 daily alongside usual heart-failure treatment; this is not a self-treatment recommendation. Do not increase the dose on your own. Seek medical advice if symptoms persist for more than two weeks during use or worsen. Do not wait with new cardiac symptoms or warning signs such as chest pain or breathlessness. If you take cardiovascular medication, discuss hawthorn with your doctor first.

Safety

Safety profile

Have cardiac complaints such as persistent palpitations, exertional breathlessness or unexplained fatigue medically assessed. Pain in the heart region, breathlessness or newly swollen legs require immediate medical advice. Hawthorn is unsuitable for self-treatment of heart disease. The EMA monograph covers traditional uses, not well-established use in heart failure. Serious conditions must be medically excluded before use for nervous cardiac complaints. If you take digoxin or other cardiovascular medication, discuss hawthorn with your doctor first. A small study in eight healthy adults found no change in digoxin pharmacokinetics with WS 1442; this does not exclude other interactions or risks with other preparations. Do not use the product if allergic to hawthorn. Use during pregnancy and breastfeeding is not recommended because data are insufficient. The EMA restricts use for nervous cardiac complaints to adults aged 18 or older; for the specified stress and sleep preparations the lower age limit is 12. Seek medical advice if symptoms worsen or persist for more than two weeks.

Look-alikes

Botany

Family

Rosaceae

Native regions

Europa, Nordafrika, Westasien, weltweit in gemäßigten Klimazonen kultiviert

Harvest window

Blüten und Blätter Mai bis Juni; Beeren September bis Oktober

Habitat

Common hawthorn (C. monogyna) is native to Europe, North Africa and parts of western Asia and has been introduced or cultivated in other temperate regions. In Austria it grows in hedges, scrub and at woodland edges. Leaf with flower is usually gathered in May and June, and fruit in September and October.

Identification & foraging

A deciduous thorny shrub or small tree, typically five to ten metres tall, with sharp spines on the twigs. The small leaves vary in their depth of lobing between species. White flowers appear in May and June in flat topped clusters (corymbs) with a distinctive almond sweet scent. The fruit is a small red pome with one to three stones, ripening in September and October. Crataegus monogyna typically has one stone per fruit and more deeply lobed leaves; Crataegus laevigata typically has two or three stones and less deeply lobed leaves. Both species are accepted as medicinal in the EMA HMPC monograph, and natural hybrids of the two also occur.

Similar plants and look-alikes

Unpleasant

Crataegus laevigata (Midland hawthorn)

Not a toxic lookalike but the second medicinally accepted hawthorn species. Crataegus laevigata typically has two or three stones per fruit and less deeply lobed leaves, Crataegus monogyna has one stone per fruit and more deeply lobed leaves. Both are accepted as medicinal in the EMA HMPC monograph, and natural hybrids of the two occur. Medicinal use still requires reliable identification of the plant and plant part and appropriate quality.

Unpleasant

Sorbus aucuparia (rowan)

Also a rose family plant with red berries, but pinnate leaves (not lobed), no thorns, and berries in larger denser clusters. Rowan is not medicinally interchangeable with hawthorn and has its own uses. If you forage, check the leaf (lobed versus pinnate) and the thorns (present in hawthorn, absent in rowan).

FAQs

Can I take hawthorn on my own for heart symptoms?

No. Cardiac symptoms require medical assessment first. Chest pain, breathlessness or newly swollen legs require immediate medical advice. The EMA lists traditional uses only; it does not establish a well-established-use indication for treating heart failure. Discuss whether a particular preparation is appropriate alongside treatment with your doctor.

How long does hawthorn take to work?

A reliable general onset of action has not been established. Heart-failure trials studied particular extracts over weeks or months; this does not define a waiting period for self-treatment. During traditional use, seek medical advice for worsening symptoms or symptoms persisting beyond two weeks. New cardiac complaints and warning signs such as chest pain or breathlessness require earlier, potentially immediate assessment.

Which is more active, hawthorn leaf and flower or the berry?

There is no blanket stronger-or-weaker ranking. The EMA monograph and the major heart-failure trials discussed here concern leaf with flower or extracts made from it. Fruits have a different composition and their own traditional uses. Study findings and doses must therefore match the plant part and preparation.

Can I take hawthorn together with cardiovascular medication?

Discuss the combination with your treating doctor first. Clinical interactions are not established for every commonly listed medication class. A small study found no change in digoxin pharmacokinetics with WS 1442, but involved only eight healthy adults. This is insufficient to guarantee safety with all heart medicines and hawthorn preparations.

References

6 sources.

M H Pittler; R Guo; E Ernst. Hawthorn extract for treating chronic heart failure. 2008. doi:10.1002/14651858.CD005312.pub2
Christian J F Holubarsch; Wilson S Colucci; Thomas Meinertz; Wilhelm Gaus; Michal Tendera; SPICE study group. The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. 2008. doi:10.1016/j.ejheart.2008.10.004
Suzanna M Zick; Bonnie Motyka Vautaw; Brenda Gillespie; Keith D Aaronson. Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. 2009. doi:10.1093/eurjhf/hfp116
European Medicines Agency, Committee on Herbal Medicinal Products. European Union herbal monograph on Crataegus spp., folium cum flore. 2016. Source
Roberta Tankanow; Helen R Tamer; Daniel S Streetman; Scott G Smith; Janice L Welton; Thomas Annesley; Keith D Aaronson; Barry E Bleske. Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha). 2003. PMID:12817526
European Medicines Agency, Committee on Herbal Medicinal Products. Assessment report on Crataegus spp., folium cum flore. 2016. Source

Legal notice: The depiction of historical significance and traditional use is context within our encyclopedia and not a health claim for any product, not a treatment promise, and not a substitute for medical advice. What may be stated on product labels, product pages, or in advertising is governed by the applicable legal requirements.