Hawthorn

Hawthorn (Crataegus monogyna and Crataegus laevigata) is a thorny shrub or small tree of the rose family with white spring flowers and red autumn berries. In European phytotherapy the leaf and flower combined are the medicinal part, and the dried berry has a softer role. The characteristic bioactives are oligomeric procyanidins (OPCs) together with flavonoids such as vitexin, hyperoside and rutin, plus small amounts of triterpene acids like crataegolic acid. In Austria you find hawthorn as a hedgerow plant in the Bauerngarten, and as one of the classic herbal teas in the Hausmittelschrank.

The well established medicinal use of a standardised leaf and flower extract in decreasing cardiac performance (NYHA class II) rests with Commission E, the WHO and ESCOP as a medicinal product assessment. The EMA HMPCEuropean Medicines Agency, Committee on Herbal Medicinal Products (HMPC) monograph for hawthorn leaf and flower (Crataegi folium cum flore) is a traditional use monograph only, for temporary heart complaints related to nervousness, mild symptoms of mental stress and as an aid to sleep. That medicinal product context is assessed by a regulator. It is not a claim that any food supplement on the shelf reproduces that effect, and a hawthorn tea or capsule sold as a food supplement is not a substitute for medical treatment of heart disease. The food supplement framing in this entry stays on the traditional use side: gentle traditional support around mild stress and the evening wind down.

Hawthorn has a long European medicinal history. The cardiac use was first set down clearly by Pietro Andrea Mattioli in his 1568 commentary on Dioscorides, and it entered regular clinical practice through 19th century Eclectic physicians. From the 19th century onwards Western physicians used hawthorn preparations as a cardiac tonic, and the plant became part of the European herbal pharmacopoeia. In Austria, the Weißdorn hedgerow is a familiar Bauerngarten feature, and a tea or tincture from the leaves and flowers belongs in the older Hausmittel tradition for the heart and for restless nerves.

Modern regulatory recognition followed in two steps. Commission E in Germany issued a positive monograph for hawthorn leaf and flower in decreasing cardiac performance corresponding to NYHA class II. The well established medicinal use framing for the leaf and flower extract in decreasing cardiac performance (NYHA class II) rests with Commission E, the WHO and ESCOP as a medicinal product assessment. The later EMA HMPCEuropean Medicines Agency, Committee on Herbal Medicinal Products (HMPC) monograph for hawthorn leaf and flower (Crataegi folium cum flore, EMA/HMPC/159075/2014) is a traditional use monograph only, covering temporary heart complaints related to nervousness such as palpitations, mild mental stress and aid to sleep, with serious heart conditions to be excluded by a doctor. Standardised extracts like WS 1442 (Crataegutt) and LI 132 are the products that anchor most of the modern clinical research and are common on the German speaking market.

The characteristic bioactives in hawthorn leaf and flower are oligomeric procyanidins (OPCs) and flavonoids (vitexin, vitexin rhamnoside, hyperoside, rutin), with smaller amounts of triterpene acids such as crataegolic and ursolic acid. Standardised pharmaceutical extracts are defined by their OPC and flavonoid content. WS 1442 is standardised to 18.75 per cent oligomeric procyanidins; LI 132 is standardised on the flavonoid side. The dried berry has a different and weaker bioactive profile than the leaf and flower, with less procyanidin content; for that reason the medicinal product extracts are made from the leaf and flower, not from the fruit.

Proposed mechanisms in the published literature include a mild positive inotropic effect on heart muscle contractility, a mild coronary and peripheral vasodilation, antioxidant activity at the vascular wall, and a weak ACE inhibition effect attributed to the procyanidins. The link between any specific bioactive and a clinically meaningful effect in people is plausible but partial, and a significant share of the mechanistic work is in vitro or in animal models. One feature of hawthorn that matters in practice is the long latency. Effects on heart symptoms and on subjective stress markers in the trial literature appear over weeks, not days. Six to twelve weeks of continuous use is the timeframe that the research is anchored on, and that pattern is reflected in the dosage section below.

The Cochrane review by Pittler and colleagues in 2008 summarised fourteen randomised controlled trials of standardised hawthorn extracts as an adjunct to conventional treatment in chronic heart failure. The pooled signal was a small but statistically significant improvement in symptomatic measures (maximum workload, exercise tolerance, pressure heart rate product, shortness of breath and fatigue) compared to placebo. The Cochrane authors concluded that hawthorn extract had a beneficial effect on symptom control and physiological outcomes in the chronic heart failure populations studied. That body of evidence is the basis for the well established medicinal use of a standardised hawthorn extract in NYHA class II recognised by Commission E, the WHO and ESCOP. The EMA HMPCEuropean Medicines Agency, Committee on Herbal Medicinal Products (HMPC) leaf and flower monograph itself is traditional use only and does not cover heart failure. It is a medicinal product context; chronic heart failure is a clinical condition managed by a doctor, not a self treatment situation, and a food supplement labelled as hawthorn does not reproduce a pharmaceutical extract.

The clinical evidence on the traditional use side (mild stress, sleep) is much smaller. Hawthorn appears in some combination preparations with other calming herbs (for example with passionflower or with valerian) where the combined product has been studied, rather than hawthorn alone. As a single herb on the stress and sleep axis, hawthorn rests on its long traditional record and on the supportive cardiovascular mechanism (mild vasodilation, perceived chest tension and palpitation around stress) rather than on a dedicated body of placebo controlled trials. The entry frames the cardiovascular evidence as the strong line and the stress and sleep evidence as traditional and supportive.

Forms and preparation

In the traditional European preparation the dried leaf and flower (Crataegi folium cum flore) are infused as a tea. One to two teaspoons of the dried herb per cup of water, freshly boiled and poured over, covered for ten to fifteen minutes, then strained. The covered infusion matters because some of the active constituents are sensitive to evaporation. The berry can be made into a separate tea or a syrup but has a weaker bioactive profile, so for traditional cardiovascular and stress support the leaf and flower mix is the relevant preparation. A tincture from leaf and flower is another classic form, usually taken as twenty to forty drops two or three times a day in a little water. On the standardised extract side, look for products that declare an extraction ratio (commonly four to seven to one or five to seven to one drug to extract ratio for leaf and flower) and that name the standardisation, for example WS 1442 standardised to 18.75 per cent oligomeric procyanidins. Products that do not declare standardisation are not comparable to the research extracts. Read the label and pick a clearly specified product if you want a research aligned dose.

Dosage

For the tea (dried leaf and flower), one to two teaspoons of the dried herb per cup, three cups per day, taken continuously over weeks. For a tincture from leaf and flower, twenty to forty drops two or three times a day in water. For a standardised dry extract, the dose range used in the chronic heart failure trials reviewed by Pittler 2008 was 160 to 900 mg per day of WS 1442 (often given as 300 mg twice a day or 450 mg twice a day). Effects in the trial literature appear over weeks, not days. Plan on six to twelve weeks of continuous use before you assess whether hawthorn fits your routine. This is not a herb you take for an acute symptom on a single day. Start with the lower end of the range and stay there for the first two to three weeks before titrating up. If you are already on a prescription cardiovascular medication (for example a beta blocker, an ACE inhibitor, a calcium channel blocker, digoxin, or an antihypertensive), do not start hawthorn on your own. Talk to your prescribing doctor first. The interaction picture with cardiovascular drugs is not fully studied, the theoretical signal is real, and the safety check belongs with your doctor, not with a label on a tea bag.