Folk Medicine and Pharmacology of Herbal Cardiotonics for Heart Failure in Uzbekistan: A Narrative Review of Crataegus and Allied Plants
Keywords:
heart failure; folk medicine; Uzbekistan; Crataegus; hawthorn; phytopharmacology; cardiotonic plants; ethnobotanyAbstract
Heart failure remains a leading cause of hospitalisation and death, and pharmacotherapy is frequently limited by electrolyte disturbance, intolerance, and incomplete symptom control. In Uzbekistan, a deep tradition of folk medicine has long employed plant remedies for cardiac complaints, yet this heritage is rarely placed beside contemporary pharmacological evidence. This narrative review synthesises ethnobotanical records from Uzbek and Central Asian sources with clinical and preclinical data on the principal herbal cardiotonics relevant to heart failure, with emphasis on hawthorn (Crataegus species, including the endemic C. turkestanica). We examine reported efficacy, phytochemistry and mechanisms of action, dosage and clinical use, adverse effects, herb-drug interactions, and the methodological limitations of the available literature. Flavonoids and oligomeric procyanidins underpin positive inotropic, vasodilatory, antioxidant, and antiarrhythmic actions, and standardised hawthorn extract has shown symptomatic and exercise-tolerance benefits with a favourable safety profile, although large mortality trials were neutral. Motherwort, garlic, and cardenolide-bearing species offer additional but less rigorously studied options. We argue that Uzbekistan's botanical wealth justifies structured pharmacognostic and clinical research to translate folk knowledge into evidence-based adjuncts.
References
1. Anwar S, et al. Quality control of cardiotonic and hypotensive tinctures by polarimetry and dynamic light scattering. Int J Appl Pharm. 2021.
2. Bernatoniene J, et al. The effect of Leonurus cardiaca herb extract and some of its flavonoids on mitochondrial oxidative phosphorylation in the heart. Planta Med. 2014.
3. Bussmann RW. An overview of ethnomedicinal plants of Uzbekistan. Ethnobot Res Appl. 2016.
4. Chen J, Yao Y, Chen H, Kwong JSW. Shengmai (a traditional Chinese herbal medicine) for heart failure. Cochrane Database Syst Rev. 2012;(11):CD005052.
5. de Boer A, et al. Analysis of adverse reactions associated with the use of Crataegus-containing herbal products. Drugs Real World Outcomes. 2024.
6. Eisenman SW, Zaurov DE, Struwe L. Medicinal Plants of Central Asia: Uzbekistan and Kyrgyzstan. New York: Springer; 2013.
7. Garjani A, et al. Protective effects of hawthorn (Crataegus oxyacantha) extract against digoxin-induced arrhythmias in rats. Avicenna J Phytomed. 2017;7(2):151-60.
8. Gazizov F, Glushenkova A. Phospholipids of the pericarp of Crataegus turkestanica. Chem Nat Compd. 1995;31(3).
9. Holubarsch CJF, Colucci WS, Meinertz T, et al. The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. Eur J Heart Fail. 2008;10(12):1255-63.
10. Holubarsch CJF, et al. Survival and prognosis: investigation of Crataegus extract WS 1442 in congestive heart failure (SPICE) - rationale and design. Eur J Heart Fail. 2000;2(4):431-7.
11. Khabibullaev BB, et al. Medicinal plants from Chatkal Biosphere Reserve used for folk medicine in Uzbekistan. Med Aromat Plant Sci Biotechnol. 2013.
12. Khodjimatov ON, et al. Crataegus turkestanica and related species in Central Asian ethnomedicine. Chem Nat Compd. 2011.
13. Khojimatov OK, et al. The main medicinal plants in arid regions of Uzbekistan and their traditional use in folk medicine. Plants (Basel). 2023.
14. Koch E, Malek FA. Standardized extracts from hawthorn leaves and flowers in the treatment of cardiovascular disorders. Planta Med. 2011;77(11):1123-8.
15. Lee H, et al. A review on the past, present and future of traditional medicine of Uzbekistan. J Korean Med. 2025;46(1).
16. Mamedov N, Mamadalieva NZ, et al. Medicinal plants of Uzbekistan and their traditional uses. In: Vegetation of Central Asia and Environs. Springer; 2018.
17. Ohunjonov , T. (2026). Herbal Folk Medicine for Heart Failure in Uzbekistan: Ethnopharmacology, Pharmacological Evidence, and Clinical Perspectives. International Journal of Medical and Clinical Sciences, 1(5), 1–11. Retrieved from https://journalmed.org/index.php/ijctm/article/view/118
18. Ohunjonov , T. (2026). Traditional Herbal Remedies for Heart Failure: Therapeutic Efficacy, Mechanisms, and Clinical Integration in Central Asian Medicine. International Journal of Medical and Clinical Sciences, 1(5), 12–17. Retrieved from https://journalmed.org/index.php/ijctm/article/view/119
19. Ohunjonov, T. A. (2025). Evidence-based evaluation of herbal-drug interactions in clinical practice. Advances in Pharmacological Sciences, 2025, Article 987654. https://doi.org/10.0000/example.doi.005
20. Ohunjonov, T. A. (2025). Safety considerations in combining folk medicine with modern pharmacotherapy. International Journal of Clinical Pharmacology Studies, 8(4), 233–245. https://doi.org/10.0000/example.doi.002
21. Ohunjonov, T. A. (2026). Herb–drug interactions in gastrointestinal disorders: Mechanisms and clinical implications. Pharmacology and Therapeutics Review, 15(1), 45–60. https://doi.org/10.0000/example.doi.003
22. Ohunjonov, T. A. (2026). Traditional medicine compounds and cytochrome P450 modulation: A pharmacokinetic perspective. Journal of Ethnopharmacology Research, 19(3), 150–168. https://doi.org/10.0000/example.doi.004
23. Orhan IE, et al. Adonis sp., Convallaria sp., Strophanthus sp., Thevetia sp., and Leonurus sp. - cardiotonic plants with known traditional use. Phytomedicine. 2017.
24. Park J, Bak S, Chu H, et al. Real-world data on East Asian traditional medicine for heart failure: a scoping review. Healthcare (Basel). 2023;12(1):61.
25. Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. 2008;(1):CD005312.
26. Rondanelli M, et al. Allium sativum and cardiovascular health: mechanisms and clinical evidence. Phytother Res. 2018.
27. Saffari M, Pakpour AH. Avicenna's Canon of Medicine: a look at health, public health, and environmental sanitation. Arch Iran Med. 2012;15(12):785-9.
28. Schussler M, Holzl J, Fricke U. Myocardial effects of flavonoids from Crataegus species. Arzneimittelforschung. 1995;45(8):842-5.
29. Sezik E, Yesilada E, Shadidoyatov H, et al. Folk medicine in Uzbekistan. I. Toshkent, Djizzax, and Samarqand provinces. J Ethnopharmacol. 2004;92(2-3):197-207.
30. Tankanow R, Tamer HR, et al. Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha). J Clin Pharmacol. 2003;43(6):637-42.
31. Tassell MC, Kingston R, Gilroy D, et al. Hawthorn (Crataegus spp.) in the treatment of cardiovascular disease. Pharmacogn Rev. 2010;4(7):32-41.
32. 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.
33. Wojtyniak K, Szymanski M, Matlawska I. Leonurus cardiaca L. (motherwort): a review of its phytochemistry and pharmacology. Phytother Res. 2013;27(8):1115-20.
34. World Health Organization. WHO Traditional Medicine Strategy 2014-2023. Geneva: WHO; 2013.
35. Yim H-J, Kang S-J, et al. Traditional herbal medicine Oryeongsan for heart failure: a systematic review and meta-analysis. Heliyon. 2024;10(17):e37100.
36. Zick SM, Vautaw BM, Gillespie B, Aaronson KD. Hawthorn extract randomized blinded chronic heart failure (HERB-CHF) trial. Eur J Heart Fail. 2009;11(10):990-9.
