Shan Zha
StarCrataegus pinnatifida Bge. var. major N.E.Br.
Traditionally used for
- Digestion
- Menstrual & women's health
- Blood pressure
- Energy & fatigue
Cautions & contraindications
- Before surgery
- Heart conditions
☯ TCM Properties
Promotes Digestion and Resolves Food Stagnation; Invigorates Blood and Dispels Stasis; Moves Qi and Alleviates Pain; Transforms Turbidity and Lowers Lipids
Traditional Chinese Uses
Shan Zha (hawthorn fruit) is the most important digestive herb in Chinese medicine for food stagnation — particularly from overconsumption of meat and fatty foods. It moves Blood, disperses clots, and relieves pain in addition to its digestive role, making it useful for postpartum abdominal pain and menstrual irregularity from Blood stagnation. Modern Chinese medicine also widely uses hawthorn for cardiovascular support, including elevated blood lipids and early-stage hypertension.
Western Herbalism Properties
Pharmacological Effects
- Digestant: Fruit increases digestive enzyme secretion and lipase/protease action.
- Hypolipemic: Oral extract lowered serum cholesterol/triglycerides and reduced atheroma in rabbits; alcoholic extract 10 g/kg abated experimental hyperlipidemia; effect mainly after high-fat diet stopped, suggesting enhanced clearance rather than blocked absorption.
- Effect on the coronary circulation: Flavones increased coronary flow in rabbit heart and in dogs (2–3 mg/kg i.v., ~37 min) with reduced myocardial O2 consumption; increased myocardial 86Rb uptake in mice and protected rabbits from acute ischemia.
- Cardiotonic: Extract strengthened toad heart contraction by 20–30%; triterpenic acids restored beat in arrested hearts; synergistic with cardiac glycosides on frog heart.
- Hypotensive and antiarrhythmic: Extract and saponins hypotensive in rabbits, cats, mice; extract 2 g/kg i.v. inhibited pituitrin arrhythmia in rabbits; flavones and saponins reversed aconitine arrhythmia.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 393.
Relationships
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Botanical Description
Crataegus pinnatifida Bunge (Rosaceae), known as Chinese hawthorn or shan zha, is a deciduous tree or large shrub native to northern China, Korea and the Russian Far East, reaching 6 to 9 meters tall with a rounded crown and few or no thorns in the cultivated form (var. major). The bark is gray-brown and shallowly fissured. The leaves are alternate, broadly ovate, 5 to 10 cm long, distinctively pinnately lobed with three to five pairs of deep, sharply toothed lobes and a pair of leaf-like stipules at the base of the petiole. White, five-petalled flowers about 1.5 cm across are borne in many-flowered, flat-topped terminal corymbs in spring. The fruit, ripening in autumn, is a globose to slightly pear-shaped pome 2 to 3 cm across, bright red with small pale lenticels, containing three to five stony nutlets in a mealy, sour-sweet flesh. The ripe fruits, sliced and dried, constitute Shan Zha in Chinese medicine.
Active Constituents
Oligomeric proanthocyanidins (procyanidins B2, C1; epicatechin oligomers)
Condensed tannin / flavan-3-ol oligomerConcentration: with the flavonoids, the major polyphenol class of the fruit
The main vasoactive constituents of hawthorn. They produce endothelium-dependent vasorelaxation and antioxidant effects, and are the fraction to which the cardiovascular activity of standardised Crataegus extracts is attributed. In the fruit they also carry the tannin load that drives phytobezoar formation.
Vitexin and vitexin-2''-O-rhamnoside
C-glycosyl flavoneCharacteristic flavone glycosides of Crataegus pinnatifida and, with hyperoside, the usual chromatographic markers for the drug. Reported activities include coronary vasodilation and antioxidant effects in preclinical models.
Hyperoside (quercetin-3-O-galactoside) and rutin
Flavonol glycosideQuantitatively important flavonols of the fruit and leaf. They contribute to the antioxidant and lipid-lowering activity seen in animal models and are commonly used as assay markers.
Ursolic and oleanolic acid
Pentacyclic triterpenoidTriterpene acids of the fruit associated in preclinical work with the hypolipidaemic and anti-inflammatory effects of Shan Zha extracts.
Chlorogenic acid
Hydroxycinnamic acid ester (phenolic acid)A major phenolic acid of hawthorn fruit contributing to its antioxidant capacity; content varies severalfold between Crataegus species and with ripeness.
Citric and malic acid
Aliphatic organic acidConcentration: high enough to make the fresh and dried fruit markedly sour, which is the basis of the drug's traditional identity
Responsible for the sour taste and for the fruit's gastric-irritant potential. With the fruit's tannins and pectin these acids account for the practical cautions around large amounts of raw fruit on an empty stomach.
Pectin
Polysaccharide (soluble dietary fibre)Contributes to the bile-acid-binding and cholesterol-lowering activity seen in rodent feeding studies, and, together with tannic acid, forms the gel matrix of hawthorn phytobezoars in gastric acid.
⚠ Drug Interactions
Digoxin (serum digoxin immunoassays, particularly Digoxin III)
Dasgupta and colleagues showed that hawthorn extract interferes with the Digoxin III immunoassay (though not with the Tina-Quant assay) and that hawthorn extract raises intracellular calcium in cardiomyocytes without an additive response when digoxin is added, consistent with both binding the same site on Na,K-ATPase. On that basis the authors advised that patients on digoxin avoid hawthorn. Note the polarity of the evidence: the analytical interference is assay-specific and well demonstrated, whereas the pharmacodynamic component is in vitro.
Clinical note: Do not prescribe Shan Zha to a digoxin-treated patient without telling the prescribing physician and the laboratory, because the digoxin level they act on may be wrong. If hawthorn cannot be avoided, ask which digoxin assay the laboratory runs.
Digoxin (pharmacokinetic interaction)
In a randomised crossover study in eight healthy volunteers, hawthorn extract 450 mg twice daily for 21 days did not significantly alter any pharmacokinetic parameter of digoxin 0.25 mg daily, and the authors concluded the two could be coadministered safely at those doses. The critical caveat is species and plant part: that study used a leaf-and-flower preparation of Crataegus oxyacantha, not the fruit of Crataegus pinnatifida, and n was 8, so it does not exclude an effect of Shan Zha on P-glycoprotein-mediated digoxin transport.
Clinical note: Reassuring but not transferable. Treat the immunoassay interference above, not the pharmacokinetics, as the actionable digoxin issue with Shan Zha.
Antihypertensives, nitrates and other vasodilators
Crataegus proanthocyanidins and flavonoids produce endothelium-dependent vasorelaxation, and standardised Crataegus leaf-and-flower extracts have measurable haemodynamic effects in heart failure. No human interaction study with an antihypertensive exists, and hawthorn's own blood-pressure effect in trials is modest, so this is a monitoring point rather than a contraindication.
Clinical note: In a patient on multiple antihypertensives or nitrates, check blood pressure at the next visit after starting a hawthorn-containing formula.
Statins and other lipid-lowering drugs
Crataegus pinnatifida fruit extract lowered serum total and LDL cholesterol in diet-induced hypercholesterolaemic rats, and Crataegus-containing preparations produced small LDL reductions in human trials. There is no evidence of a pharmacokinetic interaction with statins; the concern is only that unrecorded herbal lipid lowering can confound the interpretation of a statin dose titration.
Clinical note: Record hawthorn use in the notes so that a lipid panel change is not misattributed to the statin dose.
Raw hawthorn fruit and gastric phytobezoar (relevant with gastric surgery, gastroparesis, diabetic gastroparesis, anticholinergics and opioids)
Raw hawthorn is one of the recognised causes of phytobezoar. Hawthorn (like persimmon) is rich in tannic acid and pectin: tannic acid precipitates as insoluble tannic-acid protein on contact with gastric acid, and pectin gels and binds the precipitate into a concretion. In a single-centre series from northern China, 56% of bezoar patients came from one hawthorn- and persimmon-rich district. Delayed gastric emptying from any cause, and prior gastric surgery, sharply increase the risk.
Clinical note: Do not advise large amounts of raw or dried whole hawthorn fruit on an empty stomach, and avoid it entirely in patients with gastroparesis, previous gastric surgery, or on drugs that slow gastric emptying. Decocted, sliced Shan Zha at formula doses is the low-risk form. New epigastric pain, vomiting or early satiety in a hawthorn-eating patient warrants endoscopy, not a dose increase.
Crataegus monogyna / Crataegus laevigata leaf-and-flower extracts (WS 1442) - substitution across species and plant part
Almost all Western clinical evidence for hawthorn in chronic heart failure, including the Cochrane review and the SPICE programme, used standardised leaf-and-flower extracts of the European species Crataegus monogyna and Crataegus laevigata, principally WS 1442. Shan Zha as dispensed in Chinese medicine is the fruit of Crataegus pinnatifida (this record's var. major); the closely related southern drug Nan Shan Zha is Crataegus cuneata. The constituent profiles differ - leaf and flower are far richer in flavonoids - and the heart-failure data should not be quoted for the fruit. Hawthorn fruit contains no cardiac glycosides, so it is not a cardioactive glycoside drug in the sense that Periploca or Digitalis are.
Clinical note: State species and plant part when citing evidence to a patient. Do not offer Shan Zha as a treatment for heart failure on the basis of WS 1442 trials.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 9–12 g | Daily | — | — | 中国药典 2020 【用法与用量】9～12g。 【性味与归经】酸、甘，微温。归脾、胃、肝经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
Reduce food accumulation while descending qi to relieve distention.
Food stagnation with abdominal distention.
Core pair of a classical formula — Bao He Wan, Dan Xi Xin Fa (Zhu Danxi)
Reduce food stagnation of different kinds together, the one especially for meat and fat, the other for grain and alcohol.
Food stagnation with epigastric fullness, belching and acid regurgitation.
Core pair of a classical formula — Bao He Wan, Dan Xi Xin Fa (Zhu Danxi)
Evidence Tier
Strong evidence · 6 studiesRecorded studies by study design, strongest design at the top. This is a study-design tier only, not a GRADE rating: it does not weigh risk of bias, consistency or precision.
Systematic review / meta-analysis
1
0 verified · 1 unverified
Show the study
Randomized controlled trial
2
0 verified · 2 unverified
Other clinical trial
0
Observational / case report
1
0 verified · 1 unverified
In vitro / animal
2
0 verified · 2 unverified
Show 2 studies
Other / unclassified
0
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Hawthorn extract for treating chronic heart failure
Cochrane review of randomised trials of hawthorn extract as adjunct treatment in chronic heart failure, finding benefit for maximal workload and symptom scores. Important species caveat: the included trials used standardised leaf-and-flower extracts of European Crataegus species (largely WS 1442), not the fruit of Crataegus pinnatifida that is dispensed as Shan Zha.
Interference of Hawthorn on Serum Digoxin Measurements by Immunoassays and Pharmacodynamic Interaction With Digoxin
Hawthorn extract interfered with the Digoxin III immunoassay but not with the Tina-Quant assay, and raised intracellular calcium in cardiomyocytes without an additive effect when digoxin was added, suggesting a shared Na,K-ATPase binding site. The authors concluded that patients receiving digoxin should avoid hawthorn.
Interaction Study between Digoxin and a Preparation of Hawthorn (Crataegus oxyacantha)
Randomised crossover study in eight healthy volunteers: hawthorn 450 mg twice daily for 21 days did not significantly change any pharmacokinetic parameter of digoxin 0.25 mg daily, and the authors judged coadministration safe at those doses. The preparation was a leaf-and-flower extract of Crataegus oxyacantha, so the result does not directly cover Crataegus pinnatifida fruit.
Cholesterol lowering and vascular protective effects of ethanolic extract of dried fruit of Crataegus pinnatifida, hawthorn (Shan Zha), in diet-induced hypercholesterolaemic rat model
Ethanolic extract of dried Crataegus pinnatifida fruit lowered serum total and LDL cholesterol and improved endothelial function in rats fed a high-cholesterol diet. One of the few cardiovascular studies performed on the correct species and plant part for Shan Zha, but it is a rodent model.
Efficacy of Crataegus Extract Mixture on Body Fat and Lipid Profiles in Overweight Adults: A 12-Week, Randomized, Double-Blind, Placebo-Controlled Trial
Twelve-week randomised, double-blind, placebo-controlled trial in 105 overweight adults of a mixture of Crataegus pinnatifida leaf and Citrus unshiu peel extracts, reporting effects on body fat and lipid measures. Correct species but the leaf, not the fruit, and given in a two-herb combination, so it cannot be read as a trial of Shan Zha.
Clinical Features, Risk Factors, and Endoscopic Treatment of Bezoars: A Retrospective Analysis from a Single Center in Northern China
Retrospective single-centre series of 75 bezoar patients in northern China. Raw hawthorn and persimmon ingestion were the leading causes, and 56% of cases came from one hawthorn-rich suburban district of Beijing. Supports the practical warning against large quantities of raw hawthorn fruit.
⚠ Safety & Contraindications
- Before surgery
- Heart conditions
Contraindications
Its use is cautious in patients with weakness of the spleen and stomach and no accumulation and stagnation, or profuse gastric acid secretion.
Source: Xi S, Gong Y. Essentials of Chinese Materia Medica and Medical Formulas. Academic Press/Elsevier, 2017, pp. 189–192.
Side Effects
- Toxicity of the herb and its preparations described as very low; long-term use produced no side effects.
- Mice given 100 mg/kg/day Crataegus monogyna flavones for 1 month had normal pregnancies and offspring.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 393.
Historical Texts
Ben Cao Jing Ji Zhu
Southern Dynasties (Tao Hong-jing, c. 500 CE)Xin Xiu Ben Cao
Tang dynasty (659 CE)Ben Cao Gang Mu
Ming dynasty (Li Shi-zhen, 1596)References
- Wu J, Peng W, Qin R, Zhou H. Crataegus pinnatifida: Chemical Constituents, Pharmacology, and Potential Applications . Molecules (2014) [DOI]
- Jurikova T, Sochor J, Rop O, Mlcek J, Balla S, Szekeres L, Adam V, Kizek R. Polyphenolic Profile and Biological Activity of Chinese Hawthorn (Crataegus pinnatifida BUNGE) Fruits . Molecules (2012) [DOI]
This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.
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