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Hawthorn

Hawthorn

Botanical Description & Habitat

Hawthorn Berry :: Heart supportive vasodilator
(click image to enlarge)
Hawthorn Berry (Crataegus oxycantha)
Family
Rosacea  

Common Names:
English hawthorn
Haw
Maybush
Whitethorn


Medicinal uses
Hawthorn berry works to increase cardiovascular health. It is an excellent heart tonic; it dilates peripheral blood vessels, increases metabolism in the heart muscle, dilates coronary vessels, and improves blood supply to the heart. The herb also acts to abolish rhythm disturbances.

Medicinal parts
Leaves, flowers, and fruit

Habitat
Grows on the edges of woods and forests of Europe, northwest Africa, and western Asia.

Description
The spiky bush or tree grows to a height of 4 meters. The flowers are white, 1.5 cm across, with 5 petals and reddish stamens. The fruit are red, round to oval, 8-10 mm in diameter, and hang down in clusters.
 

Historical Properties & Uses

Hawthorn is hypotensive and anabolic
Compared to digitalis, it is much milder and safer to use, more a tonic than a specific. The herb is tonic for both high blood pressure and low blood pressure, as well as tachycardia and arrhythmia.

Mild anti-arteriosclerotic principles have been identified in hawthorn; antispasmodic and sedative properties have also been ascribed to it, but have not been experimentally verified.

This herb is approved by the German Commission E as a cardiac preparation. It enjoys major sales as a phytomedicine in the German market, over $29 million.

This herb has approval status for reducing cardiac output.

Hawthorn berry and leaf, on the other hand, are unapproved. Either there was insufficient evidence in favor, or a contraindication.

References:

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
 

Method of Action

Hawthorn is an excellent cardiotonic
Hawthorn functions by peripheral vasodilation; very mild dilation of coronary vessels; increased enzyme metabolism in the heart muscle; and increased oxygen utilization by the heart.

A noted expert in the area maintains hawthorn drugs are characterized
by three basic healing properties which complement one another:

1. Improvement of coronary blood supply which leads to a decreased frequency of anginal attacks and of subjective complaints.

2. Improvement of the metabolic processes in the myocardium, which results in an improvement of functional heart activity.

3. Abolition of some types of rhythm disturbances.

In human patients with perfusion disorders of the coronary arteries due to coronary sclerosis, hawthorn significantly decreased oxygen utilization during exercise. In 40 of 52 patients, intravenous administration of hawthorn extract for a mean period of 13.4 days produces a noticeable decrease in the ischemia reaction in the exercise EKG. In patients undergoing standard therapies such as CO2 partial baths, an improvement was seen in only 25% of the cases.

In another study on human subjects with primary heart disease, intravenous hawthorn extract produced an improvement in most all cases, as determined by a normalization of heart dynamics (the mechanical efficiency of the heart muscle). In patients with secondary heart disease the effect was not as great in terms of the number of cases helped, but significant effects were seen in those cases helped. The herb also helped patients whose heart disease was caused by hepatitis or other liver disease. Taken together, these results suggest a positive inotropic action.

In cases of cardiac insufficiency according to Stage II New York Heart Association, an improvement of subjective findings as well as an increase in cardiac work tolerance, a decreas ein pressure/heart rate product, an increas ein the ejection fraction and a rise in the anaerobic threshold have been establishe din human pharmacological studies using 160 - 900 mg aqueous-alcoholic extract per day.

Findings similar to the above have been reported by several investigators. Many of these are reviewed in Ullsperger.

Excellent results in a wide variety of coronary problems were obtained utilizing a crossed, double-blind procedure. The substance used was a German drug called Corguttin, which is composed of Adonidiss, Convallaria majalis, Hawthorn, Primula officinales, and Valerian officinalis. This product proved extremely effective in meeting the routine, daily needs of patients with minor heart problems.

Hawthorn has vasodilatory action
Hawthorn has a marked and prolonged vasodilatory action, and an ability to lower peripheral resistance to blood flow in dogs and guinea pigs. The extract was injected directly into the arteria coronaria. Intravenous injection caused no change in the volume of coronary blood flow, but still showed lowering of peripheral resistance. The blood supply of the central nervous system was influenced in the same manner as that of the coronary vessels, i.e., the resistance to blood flow was lowered, and following direct injection into the carotid, the blood volume passing through was also increased.

Hawthorn increases blood flow
In a series of experiments in dogs, aqueous solutions of heptahydroxy-flavaneglycoside, a component of hawthorn, was used to demonstrate the herb's cardiac and circulatory actions. Intra-arterial injections into the a. femoralis, a. femoris post. sup. (a muscle vessel), and a. coronaria dextra, caused increased blood flow.

In the a. saphena (a skin vessel) and the a. renalis, the blood flow was lowered. Blood pressure was raised by injection into the a. coronaria dextra and intravenous injection. No changes in urinary excretion and respiration were found. No definite dose-response relationship could be determined because the degree of response was unpredictable.

Hawthorn successfully destroys experimentally-induced blockade of anaerobic glycolysis, a condition typifying some forms of heart disease caused by enzyme insufficiency.

In patients with chronic cardiac insufficiency, hawthorn has produced a quickening of the heart beat. It increased coronary blood flow by increasing the cardiac output and by direct influence on the smooth muscles of the vessels. Arterial and venous blood pressure were not affected, the EKG was not influenced, and no pulmonary damage was observed.

Hawthorn is hypotensive
A fraction of the hawthorn extract, containing flavan polymers, had a low toxicity in the mouse, a pronounced hypotensive activity in the cat, and strong and prolonged cardiotonic action and detoxicating properties in the rabbit.

Oligomeric procyanidins isolated from hawthorn extract decreased blood pressure in cats; in mice, they decreased aggression and body temperature, and prolonged hexobarbital narcosis.

Hawthorn versus Digitalis
It was once assumed hawthorn and digitalis belonged to the same class of agents. That hypothesis has been totally refuted by studies which demonstrated hawthorn may partly antagonize the undesirable properties of digitalis.

In addition, hawthorn enhances pulse and positively potentiates the force of muscular contractions. Hawthorn enhances cardiac output or performance in rats as measured by stress swimming trials. On isolated frog heart, it has a tonic and normalizing action. Unlike digitalis, hawthorn lowers blood pressure through dilation of peripheral vessels, rather than by direct action on the heart. Thus it preserves critical reflexive blood pressure regulation.

In man, hawthorn acts even on the healthy heart to increase cardiac activity. Hawthorn appears to have less of an immediate effect than digitalis. After longer periods of use, subjective betterment accompanied by objective measurable improvement in tonus and regulation of cardiac activity are observed with hawthorn. Unlike digitalis, hawthorn exhibits an absence of cumulative activity; it appears to occupy a position somewhere between digitalis and adrenalin.

Heart tissue pretreated with either Hawthorn or Digitalis becomes sensitized to the other, so only about half the normal dose of the second is required to obtain normal results. This suggests a synergism between the two substances.

Hawthorn has an anabolic effect on metabolism
After 14 hours of abstinence from food, the blood levels of free fatty acids, free glycerol, triglyceride, glucose, lactate, and pyruvate were measured in ten human subjects. These levels were measured again 30, 60, and 120 minutes after intravenous injection of hawthorn extracts. Thirty and sixty minutes after injection, a significant decrease in free fatty acids and lactate was observed. Glucose and pyruvate also decreased, whereas the concentration of triglycerides increased.

The observed alterations in fat and carbohydrate metabolism suggests hawthorn has an anabolic effect on metabolism, presumably by an influence on the enzymatic system. In this way, a decrease in oxygen and energy consumption would occur.
 

Drug Interactions & Precautions

Known Interactions
The effects of hawthorn and digitalis are synergistic, only half the normal dose of digitalis is required if hawthorn is also being used.

Possible Interactions
Diuretic-induced hypokalemia may increase the activity of hawthorn; quinidine, procainamide, and propranolol may also enhance its effects.

Conversely, the effects of the herb may be reduced by propantheline, spironolactone, and triamterene, as well as by antacids, antidiarrheal absorbent suspensions, neomycin, cholestyramine, and other anionic exchange resins.

Hawthorn is synergistic with parenteral calcium salts, pancuronium, succinylcholine, rauwolfia alkaloids, ephedrine, epinephrine, and other adrenergic agents.

The inotropic action of this herb may be reduced by propranolol; however, the effects of the two substances on AV are additive.

Cyclopropane or halogenated hydrocarbon anesthetics may sensitize the myocardium to the cardiotonic effects of hawthorn, although the chances of this happening are very low.

Comments
The cardiac alkaloids in hawthorn may antagonize the action of heparin.

Certain drugs induce activity by hepatic microsomal enzymes metabolizing cardiac glycosides. These agents probably affect the action of hawthorn, but in an as yet unknown manner.

To the extent that hawthorn's action depends on the presence of cholinergic substances, it will be affected by the decrease in cholinergic-receptor stimulation produced by anticholinergics. Drugs utilized to treat angina pectoris, such as nadolol and propranolol HCl, may reduce AV conduction induced by this herb.
 

Safety Factors & Toxicity

No toxicity has been attributed directly to hawthorn. However, since it is an active cardiotonic herb, users should exercise extreme caution when combining this herb with other cardiac drugs.

The German Commission E status of the berry and leaf is "null" or neutral i.e. while they are not approved, there is no documented risk. There may also be some concern over the claims made by manufacturers i.e. they are unproven.

Hawthorn leaf with flower has approval status by the German Commission E.

The German Commission E recommends Hawthorn leaf with flower be used for a minimum of 6 weeks.

References:

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.


 

Preparation & Administration

Three times a day
Use every three hours in congestive heart failure

Dried berry
0.3-1 grams

Tea
made from 1/4-1/2 tsp of dried berry

Fluid extract
1:1 in 25% alcohol, 0.5-1 ml

Tincture
1:5 in 45% alcohol, 2-4 ml

This herb has approval status by the German Commission E.

Recommended daily dosages in Germany are as follows:

Hawthorn leaf and flower: 160 - 900 mg extract.

The German Commission E recommends Hawthorn leaf with flower be used for a minimum of 6 weeks.

References:

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Note: This Herbal Preparation information is a summary of data from books and articles by various authors. It is not intended to replace the advice or attention of health care professionals.
 

References

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