-IBIS-1.7.0-
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herb
Crataegus spp. (Hawthorn)
Botanicals

-IBIS-1.7.0-

rx

herb

Crataegus spp. (Hawthorn)

Botanicals

definition

botanical name(s): Crataegus oxyacantha (syn. C. laevigata) Crataegus monogyna.

synonyms: Hawthorn, red haw, maythorn, quickset, thorn-apple tree, whitethorn, hedgethorn.

part(s) used: berries, flowers, leaves.

qualities: sweet, slightly bitter, cool, dry, astringent.

affinities: heart, arteries, blood.

actions: cardiotonic, myocardial trophorestorative; coronorary and peripheral vasodilator, anti-arrhythmic, antioxidant, hypocholesterolemic, hypotensive, positive inotrope,

dosage:

» Tincture (flowers & leaves) : 1 - 2 ml three times daily Tincture (berries) : 2 - 4 ml. three times daily

(Preparations may vary, some are 50/50 Flower/Berries.)

» Dried herb : Infusion (flowers & leaves) Decoction (berries) Two teaspoons per cup (30gm/500ml) One cup three times daily

» Powdered dried herb : 500 - 1000 mg three times daily

» Standardised Extract : 100-250mg three times daily (Standardised to 1.8% vitexin or 10% total flavonoids as hyperoside)

therapy: coronary artery disease; angina pectoris; myocardial hypoxemia; Cardiac insufficiency (NYHA Stage I and II), arrhythmias; senile degeneration of the heart and atherosclerosis; post-infectious weakening of myocardium (Weiss pp. 164-65); paroxysmal tachycardia; Buerger's disease, (British Herbal Pharmacopoeia), synergist to reduce dosage of cardiac glycoside herbs (or drugs).

specific indications: hypertension with myocardial weakness, angina pectoris (British Herbal Pharmacopoeia).

constituents:

» Flavonoids: (hyperoside, vitexin rhamnosides).

» Oligimeric procyanidins and flavans (catechin and epicatechin dimers to octomers).

» Triterpene derivatives (including oleanolic acid, ursolic acid).

» Aromatic acids (chlorogenic and caffeic acids).

» Alkylamines (including including acetylcholine, dopamine).

» Other: purines, uric acid, ascorbate, amygdalin, volatile oil.

pharmacology:

» Cardioactivity: It is established that Crataegus oligomeric procyanidins and flavonoids increase myocardial and coronary blood flow, that it is positively inotropic and and hypotensive, but the mechanism of action is unclear. Crataegus flavonoids inhibit cAMP Phosphodiesterase, and myocardial Na+/K+ ATP'ase. The same compounds exhibit high antioxidant free radical scavenging activity, and are hypolipidemic via an action on hepatic LDL receptors and increased bile secretion. Crataegus also inhibits TXA2 (Thromboxane) formation, while stimulating prostacycline. Crataegus prolongs rather than reduces the myocardial refractory period, unlike most positive inotropes, hence reducing risk of arryhthymia. Animal studies have confirmed the abilty of Crataegus to lower blood pressure, increase myocardial perfusion, minimise ischemic damage (reduces post infarct LDH by 50%).(Literature Review see American Herbal Pharmacopoeia).

Clinical trials:

Several controled studies have been performed with Crataegus extracts and NYHA stage I and II cardiac insufficiency patients. Crataegus increased exercise tolerance, decreased systolic BP and heart rate (Schmidt 1994), decreased severity of symptoms subjectively as well as HR, BP (Leuchtgens, 1993). In another group (n=1476) Crataegus decreased symptom severity by 66%, and was associated with systolic drop of 10mm and diastolic drop pf 5mm average blood pressure. (Loew, 1996)

AHPA Botanical Safety Rating: 1

toxicity: 1

Crataegus has minimal or negligible toxicity. The safe theraputic dose range for Hawthorn is wide. The herb may be used for extended periods where necessary, even at the higher doses. generally dosage will be proportional to the severity of the condition.

drug interactions:

» Crataegus will synergise with the cardiac glycoside containing plants such as Convallaria, Digitalis, Strophanthus, Urginea, Apocynum, Asclepias etc., as well as the hypotensive alkaloids of Veratrum and Rauwolfia. Western clinical herbalists use Crataegus as an adjuvant to lower the dose of these more toxic herbs required for effective action.

» Crataegus potentiates the activity of cardiac glycosides including digitoxin, digoxin etc. Patients using these medications should be monitored by a herbalist or physician since the dose of pharmaceutical drug will need to be reduced during intercurrent therapy.

footnotes

General references: Weiss R., 1988; American Herbal Pharmacopoeia (in press, 1998).

Brinker F. 1995. Botanical Medicine Research Summaries. (from Eclectic Dispensatory of Botanical Therapeutics, vol.11), Sandy, Oregon: Eclectic Medical Publications.

British Herbal Medical Association. 1983. British Herbal Pharmacopoeia. West Yorks, England: The British Herbal Medical Association.

Leuchtgens, H.1993. Crataegus-spezialextrakt WS 1442 bei Herzinsuffizienz NYHA II, Eine plazebokontrollierte randomisierte Doppleblindstudie. Fortschr. Med. 111:352-354.

Loew,D. et al., 1996. Efficacy and tolerability of a hawthorn preparation in patients with heart failure stage I and II according to NYHA - a surveillance study. 2nd International Congress on Phytomedicine. Munich 1996.

Schmidt, U. et al., 1994. Efficacy of the Hawthorn preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomedicine, 1:17-24.

Weiss, R.F. 1988. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum; Beaconsfield, England: Beaconsfield Publishers, Ltd.