At a glance: Hawthorn is not one uniform herbal drug. In European herbal medicine, the most important medicinal material is leaf with flower (Crataegi folium cum flore), while the red fruits have their own long history as food and medicine. Leaves, flowers and fruits overlap chemically but are not identical, and evidence generated with a standardised leaf-and-flower extract should not automatically be transferred to hawthorn berries.[1][2][3]
Botanical profile
- Genus: Crataegus.
- Important European species: Crataegus monogyna Jacq., C. laevigata (Poir.) DC. and related species/hybrids.
- Family: Rosaceae.
- Medicinal parts: leaf with flower, and separately the fruit.
- EMA herbal drug: Crataegi folium cum flore — hawthorn leaf and flower.[1]
Hawthorn is a thorny shrub or small tree common in hedgerows across Britain and Europe. Its spring flowers are usually white or pinkish; the red fruits that follow in autumn are technically pomes rather than true berries.
Leaf, flower and fruit are not interchangeable
Herbal books often use the single word “hawthorn”, but a pharmacognosy monograph needs to be more precise. The main medicinal materials include:
- Flowering tops / leaf with flower: the spring material represented by the EMA monograph.
- Flowers: sometimes gathered or used with less leaf in traditional practice.
- Leaves: usually used together with flowers rather than as an isolated modern medicinal drug.
- Fruit: the autumn red haws, used as food, syrup, conserve, wine and in herbal preparations.
A comparative chemical study of C. monogyna flower buds, flowers and fruits found clear differences across developmental stages and plant parts, including differences in phenolics, sugars, fatty acids, tocopherols and antioxidant measurements.[3]
Major constituents — leaf with flower
Leaf-and-flower preparations are particularly associated with flavonoids including hyperoside and vitexin derivatives, oligomeric procyanidins, phenolic acids and smaller amounts of triterpenes and other polyphenols.[2][4]
Major constituents — fruit
Hawthorn fruits also contain flavonoids and procyanidins, but they additionally make an important nutritional contribution through sugars, organic acids, anthocyanin pigments, pectins, vitamin-related compounds and other fruit phenolics. Ripeness changes this profile substantially.[3][5]
Traditional use
Hawthorn has a long European reputation as a heart and circulation herb. Flowering tops have traditionally been used for a sensation of a weak or ageing heart, palpitations associated with nervousness, mild breathlessness on exertion and poor peripheral circulation. It has also been used as a calming cardiovascular herb where emotional tension and awareness of the heartbeat occur together.
The fruits have traditionally been eaten and prepared as syrups, wines, jellies and herbal remedies. In European folk practice they have been used as a nourishing cardiovascular tonic, while other regional traditions have used hawthorn fruits for digestion, food stagnation and abdominal discomfort. Hawthorn has therefore occupied both a food and medicine role for centuries.
Contemporary herbal practice
In contemporary Western herbal practice, hawthorn is often treated as a slow, restorative cardiovascular herb rather than an acute “heart medicine”. Leaf with flower is commonly used where mild circulatory weakness, nervous palpitations or reduced cardiovascular resilience are part of the picture, while fruit may be used as a gentler food-like tonic or included alongside the flowering tops. Practitioners may combine hawthorn with herbs such as motherwort, lime flower or garlic according to the presentation. The plant-part distinction remains clinically important: a berry syrup and a standardised leaf-and-flower extract are not interchangeable simply because both are hawthorn.
European regulatory perspective: leaf with flower
The European Medicines Agency’s HMPC has a European Union herbal monograph specifically for Crataegus leaf with flower. The first final monograph was published in 2016, with a Revision 1 consultation undertaken in 2025.[1]
Cardiovascular research
Modern hawthorn research has focused largely on cardiovascular function. Leaf-and-flower extracts have been investigated for effects on myocardial function, vascular tone, endothelial signalling and exercise tolerance in people with cardiac conditions. Results depend strongly on the extract and clinical population. Evidence from a characterised extract should not automatically be assigned to tea, berry syrup or an unstandardised supplement.
Pharmacology
Proposed cardiovascular mechanisms include endothelial nitric-oxide signalling, effects on vascular tone, myocardial calcium handling, antioxidant effects of flavonoids and procyanidins, and effects on vascular and myocardial remodelling pathways.[2][4]
Hawthorn fruit research
Hawthorn fruit has attracted growing research interest as both a medicinal food and a source of polyphenols. Recent reviews describe cardiovascular, metabolic, anti-inflammatory and food applications while emphasising the need for better clinical standardisation.[2][5]
Preparations
- infusions of leaf and flower;
- tinctures and fluid extracts of flowering tops;
- standardised dry leaf-and-flower extracts;
- fresh or dried fruits;
- fruit syrups, decoctions, wines and preserves; and
- combined preparations using flowering tops and fruit.
Safety and cardiovascular medicines
Hawthorn is usually well tolerated in medicinal use, but because it is used specifically in people who may already have cardiovascular disease, medication review matters. New chest pain, fainting, marked breathlessness, a new irregular heartbeat or rapidly worsening leg swelling require medical assessment rather than self-treatment with a cardiovascular herb.
Student note: common evidence traps
- Leaf with flower is not the same drug as fruit.
- The EMA monograph is for folium cum flore, not generic “hawthorn berries”.
- Check the Crataegus species because the genus contains many species and hybrids.
- Do not cite a standardised extract trial as evidence for homemade berry syrup.
- Fruit chemistry changes with ripeness.
- Traditional “heart tonic” use should not be converted into a diagnosis or treatment claim for modern cardiac disease.
References
- European Medicines Agency, Committee on Herbal Medicinal Products. Crataegi folium cum flore — Crataegus spp., folium cum flore. European Union herbal monograph and assessment documents.
- Kępińska-Pacelik J, Biel W. Hawthorn (Crataegus monogyna Jacq.): a review of therapeutic potential and applications. Molecules. 2026;31(2):226.
- Barros L, Carvalho AM, Ferreira ICFR. Comparing the composition and bioactivity of Crataegus monogyna flowers and fruits used in folk medicine.
- Traditional uses, phytochemistry, pharmacology and safety concerns of hawthorn (Crataegus genus): a comprehensive review. Journal of Ethnopharmacology. 2023.
- Crataegus monogyna fruit as a functional ingredient: 2025 review.
Additional materia medica sources
- ESCOP. Crataegi folium cum flore and Crataegi fructus, ESCOP Monographs — particularly useful because ESCOP treats flowering tops and berries separately.
- Blumenthal M, et al., eds. The Complete German Commission E Monographs. American Botanical Council; 1998.
- British Herbal Medicine Association. British Herbal Pharmacopoeia 1983 and British Herbal Compendium.
- Mills S, Bone K. Principles and Practice of Phytotherapy. 2nd ed. Elsevier; 2013.
- Hoffmann D. Medical Herbalism. Healing Arts Press; 2003.
Last reviewed: 20 September 2026. Educational reference only; not an individual cardiovascular diagnosis or prescribing guide.
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