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Traditional Chinese medicine · Western herbalism

HawthornCrataegus pinnatifida (shan zha); Crataegus monogyna and C. laevigata (Western)

Hawthorn fruit is the Chinese herb for meat and grease stagnation (9 to 12 g in the Pharmacopoeia); we could find no human gut trial, and it interacts with heart drugs.

Botanical name
Crataegus pinnatifida (shan zha); Crataegus monogyna and C. laevigata (Western)
Part used
fruit (berry); leaf and flower in Western cardiac products
Also called
pinyin Shan zha (山楂); Haw, Hawthorn berry, Chinese hawthorn (C. pinnatifida)
Used in
Traditional Chinese medicine, Western herbalism
Taken for
Indigestion, Bloating, Loose stools and diarrhea
Sold as
decoction, capsules, extract, tincture, tea, as a food

The plant

Hawthorn is a thorny shrub or small tree of the rose family (Rosaceae). Two groups of species matter. In China the fruit of Crataegus pinnatifida is the medicine shan zha: a small, sour fruit that is also eaten as a daily food, sold dried as slices, sometimes roasted or charred. In Europe the cardiac supplements use Crataegus monogyna and C. laevigata, typically as standardized extracts of the leaf with flower, with the berries used in tinctures and teas.

The same genus name therefore covers two different markets. Digestive use belongs mostly to the Chinese fruit; the extracts with human trial data (all in heart failure and blood pressure) are leaf-and-flower or berry extracts from the European species. A product labeled “hawthorn” may be dried fruit slices for a decoction, a capsule of ground berry, or a standardized leaf-and-flower extract, and these are not interchangeable.

How the traditions use it

Traditional Chinese medicine (about TCM)

TCM classes shan zha as slightly warm, sour and sweet, entering the spleen, stomach and liver channels. The Chinese Pharmacopoeia entry lists its functions as promoting digestion and fortifying the stomach, moving qi and dispersing blood stasis, and transforming turbidity and lowering lipids. The leading use is what the texts call meat stagnation: food, especially meat and greasy meals, that the tradition says sits undigested in the stomach, with fullness in the upper abdomen, and with abdominal pain and diarrhea. The entry gives 9 to 12 g and says the charred form is stronger for meat stagnation and for dysentery that does not clear. The Pharmacopoeia also lists blood-stasis amenorrhea, postpartum stasis, chest and heart pain, hernia pain and high blood lipids. A review of the species cites the Compendium of Materia Medica for dyspepsia.

Western herbalism

In European herbal medicine hawthorn is first a heart herb, and the leaf with flower and the berries are the parts used. A review of the species notes that the berry has also been used for gastrointestinal diseases, to stimulate digestion and promote stomach functions, and for indigestion, epigastric distension, abdominal pain and diarrhea, and that tradition called it antispasmodic and astringent. The EU committee on herbal medicines accepts hawthorn leaf and flower as a traditional medicine for temporary heart complaints related to nervousness, such as palpitations, and for mild mental stress and sleep; digestion is not among its indications.

What is in it

More than 150 compounds have been isolated from C. pinnatifida, with flavonoids the most abundant, along with triterpenic acids (ursolic, oleanolic, corosolic, maslinic), organic acids (malic, citric, quinic, tartaric) and chlorogenic and caffeic acids. European extracts are standardized to oligomeric procyanidins (WS 1442 to 18.75 percent) or flavonoids. In laboratory work an alcohol extract lowered contraction of rat stomach and intestinal muscle strips, an aqueous extract raised it, and organic acids increased mouse gut motility. In rats fed a high-fat diet, a charred-hawthorn pill raised gastrin and motilin and shifted the gut microbiota. These are animal and lab results.

What the human trials show

We could find no controlled trial in people of hawthorn fruit, or of shan zha in a named formula, for indigestion, bloating, stagnation or diarrhea. The review of C. pinnatifida mentions one study in which children on azithromycin who also took hawthorn slices had fewer gastrointestinal side effects than controls (p < 0.05), reported without further detail, and it states that systemic toxicity and safety studies are lacking. The digestive case rests on tradition and on rat studies.

The human evidence for the genus is in the heart. A Cochrane review of hawthorn leaf-and-flower extract in chronic heart failure included 14 trials; in 10 trials with 855 patients, maximal workload rose by 5.35 watts (95% CI 0.71 to 10.00) against placebo. The SPICE trial gave 900 mg a day of the extract WS 1442 to 1,338 people with heart failure for 24 months, against 1,343 on placebo; time to first cardiac event did not differ (620 against 606 days, p = 0.476). A meta-analysis of six trials and 428 people found a fall in systolic blood pressure of 6.65 mmHg on 250 to 1,200 mg a day for 2 to 6 months.

What has not been tested: shan zha for any digestive outcome, charred versus raw fruit, or the interaction of fruit decoctions with heart and blood pressure drugs. The cardiac results do not transfer to digestion.

StudyDoseWhat it found
Rat study of Dashanzha Pill made from raw versus charred hawthorn fruit in high-fat-diet dyspepsia (animal, not human) PMID 34710267Oral pill in ratsCharred form raised gastrin and motilin more, lowered VIP and restored gut microbiota composition; no human data
Cochrane review, hawthorn leaf-and-flower extract in chronic heart failure; 14 trials, 855 patients in the 10-trial meta-analysis (heart, not gut) PMID 18254076Extract, doses variedMaximal workload +5.35 W (95% CI 0.71 to 10.00); adverse events infrequent, mild, transient: nausea, dizziness, cardiac and GI complaints
SPICE trial, 2,681 people with heart failure (heart, not gut) PMID 19019730WS 1442, 900 mg a day for 24 monthsNo effect on time to first cardiac event (620 vs 606 days, p = 0.476); adverse events comparable with placebo
Systematic review of Crataegus adverse events: 24 studies, data from 5,577 patients PMID 16752934160 to 1,800 mg a day for 3 to 24 weeksMostly mild to moderate; dizziness, gastrointestinal complaints (24 reports), headache, palpitation; no drug interactions reported
Randomized crossover digoxin interaction study, 8 healthy volunteers PMID 12817526WS 1442 450 mg twice daily for 21 days with digoxin 0.25 mgNo significant change in digoxin pharmacokinetics (AUC 79 vs 73 mcg.h/L, p > 0.05)
Laboratory study of hawthorn and digoxin: immunoassay interference and rat heart cells PMID 20670141In vitroInterfered with one of two digoxin immunoassays; both extracts raised intracellular calcium with no additive effect; authors advise people on digoxin to avoid hawthorn

How much the studies and the texts used

The Chinese Pharmacopoeia dose for dried shan zha is 9 to 12 g; it also lists a charred form, and the fruit is eaten fresh as a food. No trial gives a digestive dose. For the European extracts, SPICE used 900 mg a day of WS 1442 for 24 months, the digoxin study used 450 mg twice a day for 21 days, the blood pressure trials ranged from 250 to 1,200 mg a day for 2 to 6 months, and the heart failure and safety reviews covered extracts from 160 to 1,800 mg a day for 3 to 24 weeks. The EU monograph page gives no dose and refers readers to the package leaflet.

Doses here describe what studies and pharmacopoeias used. They are not a recommendation for any person; a clinician or pharmacist who knows your medicines and conditions is the right person to ask.

Side effects and cautions

The adverse-event review of 24 studies with data from 5,577 patients found mostly mild to moderate effects: dizziness or vertigo, gastrointestinal complaints, headache, palpitation and migraine, plus eight severe events with one extract (LI 132); its authors still call for care with unsupervised use alongside other medicines. The Cochrane review lists nausea, dizziness, and cardiac and gastrointestinal complaints. The EU monograph page says no side effects had been reported at the time of its assessment and that leaf-and-flower medicines are for adults only for the heart indication; it does not address pregnancy. A review of C. pinnatifida states that systemic toxicity studies are lacking. Because hawthorn acts on the heart and blood pressure, its main caution is with cardiac medicines.

Interactions

Hawthorn lowers blood pressure and acts on the heart, so cardiac and blood pressure drugs are the concern. A lab study found hawthorn interfered with one digoxin blood test and raised heart-cell calcium without adding to digoxin, and its authors advise people on digoxin to avoid it; a trial in 8 healthy volunteers found no change in digoxin levels. Reviews also list possible interactions with beta-blockers and blood pressure drugs, consistent with a 6.65 mmHg fall in systolic pressure in a meta-analysis of six trials. No interaction was reported in the adverse-event review, which did not test for one.

Hawthorn on the shelf: the products that contain it

The products here name hawthorn among their actives. How much of it a serving holds, and whether that matches any trial, is on each page.

Health Concerns Quiet Digestion 4.5 out of 5 from 54 ratings from Amazon · $2.39 per day at two capsules three times a day ($35.90 for 90 on the brand site and Amazon, a 15-day bottle); the 270-capsule size is $1.89 a day

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Often paired or compared

TCM / Western Orange peel Citrus reticulata (chen pi); Citrus sinensis (sweet orange); Citrus aurantium (bitter orange) TCM Massa fermentata (shen qu) Massa Medicata Fermentata (a fermented mixture, not a single plant) TCM Barley sprout (mai ya) Hordeum vulgare TCM Radish seed (lai fu zi) Raphanus sativus

Questions people ask

What is shan zha used for in TCM?

The Chinese Pharmacopoeia lists shan zha for promoting digestion and fortifying the stomach, moving qi and dispersing blood stasis, and lowering lipids. Its leading use is meat stagnation, the pattern of fullness, belching and abdominal pain with diarrhea after meat or greasy meals. The Pharmacopoeia gives 9 to 12 g.

Has hawthorn been tested for indigestion?

We could find no controlled trial in people of hawthorn fruit for any digestive outcome. The human trials are of leaf-and-flower extracts in heart failure and blood pressure, which do not carry over to digestion.

Does hawthorn interact with heart medicines?

Hawthorn acts on the heart and lowers blood pressure, and reviews list possible interactions with digoxin, beta-blockers and blood pressure drugs. A lab study found it interfered with a digoxin blood test, while an 8-person trial found no change in digoxin levels.

Is the Chinese hawthorn the same as the European one?

No. The Chinese medicine is the fruit of Crataegus pinnatifida, used in decoctions. The European cardiac extracts come from C. monogyna and C. laevigata, usually leaf and flower, and the trials of those extracts were not trials of shan zha.

What is charred hawthorn?

The Pharmacopoeia lists a charred form of shan zha, stronger than the raw fruit for meat stagnation and dysentery that does not clear. A rat study of Dashanzha Pill found the charred form raised gastrin and motilin more than the raw form.

Sources