Dr. Rawls is a licensed medical doctor in North Carolina and a leading expert in integrative health. He has extensive training in alternative therapies, and is the Medical Director of Vital Plan, a holistic health and herbal supplement company in Raleigh, NC.
Hawthorn is a small tree with thorny branches whose berries, flowers, and leaves are used as medicine. It has been the subject of extensive modern research demonstrating its cardiovascular benefits. Hawthorn is also helpful for supporting the nervous system, digestion, and connective tissues.
Hawthorn is a thorny, shrubby tree belonging to the Rosaceae family. Its genus, Crataegus, contains over 200 species. Crataegus laevigata and Crataegus monogyna are most commonly used in Western herbal medicine, although various other species have been used for food, medicine, and tools throughout history and across the world.
In spring, hawthorn produces five-petaled white or pink flowers that later give rise to red berries. The leaves are bright green, and the wood is durable and strong.2 Recent studies confirm that the berries, leaves, and flowers contain phytochemicals that can benefit several systems of the body.
One of hawthorn’s most impressive and well-researched benefits is its ability to support the cardiovascular system. Hawthorn can increase heart muscle contraction force, increase coronary blood flow, reduce the oxygen demand of the heart, protect against blood vessel damage, mildly reduce blood pressure, regulate heartbeat, and improve heart rate variability (HRV).3,4,5
Hawthorn extract can be beneficial in protecting against and decreasing the damage of atherosclerosis, a hardening of the arteries caused by a buildup of fats, cholesterol, and other substances. Additionally, hawthorn can lower LDL cholesterol and has demonstrated the ability to decrease diet-induced high cholesterol levels.3,5,6,10
Hawthorn subtly reduces elevated blood pressure and has wide-ranging circulatory supportive qualities. Its ability to dilate blood vessels and support blood flow can help improve circulation and deliver oxygen and nutrients to tissues.
Hawthorn’s long history of use as a cardiotonic is affirmed by numerous clinical trials. A 2008 Cochrane Review evaluated 14 double-blind, placebo-controlled clinical trials and concluded that hawthorn extract, as an adjunct to conventional therapy, significantly benefits symptom control and physiological outcomes of chronic heart failure.1
Hawthorn has also been shown to be beneficial for reducing stress-related palpitations and may be combined with herbs like lemon balm, milky oats, or motherwort for this purpose.5,6
Hawthorn has mild nervine properties that can calm an overexcited nervous system.6 The berries have traditionally been used for heartache, nervousness, sleep disorders, and stress.
One animal study showed hawthorn pulp and seed extract have calming and mild pain-relieving effects.7
In a double-blind, placebo-controlled clinical trial, an herbal preparation containing hawthorn, California poppy, and magnesium was found to be safe and more effective than the placebo in relieving mild to moderate anxiety.8
Hawthorn contains compounds that increase the secretion of digestive enzymes and the enzyme activity within the stomach. These compounds support the movement of food through the digestive tract, helping to regulate gastrointestinal dysfunction such as bloating, constipation, and gas.9
In addition, hawthorn has a mild antispasmodic quality, which can help ease uncomfortable digestive issues such as irritable bowel syndrome and intestinal cramping.
Anti-inflammatory compounds such as flavonoids found in hawthorn help strengthen collagen, a protein critical to the integrity of bones, cartilage, joints, ligaments, skin, tendons, and vascular tissue. These flavonoid compounds can also help reduce excessive inflammatory responses that compromise collagen health. This action aids in protecting connective tissue against inflammatory conditions like rheumatoid arthritis and others.6
While not as potent of an antimicrobial herb as other herbs such as andrographis or cat’s claw, hawthorn does have some modest antimicrobial properties. In vitro studies on various species of hawthorn extract demonstrated antibacterial activity, and certain compounds in the hawthorn species Crataegus sinaica, specifically, had an inhibitory effect against herpes simplex virus1.3,9/sup>
In European herbal traditions, the berries, flowers, and leaves are utilized for their astringent, antispasmodic, cardiotonic, diuretic, and hypotensive properties.11 The Swiss physician Paracelsus (1493-1541) may have been the first to mention hawthorn’s action upon the heart. By the late 19th century (and probably even earlier), European homeopathic and medical doctors frequently used hawthorn for cardiovascular conditions.12
At least 11 species of hawthorn were used by Native American tribes for back pain, bladder and digestive issues, circulatory support, and more. Tools were crafted out of the thorns and wood, and the berries were consumed as food by various coastal tribes.6,12
Also, in North America, the Eclectic physicians of the late 19th and early 20th century administered hawthorn for various heart conditions.13
The species Crataegus pinnatifida has been used in Chinese medicine for cardiovascular issues dating back to 659 CE.12 Earliest uses of the berries were for chest pain, indigestion, hernias, and improving blood flow postpartum.9
In traditional Chinese medicine (TCM), the concept of shen is often translated as “spirit” and encompasses all of an individual’s mental, spiritual, and creative activities. Hawthorn is considered a shen tonic and has been used in TCM to soothe anxiety, insomnia, restlessness, and reduce stress-induced heart issues such as palpitations.6
Hawthorn is most commonly prepared as capsules, tea, or tincture. The berries, flowers, and leaves are used.
To make hawthorn tea, steep one teaspoon of dried berries, flowers, and/or leaves in one cup of water for at least 15 minutes. Drink one cup up to three times daily. Try combining hawthorn with herbs like lemon balm or holy basil for a stress-soothing tea, or combine it with hibiscus for more of a cardiovascular supportive tea.
Typical dosing recommendations for hawthorn tincture are 1.5 to 6 mL taken up to three times daily.
Hawthorn can also be taken as a capsule, generally 1000 mg up to three times per day. If using a powdered extract capsule, look for products standardized to at least 1.5%-2% vitexin. Vitexin is a compound found in hawthorn that has beneficial physiological effects, including but not limited to, being hypotensive, anti-inflammatory, antioxidant, and neuroprotective.
Hawthorn is most beneficial when taken consistently over a longer period of time.14
Due to hawthorn’s benefits for the cardiovascular system, it may theoretically affect the efficacy of beta-blockers and other blood pressure medications, by possibly strengthening their blood pressure-reducing capabilities. Be sure to work with your healthcare provider if you’re taking these medications to see if they recommend a possible drug dosage adjustment. Note that this concern is theoretical and that large-scale clinical studies have not demonstrated any drug interactions with hawthorn when used at normal doses such as those mentioned above or as recommended by your healthcare provider.16
Always check with your healthcare practitioner before use if you are taking medications. For more general education on potential interactions between herbs and medications, check out Dr. Bill Rawls’ article: Is it Safe to Take Herbs with My Medications?
Hawthorn may be contraindicated in individuals taking heart medications (see above potential interactions. There are no reports of toxicity, and at normal doses, such as those mentioned in the How To Use and Dosing section, it is considered safe to use during pregnancy and breastfeeding.
This information is intended only as general education and should not be substituted for professional health advice. Any mentioned general dosage option, safety notices, or possible interactions with prescription drugs are for educational purposes only and must be considered in the context of each individual’s health situation. Use this information only as a reference in conjunction with the guidance of a qualified healthcare practitioner.
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1. Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. 2008;(1):CD005312. Published 2008 Jan 23. doi:10.1002/14651858.CD005312.pub2
2. Hawthorn. Yale Nature Walk. https://naturewalk.yale.edu/trees/rosaceae/cratageus/hawthorn-48. Published March 2, 2016. Accessed March 14, 2022.
3. Bone K, Mills S. Principles And Practice Of Phytotherapy. London: Elsevier Health Sciences UK; 2013:671-684.
4. Tassell MC, Kingston R, Gilroy D, Lehane M, Furey A. Hawthorn (Crataegus spp.) in the treatment of cardiovascular disease. Pharmacogn Rev. 2010;4(7):32-41. doi:10.4103/0973-7847.65324
5. Wang J, Xiong X, Feng B. Effect of crataegus usage in cardiovascular disease prevention: an evidence-based approach. Evid Based Complement Alternat Med 2013;2013:149363. doi:10.1155/2013/149363
6. Christa S. In: The Essential Guide to Western Botanical Medicine. Arcata, CA: Christa Sinadinos; 2020:412-414.
7. Can OD, Ozkay UD, Oztürk N, Oztürk Y. Effects of hawthorn seed and pulp extracts on the central nervous system. Pharm Biol. 2010;48(8):924-931. doi:10.3109/13880200903305500
8. Hanus M, Lafon J, Mathieu M. Double-blind, randomised, placebo-controlled study to evaluate the efficacy and safety of a fixed combination containing two plant extracts (Crataegus oxyacantha and Eschscholtzia californica) and magnesium in mild-to-moderate anxiety disorders. Curr Med Res Opin. 2004;20(1):63-71. doi:10.1185/030079903125002603
9. Wu J, Peng W, Qin R, Zhou H. Crataegus pinnatifida: chemical constituents, pharmacology, and potential applications. Molecules. 2014;19(2):1685-1712. Published 2014 Jan 30. doi:10.3390/molecules19021685
10. Wang SZ, Wu M, Chen KJ, et al. Hawthorn Extract Alleviates Atherosclerosis through Regulating Inflammation and Apoptosis Related Factors: An Experimental Study. Chin J Integr Med. 2019;25(2):108-115. doi:10.1007/s11655-018-3020-4
11. Khan IA, Abourashed EA. In: Leung’s Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics. Hoboken, NJ: Wiley; 2010:352-354.
12. Engels G, Brinckmann J. Hawthorn. American Botanical Council. https://www.herbalgram.org/resources/herbalgram/issues/96/table-of-contents/herbalgram-96-herb-profile-hawthorn/. Accessed March 14, 2022.
13. Crataegus. Crataegus oxyacantha. Henriette’s Herbal Homepage. https://www.henriettes-herb.com/eclectic/ellingwood/crataegus.html. Accessed March 14, 2022.
14. Noel Groves M. Body Into Balance. Storey Publishing; 2016.
15. Degenring FH, Suter A, Weber M, Saller R. 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. Phytomedicine. 2003;10(5):363-369. doi:10.1078/0944-7113-00312
16. Garner-Wizard M, Henson S, Hoots D, Robbins S, Van De Walle G. Review of Proprietary Hawthorn Extract WS® 1442 for Treating Heart Failure – American Botanical Council. American Botanical Council. https://www.herbalgram.org/resources/herbclip/issues/bin_589/031831-589/. Published 2018. Accessed March 16, 2022.
17. Tadić VM, Dobrić S, Marković GM, et al. Anti-inflammatory, gastroprotective, free-radical-scavenging, and antimicrobial activities of hawthorn berries ethanol extract. J Agric Food Chem. 2008;56(17):7700-7709. doi:10.1021/jf801668c
18. Grieve M. Hawthorn. A Modern Herbal. https://www.botanical.com/botanical/mgmh/h/hawtho09.html. Accessed March 14, 2022.