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Essential oils and 'aromatherapy': their modern role in healing

M. Lis-Balchin
The Journal of the Royal Society for the Promotion of Health 1997 117: 324
DOI: 10.1177/146642409711700511

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 Article

Essential oils and ’aromatherapy’:

their modern role in healing
M Lis-Balchin

Maria Lis-Balchin
BSc, PhD
School of Applied Science
Key words
Alternative medicine; aromatherapy; bioactivity; essential oils; stress relief
South Bank University
Borough Road
London Abstract ’Aromatherapy’ is one of the most actively growing forms of alternative
SE1 0AA medicine combining massage together with counselling and a nice odour. Most clients
suffer from some kind of stress-related disorder and aromatherapy encourages the healing
process largely through relaxation and the relief of stress. Stress is also a major problem in
hospitals, hospices and homes for the aged and physically or mentally-challenged.
Aromatherapy is welcomed by nurses who want to be closer to their patient and doctors
who can refer patients with stress-related disorders who do not respond to conventional
medicines.
The actual mode of action of essential oils in vivo is still far from known, although there
is strong in vitro evidence that essential oils can act as an antimicrobial or antioxidant agent
or have a pharmacological effect on various tissues. Studies have shown that essential oils

have an effect on brainwaves and can also alter behaviour. It is possible that most of the
effect of the oils is probably transmitted through the brain via the olfactory system. Used
professionally and safely, aromatherapy can be of great benefit as an adjunct to
conventional medicine or used simply as an alternative.

Introduction . just about any ’cosmetic’

’Aromatherapy’ is one of the most actively
growing forms of alternative medicine in
this country, especially in nursing, and yet
has had very little scientific evaluation. The
dictionary definition of aromatherapy is
&dquo;the treatment of disorders and diseases
using a distinctive or usually pleasant
smell&dquo;. There is no mention of the
massaging of essential oils over the body or
their absorption through the skin and effect
on target organs in this definition. However,
in the UK there is an emphasis on
massaging very diluted plant essential oils
(2-5 drops per 5ml of carrier such as almond
oil) into the skin as the major aromathera-
peutic procedure. This is usually accom-
panied by counselling which involves
listening to the client and understanding
the problem(s) whilst suggesting ways in
which the lifestyle, diet and self-esteem
could be changed. There is often the added
skin lotions and in
products. Many products are now being
marketed as ’aromatherapy products’
whereas before they were simply scented
products and therefore unremarkable!
Aromatherapy in France and Germany, in
direct contrast to that in the UK or US,
involves medically qualified doctors using
essential oils as conventional internal
medicines, and often in very large doses.
Thus there is a vast difference between the
two aromatherapy procedures as the latter is
‘conventional’ whilst the former iss
’alternative’. Alternative medicine is based
on ’healing’ and healing is largely based on
belief. In the past healing was achieved by
members of the clergy who gave people
spiritual guidance and a feeling of peace and
security. Doctors were only consulted in
acute emergencies and at birth or death,
but again gave a sense of security and,
although they did not prevent death, they
were often present at the point of death,

use of essential oils in the bath, burners, in providing more or less a counselling service
324
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to the family, with or without the help
of the clergy. Nowadays psychiatrists
and psychologists have largely taken
over from the clergy. General
Practitioners are nowadays inundated
with administrative work as well as
patients and they have no time to lis-
ten to the patient, let alone calm them
down, provide security, etc. The often
short and irregular appointments
with different doctors every time do
not lend themselves to a bonding with
the patient: there is, therefore, no
real ’healing’. This is the main reason
for the success of the alternative
practitioners. It seems that the latter
treat patients giving them their undi-
vided attention, whilst conventional
medical practitioners just treat dis-
eases.
Thehealing process involves
convincing the patient of the benefits
of the treatment, hence essential oil
therapy could be very successful as the
wide-ranging plant oils lend them-
selves to scientific verification.
Unfortunately, there has been very
little actual scientific research into the
efficacy of aromatherapy. Perhaps the
main difficulty is that it is virtually
impossible to do randomised double
blind studies involving different
odours. Secondly, there is a variation
in the treatment for each client, based
on ’holistic’ principles, and each
person can be treated with one to five
different essential oil mixtures on
subsequent visits, involving one to
four different essential oils in each
mixture. Each aromatherapy book lists
different essential oils for treating
similar ailments as each therapist is
determined to show some new
applications whilst offering, at best,
one vague case study. Thirdly, there is
the general assumption that there is
no need to validate case study reports
and carry out incredibly long and
tedious double blind studies as this is
alternative medicine. If the procedure
’works’, there is no need to study it.
Clinical studies to date
There have been few clinical studies to
date (Table 1) and in most studies
there have been large assumptions
Table 1 Clinical studies
regarding the effectiveness of a given
essential oil without prior scientific
evidence. In fact, many attributes of
essential oils are directly taken from
English herbals (for example,
Culpepper, 1700) and the direct
extrapolation to essential oils is there-
fore often fallacious if not entirely
incorrect. Herbal teas, tinctures and
other preparations have entirely
different compositions to that of the
essential oil alone as they contain
many very active water-soluble com-
ponents. The scientific and botanical
acumen of mostt writerss of
aromatherapy books is negligible
and therefore their interpretation of
the literature is often suspect. An
example of botanical misinterpre-
tation can be seen in the widely
quoted (Tisserand, 1975) attributes of
geranium oil which are take verbatim
from Culpepper’s Herbal which
quotes the herbal functions of native
European Geranium plants e.g. G
robertianum (Herb Robert) and not
those of the Southern African species
of Pelargonium from which geranium
oil is distilled. The antiviral effect of
Melissa oil has been misinterpreted as
scientific papers referred to the water-
soluble fraction as active and not
the lipophylic fraction (Herrman
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on aromatherapy
and Kucera, 1967).
In the first study shown in Table 1,
Cornwell and Dale (1995) assumed
that ’lavender oil’ was very antiseptic.
However, studies carried out in a
range of commercial lavender oils have
shown a very wide variation in
antibacterial effect (Lis-Balchin, 1995)
and a similarly large variation in
activity in other named essential oils
(Lis-Balchin et al, 1996a; 1996b).
Studies of the use of aromatherapy in
childbirth (Burns and Blaney, 1994)
were not very conclusive, mainly
because a large number of different
essential oils were used at different
times and in different ways and there
was a bias towards the use of a few oils,
e.g. lavender and clary sage, the latter
having a probably undeserved (and
unproven) status of being oestrogenic.
There was no statistically significant
difference between three treatments
involving aromatherapy massage
using lavender oil, massage alone and
giving the patients 30 minutes of rest
alone in an intensive care unit
(Dunn
et al, 1995). Perhaps the failure of this
study was due to the way the
aromatherapy treatment was given, as
‘verbalisation’ was kept to a
minimum, in the normal
contrast to
aromatherapy treatments, where
325
’counselling’ plays a major role (unless
aromatherpy massage is used only for Table 2 Sedative and stimulant essential oils
beauty purposes). The ’double blind’
study using two different types of
lavenderr oilI (Buckle, 1993)
completely disregarded the use of
controls and the assumption was made
that (a) there would be a beneficial
effect through the use of lavender and
that (b) lavender exerted an effect
through its absorption by the skin
rather than through its inhalation and
effect through the limbic system (as
patients wore oxygen masks which
were, however, inadequate in
preventing inhalation). It seems
totally unbelievable that the author
then concluded that, due to the small

(insignificant) changes in the effect

between the two essential oils, it
would rule out massage, touch or
placebo as being sole contributory
factors.
An interesting application of
essential oils by a neuropsychiatrist
(Betts et al, 1995) showed that out of
30 epileptic patients treated with
conventional therapy with the added
use of essential oils, nine became free

from seizures for some considerable

time and another 20 patients were
greatly improved. It was interesting to
also note that the majority of the
patients chose ylang ylang oil from a
whole range of different odours. This
study is very often quoted as an
example of ’alternative medicine’, but
it is, in fact, only an example of the
complementary application of conven-
tional and alternative disciplines
working together. 1 Kubota et al (1992): CNV studies in man
Scant attention has been given to 2 Torii et al (1988): CNV studies in man
the actual chemical composition of the 3 Manley (1993): CNV studies in man
essential oils used and even the exact 4 Buchbauer (1991, 1993); Jager et al (1992): motility of mice
botanical origin type of the oil was 5 Lis-Balchin et czl (1995, 199C~): smooth muscle in vitro
ignored, e.g. there are three main
commercial types of chamomile oil - * denotes unknown species
German (Matricaria recutica), Roman
or English (Chamamaelium nobile) and

Moroccan (Ormeni.r multicauli.r) - all essential oils and, of these, often vague out on most of them. Only commer-
differing in both genus and compo- chemotypes preferentially
are by used cially used essential oils have been
sition ! Similarly eucalyptus oil can be
some aromatherapists. The danger tested as these are mainly used in the
extracted from 120 different species
and at least three entirely different here is that little is known about food and cosmetics industries.
commercial oils are available. There is them, the composition is very variable However, large scale admixing, deter-
a large number of chemotypes of some and no toxicity tests have been carried penation, dilution and adulteration

326
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also occur. Each oil used in a study
should therefore be fully analysed and
the same oil used throughout. There
needs to be a more standardised
approach to further research involving
aromatherapists, clinicians and
scientists with essential oil expertise.
Many past studies in Italy and
France have offered very little in the
way of scientific evidence on the
efficacy of essential oils on patients
and were reported in a rather unscien-
tific way. There may well have been
some successes in the treatment of
depressed patients (Rovesti and
Colombo, 1973), but there is little
data supplied as to the precise diag-
nosis of the patients, their symptoms,
which symptoms were relieved, the
number of patients involved and the
statistical significance or otherwise of
the results. Under such circumstances,
the evidence is, at best, anecdotal.
Most of the recent work has never
been published in peer-reviewed
journals but has been quoted as
gospel, e.g. Franchomme and Penoel
(1990) and only single case studies are
presented on the efficacy of treatment,
used largely internally.
Scientific proof of essential oil
efficacy: aroma science
Essential oils have been used
externally to eradicate fungal or
bacterial infections since the Black
Death (and before); doctors would
wrap scarves soaked in essential oils
such as camphor round their necks and
over their mouths when visiting
patients (Valnet, 1982). In World War
II wounded soldiers had their wounds
treated with essential oils until
penicillin and other antibiotics
became available (Valnet, 1982).
Many plant essential oils are
extremely potent antimicrobials in
vitro and can have an effect on 25 out
of 25 different bacteria (Lis-Balchin,
1995; Lis-Balchin et al, 1996a;
1996c). Many are also strong
antioxidant agents and have recently
been shown to stop ageing in animals
(Dorman et al, 1995).
The use of rubifacients causing
friction at a site of pain or swelling is
a well-known function for camphor
and turpentine oil and is the basis of
well-known brands e.g. Vicks and
Tiger Balsam. There is also long-
standing evidence for the benefits of
inhaling certain essential oils to
relieve coughs, congestion, etc in the
respiratory tract using mixtures of
Eucalyptus globulu.r, pineneedle and
camphor (Martindale, 1992) which
could also alleviate sleeplessness and
save on diazepams. Various oils of the
Umbelliferae family, e.g. fennel, dill
and caraway, are used (as well as
peppermint) in remedies forr
indigestion, flatulence and dyspepsia.
Many fragrances have been shown
to have an effect on mood and, in
general, pleasant odours generate
happy memories, more positive
feelings and a general sense of well-
being (Warren and Warrenburg,
1993). Much of this type of research
has been conducted by perfumery
companies boost sales and some
to
essential oils have also been applied in
hospitals in the USA to create a more
happy and positive atmosphere and
also in offices and factories in Japan to
enhance productivity.
Many essential oil vapours have
been shown to depress Contingent
Negative Variation (CNV) brainwaves
in human volunteers (Table 2) and
these are considered to be sedative.
Others increase CNV and these are
considered stimulant. The effects of
inhaling different essential oils on the
CNV is compared to the effect on
mouse motility and the direct effect of
the essential oil on smooth muscle in
vitro (Table 2). Although there is a
great difference in the application of
the oils and the measurement of their
effect, there is, surprisingly, a frequent
agreement. There was a better agree-
ment between the effect of individual
essential oils (and mixes of three or
more) on smooth muscle in vitro
and the predicted effect on clients, as
judged by aromatherapists (Lis-
Balchin, 1996).
An interesting single study
involving an anosmic showed that, as
in normal people, there were changes
in cerebral blood flow on inhaling
Downloaded from rsh.sagepub.com at UNIV TORONTO on November 12, 2014
certain essential oils (Buchbauer
et al, 1993b), thus showing a positive
brain effect to the oil despite the
inability smell
to it. There is some
evidence that certain essential oils can
lower blood pressure if it is elevated,
e.g. nutmeg (Warren and
Warrenburg, 1993). There is,
however, virtually no scientific
evidence, as yet, regarding the direct
action of essential oils, applied
through massaging of the skin, on
specific internal organs. This is
despite some evidence that certain
essential oils can be absorbed either
through the skin or the lungs (Table
3).
Some essential oils are already used
as orthodox medicines. The use of
peppermint oil and some components
of essential oils such as pinene,
limonene, camphene and borneol
given orally can cure certain internal
ailments e.g. gallstones (Somerville et
al, 1985) orr ureteric stoness
(Engelstein et al, 1992). Essential oils
used extensively as orally or rectally-
introduced medicines by doctors in
France and Germany involve large
doses, sometimes in excess of 45 ml
per day (Franchomme and Penoel,
1990) rather than the almost homeo-
pathic doses used by aromatherapists
in their massage oil mixes in the UK
and USA which rarely exceed 0.5 ml
per massage. Most of the essential oils
are, of course, volatalised during the
massage.
Manyessential oils are very active
on many different animal tissues in
vitro (Lis-Balchin et al, 1996a), but we
have no idea as yet whether their
activity in minute amounts (as used in
aromatherapy massage) can benefit the
patient through direct action on target
organs or tissues rather than through
the odour pathway leading into the
mid-brain’s ’limbic system’ and
thence through the normal sympa-
thetic and parasymmpathetic path-
ways.
Future clinical application of
aromatherapy
What could be achieved by using
aromatherapy as an adjunct to clinical
327

Table 3 Evidence for transfer of components of
essential oil into blood/brain when applied to
skin, orally or by inhalation
medicine especially in hospitals and
general practice? So far there have
been many ’successes’ in various areas,
notably hospices. There are no miracle
cures, but an alleviation of suffering
and possibly pain, mainly through
relaxation due to gentle massage and
the presence of someone who cares and
listens to the patient. This is probably
also the case in geriatric wards, in
general wards, in the treatment of
severely physically and mentally-
challenged children and adults, etc.
There is a need for this kind of healing
contact and aromatherapy with its
added power of odour fits this niche.
Future studies may reveal the indi-
vidual benefits of different essential
oils for different ailments but, in
practice, this may not be of the
greatest importance as aromatherapy
offers relief from stress and this in
328
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Iffammausm
itself is of the greatest benefit for
most
people.
Nurses and other health care
professionals also have the wish to
learn and train in the use of
aromatherapy in favour of all the
other alternative therapies (Trevelyan,
1996). The medical profession is also
turning towards this branch of
alternative medicine as it is useful in
the treatmentt of patientss
whose symptoms are largely based
on stress and who do not respond to
conventional medicine.
More clinical and toxicological
research is needed, as well as better
teaching, in order to extend the use of
aromatherapy. From the toxicological
aspect, there is the danger of causing
dermatitis in sensitive people (Rudzki
et al, 1976) and the danger of airborne
contact allergic dermatitis through
VVB...~U~B... VJ. B...~~B...J..J.&dquo;’J..aJ.. VJ.J.~ u.J.J.’-l L.L.I.’-’.I..L
and Korting, 11995).
(Schaller and
storage (Schaller 995).
There may also be danger in the
overuse of essential oils during
pregnancy and childbirth. Studies
during childbirth in particular should
take into account the baby’s health, as
there is always the danger of over-
sedation of the infant and the
subsequent lack of breathing reflex.
Clinical studies should include
essential oils which are not generally
employed in order to assess the
efficacy of frequently used oils and
eliminate aromatherapists’ bias, as
well as to indicate whether the effect is
actually due to any essential oil in
particular.
Studies using case notes of past
clients could also be of help in
assessing the efficacy of usage of
certain essential oils for different
clinical conditions.
Conclusion
Aromatherapists are against scientific
influence as they want to retain the
mystical element of the process. This
can be accommodated in their private
practice, but not in hospital wards.
However, we can retain all the benefits
of touch, sympathy, understanding
and caring which will all help in
relieving stress, anxiety and feelings of
loneliness, apathy and depression.
This allows the patients to help in
their own healing. The attributes of
certain individual essential oils can
also be applied successfully and
researched further. Mobility can be
improved in cases of Parkinson’s
disease or muscular dystrophy or
multiple sclerosis by both the massage
and relaxation produced.
In conclusion, aromatherapy can be
most successfully used in clinical
medicine in conjunction with conven-
tional medicine and sometimes as a
purely alternative treatment for
certain clients.
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