Hawthorn is the common name for the genus Crataegus (The Plant List, 2011). Defined as a member of the rosaceae family, hawthorn contains hundreds of species within its genus (American Botanical Council, 2013).
Having a historical use in phytotherapy, hawthorn was even mentioned in Nicholas Culpepers ‘The Complete Herbal’, published in 1652 during the reign of Elizabeth 1st. At that time, Culpeper quotes the berries being used for dropsy, now known as oedema, with the flowers and seeds being boiled to 'give instant relief to the tormenting pains of the body' (Culpeper, 2009, 186). A legend states that the crown of thorns worn by Jesus was made from hawthorns, as well as other mystical tales associated with celtic traditions and druidism.
Traditionally hawthorn has been used for a wide variety of ailments. With modern research and pharmacology, hawthorn is now primarily prescribed for the benefit of the cardiovascular and circulatory system (Mills and Bone, 2013, 671). Western herbal medicine has a tendency for utilising the berries, seeds, leaves and flowers (Holmes, 2007, 298). Chinese medicine places a lot of medicinal value on Hawthorn, even the root, although this is not its traditional form of use. Dr D. Greene of County Clare, Ireland was one of the first 'western' Doctors in the late 19th century to use a tincture of hawthorn berries to treat his patients (Bartram, 1998, 215). Whilst attaining a reputation for the treatment of heart disease he kept the remedy a secret, only to be revealed by his daughter after his death.
According to researchers (Mills and Bone, 2013, 672) the pharmacologically active constituents of hawthorn include oligomeric procyanidins (OPCs), flavonoids (such as vitexin, rutin and quercetin etc.) and triterpines (such as crataegolic acid, ursolic acid etc.) to name a few.
Oligomeric procyanidins (OPCs) are naturally occurring metabolites in hawthorn that exist at different concentrations and varieties in numerous plants. OPCs are known for their anti-oxidant activity but have also been reported to show anti-inflammatory, anti-carcinogenic and vasodilatory actions (Fine 2000). According to Mills and Bone (2013, 672) the leaves contain the highest levels of OPCs.
It has been suggested that the different phenolic compounds from hawthorn are what make the plant so bioactive within humans and animals (Yang and Liu, 2012). Flavonoids are naturally occurring polyphenolic compounds mainly found in plants, particularly fruit and vegetables. Flavonoids have been shown to possess anti-inflammatory and anti-oxidant capabilities in a variety of tests (Middleton 1998). A study by Hertog et al (1995) concluded that ‘average flavonoid intake may partly contribute to differences in coronary heart disease mortality across populations’. This study showed how flavonoid intake was inversely correlated with mortality from coronary heart disease. According to Mills and Bone (2013, 672), the flowers contain the highest levels of flavonoids.
In combination together, the above constituents work efficiently and positively for different cardiovascular disorders. It must be noted that although many chemical constituents of hawthorn have been isolated, when the plant is prescribed, the particular part (flowers, berries or leaves) is given as a whole.
Along with chronic inflammation, another common occurrence in heart failure is atherosclerosis plaque formation. This is caused by the collection or build-up of low-density lipoprotein (LDL) in arterial walls and blood vessels. In a study performed in vivo hawthorn was shown to inhibit LDL oxidation (Quettier-Deleu, 2003).
An important published paper (Pittler et al, 2003) was a meta-analysis of trials in which hawthorn was used for heart failure in human subjects. A total of 8 trials were accepted with a total amount of 632 patients receiving hawthorn in various dosages. The meta-analysis concluded ‘these results suggest that there is a significant benefit from hawthorn extract as an adjunctive treatment for chronic heart failure’. Patients were reported to have noted how fatigue had improved, as well as researchers seeing heart rates decrease and maximal workload improve. All studies considered in this analysis had to be randomised, double-blind, placebo controlled trials.
Exercise is important to maintain a healthy heart and is proven to lower the blood pressure and improve quality of life (Park et al, 2014). In a trial performed by Degenring et al (2003) patients with heart failure were recruited for monitoring whilst using an exercise bike. These patients were also given hawthorn extract made from the berries. An improvement in exercise tolerance taken from heart rate and blood pressure readings was shown. The trial concluded hawthorn berries may exert beneficial effects with long term therapy for patients with heart failure.
In astrology hawthorn is listed as a masculine plant, with its chosen planet as Mars and its element listed as fire (Davies, 2000, 24). Contrary to its masculinity it seems in the West, hawthorn has always maintained some sort of connection with the feminine, the ancient Greeks and Romans both using hawthorn blossoms in wedding ceremonies to promote fertility (Davies, 2000, 10). Protection, luck, prosperity and hope seem to be common themes among folklore traditions surrounding the Crataegus species, although it is not uncommon to find different traditions that have associated it with negative energy.
Supporting the feminine nature of hawthorn, Peter Holmes in the book 'The Energetics of Western Herbs Volume 1' describes it as an 'emblem of the beauty and harmony-loving rose family, hawthorn is a feminine type of plant'. Describing further how it tonifies the Yin (the female of the Yin and Yang philosophy in traditional chinese medicine) it seems eastern medicine has also connected this tree with more feminine characteristics and energy (Holmes, 2007, 299).
In terms of contraindications and toxicology, hawthorn is generally accepted as a safe remedy used on its own or alongside other treatments. A systematic review of adverse events associated with hawthorn use (Daniele et al 2006) concluded that ‘hawthorn is well tolerated’. No known adverse effects have been reported in children and hawthorn is compatible with breastfeeding (Mills and Bone, 2013, 682). The most common concern with hawthorn is the use in conjunction with pharmacological prescriptions, most notably heart and blood pressure medication, which is why it is stated working with a qualified herbalist and/or doctor is essential (Mills and Bone, 2013, 682).
Although hawthorns effects can be used for other ailments, as a proven heart tonic it would seem hawthorn is an obvious well tried and tested herbal remedy for heart related diseases and cardio-vascular disorders.
American Botanical Council, Herbal Gram (2013) Hawthorn Berry. [online]. Available at: http://cms.herbalgram.org/expandedE/Hawthornberry.html?ts=1413219484&signature=025782e03c23f3c1d0915033264d5343
Bartram, T. (1998) Bartram's Encyclopedia of Herbal Medicine, London, Robinson.
Culpeper, N. (2009) The Complete Herbal, London, Arcturus.
Daniele, C. Mazzanti, G. Pittler, M.H. Ernst, E. (2006) Adverse-event profile of Crataegus spp.: a systematic review, Drug Safety, 29(6) p. 523-535.
Davies, J. (2000) In a Nutshell – Hawthorn, Dorset, Element.
Degenring, FH. Suter, A. Weber, M. Saller, R. (2003) A randomised double blind placebo controlled clinical trial of a standardised extract of fresh Crataegus berries (Crataegisan) in the treatment of patients with congestive heart failure NYHA II, International Journal of Phytotherapy and Phytopharmacology. Vol. 10 (5), p. 363-9.
Fine, A. (2000) Alternative Medicine Review, vol.5, no.2, p. 144-151.
Hertog, MG. Kromhout, D. Aravanis, C. et al (1995) Flavonoid intake and long-term risk of coronary heart disease and cancer in the seven countries study. Archives of Internal Medicine, Feb 27;155(4) p. 381-6.
Holmes, P. (2007) The Energetics of Western Herbs, California, USA, Snow Lotus, Vol.1.
Middleton, E Jr. (1998) Advances in Experimental Medicine and Biology, 439. p. 175-182.
Mills, S. and Bone, K. (2013) Principles and Practice of Phytotherapy, Modern Herbal Medicine, Second Edition, London, Elsevier.
Park, JH. Miyashita, M. Takahashi, M. et al (2014) Low-Volume Walking Program Improves Cardiovascular-Related Health in Older Adults, Journal of Sports Science and Medicine, Vol. 13, p. 624-631.
Pittler, M.H. Schmidt, K. Ernst, E. (2003) Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials, American Journal of Medicine, 114(8), p. 665-674.
Quettier-Deleu, C. Voiselle, G. Fruchart, J.C. Duriez, P. et al. (2003) Hawthorn extracts inhibit LDL oxidation, Pharmazie, August, 58(8), p. 577-581.
The Plant List (2011) Crataegus monogyna Jacq. [online]. Available at: http://www.theplantlist.org/tpl1.1/record/rjp-49
Yang, B. Liu, P. (2012) Composition and health effects of phenolic compounds in hawthorn (Crataegus spp.) of different origins, Journal Of The Science Of Food And Agriculture, 92(8) p. 1578-1590.
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