Aspen Pub.

/HNP

AS130-02

August 13, 2002

20:14

Char Count= 0

THEME ARTICLES

Aromatherapy: Mythical,
Magical, or Medicinal?
Aromatherapy, a branch of herbology, is one of the fastest growing therapies in the world today. Historically,
essential oils are best used in the form of massage or bath oils or inhalations. Frequently, it is reported that
aromatherapy leaves one feeling uplifted, stimulated, invigorated, or rejuvenated, depending on the oil used.
When inhaled, the various aromas penetrate the bloodstream via the lungs causing physiologic changes. In turn,
the limbic system, which controls our emotions and memories, is affected. Some consider aromatherapy as
mystical or magical; others, however, are attempting to validate empirically this ancient therapy as medicinal.
Key words: alternative medicine, aromatherapy, complementary medicine

Deborah V. Thomas, EdD, ARNP, CS

Assistant Professor
School of Nursing
University of Louisville
Louisville, Kentucky

My soul travels on the smell of perfume like the souls

of other men on music.

Charles Baudelaire
Little Poems in Prose: A Hemisphere of Hair (1857)

INTRODUCTION
How does that make you feel? Ah, the
quintessential question of mental health professionals. Is how we feel complexly related to or merely subjugated to the simplest
anatomy of the olfactory system? Is aromatherapy magical, mythical, or medicinal?
Perhaps the answer will never be clearly defined; however, there are some things we do
know. Specifically, we know that, for many
individuals coming home after a long day
at work, the simple ritual of lighting a candle or two around the house will help to
soothe the soul and calm the nerves, allowing
the body and mind to relax and reenergize.
The popularity of various complementary
and alternative medicine (CAM) therapies,
including aromatherapy, is on the rise due
Holist Nurs Pract 2002;17(1):816
c 2002 Lippincott Williams & Wilkins, Inc.

Aspen Pub./HNP

AS130-02

August 13, 2002

20:14

Char Count= 0

Aromatherapy

in part to trends in cultural communication,

marketing, and product promotion. Also, it is
reflected in nurses use of aromatherapy. The
three most common CAM therapies used
by nurses are aromatherapy, massage, and
reflexology.1
The practical link between smell, emotions, thoughts, and feelings is obvious to
most of us. We usually associate smells with
a pleasant or unpleasant feeling, hardly ever
a neutral one. This is a powerful indicator
of how smells, via the olfactory nerves, link
up with the limbic system in the brain. The
limbic system is the command central for
our emotional or affective states, and it is
connected to the olfactory bulb.2
This does not preclude or negate the notion that many other sensory inputs could
stimulate equally pleasant thoughts or feelings. While the sense of smell enjoys no particular advantage when it comes to accessing various parts of the brain, neither can
it be ignored. Perception of the experience
is what matters most, not the reality of the
experience, which may not be empirically
supported.
Thus, the value of aromatherapy cannot be underestimated; this fact in itself contributes to the difficulty in defining empirical support. There is a great deal of debate
over the efficacy of aromatherapy. Some argue that claims for therapeutic value or benefit outweigh the scientific evidence.3,4 Regardless of the side of the debate on which
you fall, the use of CAM therapies, of which
aromatherapy is but one, is gaining continued attention from consumers and health
care providers.5 This requires nursing to
move forward with research that will support claims on either side of the debate regarding use and benefit of aromatherapy as
one modality of CAM.

The purpose of this article is to briefly review the definition and history of aromatherapy, present a summary of current research
related to uses of aromatherapy in various
clinical situations, and discuss ethical implications for practice.
DEFINITION
Current literature defines aromatherapy as
the use of pure essential oils from various
parts of a plant, including the blossoms,
roots, or leaves, to help improve physical
and mental health, quality of life in general,
or just for fun.2,6 Pleasant smelling botanical
oils such as rose, lemon, lavender, and peppermint can be added to the bath, massaged
into the skin, inhaled directly, or diffused to
scent an entire room. Thus, aromatherapy
means treatment using scents.
There are about 150 essential oils. Table 1
provides a sampling of these and their varied effects. Most essential oils have antiseptic properties; some are antiviral, antiinflammatory, pain relieving, antidepressant,
or expectorant. Those who use aromatherapies may take advantage of other properties
of essential oils such as stimulation, relaxation, and digestion improvement as well as
their diuretic properties.
HISTORY
Aromatherapy dates back over 6,000 years
to ancient Egypt, the Far East, China, and Renaissance Europe. Ayurveda is Indias traditional, natural system of medicine that has
been practiced for more than 5,000 years.
Ayurveda is a Sanskrit word that, literally
translated, means science of life; it includes the use of aromatic oils in rejuvenating and healing recipes.

Aspen Pub./HNP

AS130-02

10

August 13, 2002

20:14

Char Count= 0

HOLISTIC NURSING PRACTICE/OCTOBER 2002

Table 1. Essential oils and effects

Essential oil

Effect

Basil
Bergamot
Chamomile
Cedarwood
Clary sage
Cypress
Eucalyptus
Fennel
Frankincense
Geranium
Hyssop
Jasmine
Juniper
Lavender
Lemon
Lemongrass
Marjoram
Melissa
Myrrh
Neroli
Orange
Patchouli
Peppermint
Petitgrain
Pine
Rose
Rosemary
Sandalwood
Tea tree
Thyme
Ylang ylang

Uplifting, refreshing, clarifying, aiding concentration

Refreshing, uplifting
Refreshing, relaxing, calming, soothing, balancing
Sedating, calming, soothing, strengthening
Warming, relaxing, uplifting, calming, causing euphoria
Relaxing, refreshing, providing astringent qualities
Head clearing, providing antiseptic and decongestant properties, invigorating
Providing carminative properties, easing wind and indigestion
Relaxing, rejuvenating, easing breathing, dispelling fears
Refreshing, relaxing, balancing, harmonizing
Providing decongestant properties
Relaxing, soothing, building confidence
Refreshing, stimulating, relaxing, promoting diuresis
Refreshing, relaxing, providing therapeutic qualities, calming, soothing
Refreshing, stimulating, uplifting, motivating
Toning, refreshing, fortifying
Warming, fortifying, sedating
Uplifting, refreshing
Toning, strengthening, rejuvenating, providing expectorant properties
Relaxing, dispelling fears
Refreshing, relaxing
Relaxing, enhancing to sensuality
Cooling, refreshing, head clearing
Refreshing, relaxing
Refreshing, providing antiseptic properties, invigorating, stimulating
Relaxing, soothing, enhancing to sensuality, building confidence
Invigorating, refreshing, stimulating, clarifying
Relaxing, warming, building confidence, grounding
Acting as antiseptic, strengthening to immune system
Acting as antiseptic, refreshing, strengthening to immune system
Relaxing, soothing, enhancing to sensuality

The medieval physician Avicenna is

credited with determining the methods for
extracting essential oils from plants.3 The
ancient Egyptians used aromatherapy for
religious and medicinal purposes and in
incense, embalming, perfumes, and cosmetics. Wigs often were scented with oils to
mask the stench of unsanitary streets and
bodies. Hippocrates, the father of modern

medicine, used aromatherapy baths and

scented massage. He also used aromatic
fumigations to rid Athens of the plague.
In France, hospitals often burned rosemary
and lavender for fumigation.
In the 1930s the term aromatherapy
was coined when French chemist Rene
Maurice Gattefosse discovered the benefits
of lavender oil when it healed his burned

Aspen Pub./HNP

AS130-02

August 13, 2002

20:14

Char Count= 0

Aromatherapy

hand without leaving scars. He then started

investigating the effects of other essential
oils for healing.7 During World War I,
French army surgeon Dr Jean Valnet experimented on wounded soldiers and found
that essential oils were excellent antiseptics
that detoxified. Later, Madame Marguerite
Maury elevated aromatherapy as a holistic
therapy. She started prescribing essential
oils as remedies for her patients ailments.
She also is credited with the modern use of
essential oils in massage.7
Today, essential oils are very potent,
complex, highly fragrant, and volatile substances. Essential oils consist of chemical
compounds that contain hydrogen, carbon,
and oxygen. The primary functional groups
of the essential oils used in aromatherapy are
monoterpenes, esters, aldehydes, ketones,
alcohols, phenols, and oxides.8
Current aromatherapy products are available as ointments, lotions, creams, soaps,
shampoos, bath salts, massage oils, compresses, vaporizers, personal mists, room
diffusers, room mists, incense, and candles.
Most aromatherapy products are delivered
to the body via massage or inhalation. Historically, aromatherapy must be acknowledged as a timeless intervention, growing
and evolving as practitioners use scientific
rigor to explore its effects.
RESEARCH
A review of the literature suggests major gaps in the knowledge related to the
clinical application of aromatherapy in relation to issues of dosage, methods of administration, and therapeutic effects.9 There
is a paucity in both quantitative and qualitative studies pertinent to aromatherapy as
a specific modality of complementary ther-

11

apy. There are many peripherally relevant

articles that address anecdotal practice standards, opinions, or philosophical beliefs as
they relate to the practice of complementary or alternative therapies. No randomized,
controlled, double-blind studies were found.
One problem encountered with this literature review is that there appeared to be many
studies related to aromatherapy. However, on
further examination most of these studies actually were looking at alternative medicine
as a whole and most often reported research
related to the use of herbs. The following are
examples of the types of studies currently
reported in the literature on aromatherapy in
clinical settings.
Walsh and Wilson10 randomly assigned severely disabled participants in an
extended-stay neurology unit to receive
five hourly sessions of one of four of the
following treatment regimens: relaxation,
aromatherapy, reflexology, or aromatherapy
and reflexology combined. Treatments
occurred weekly for 5 weeks. Daily records
of perceived problems, pain, and mood
were maintained throughout the study.
Results indicated that patients daily mood
ratings were highest when aromatherapy
and reflexology were combined.
Using the General Health Questionnaire,
results suggest a positive reduction in reports of psychological distress by these
patients. Methodological flaws were preempted by use of visual analog scales and
semi-structured interviews using psychometrically valid measures of mental health
and personal adjustment. In addition, nurses
were unaware of which type of therapy
was being administered to participants until completion of the study. As a result
of this study, regular baseline assessments
for all new patients and post-intervention

Aspen Pub./HNP

AS130-02

12

August 13, 2002

20:14

Char Count= 0

HOLISTIC NURSING PRACTICE/OCTOBER 2002

evaluations have been implemented as standard practice.10

Tate11 attempted to establish efficacy of
peppermint oil as treatment for postoperative nausea. There were no statistically
significant differences between subjects or
variables. In this three-condition design,
peppermint oil was the independent variable
and nausea was the dependent variable.
Sample size was 18 patients who underwent
gynecologic surgery.
Subjects were randomly assigned to either a control group (no treatment), group 2
(placebo), or group 3 (peppermint oil). All
patients were in single rooms on two wings
to eliminate cross-contamination. Results of
this study indicate there is some evidence
to suggest that peppermint oil may improve postoperative nausea in gynecologic
patients.11 Further studies with varied postoperative patients need to be performed.
In a study by Dunn and associates,12
122 patients admitted to a general intensive
care unit (ICU) were randomly chosen to receive massage, aromatherapy using essential
oil of lavender, or a period of bed rest. Assessments before and after included physiologic stress indicators and patients selfreport of anxiety levels, mood, and ability to
cope with the ICU experience.
Of the 122 initial participants, 77% were
able to complete subjective assessments. Results suggest that patients who received aromatherapy reported significantly greater im-

Patients who received aromatherapy

reported significantly greater
improvement in their mood and
perceived level of anxiety.

provement in their mood and perceived level

of anxiety. These participants also felt less
anxious and more positive immediately following the therapy, although this effect was
not sustained or cumulative.12 The results
of this study cannot be generalized; however, the findings raise a number of important
points for health care providers to consider
when planning for the care of patients.
Blanc and coworkers5 conducted a random population telephone sample of adults
aged 18 to 50 with a self-report of a physician diagnosis of asthma or rhinosinusitis. The study objective was to determine
prevalence of specific CAM use, including aromatherapy. Structured telephone interviews inquired about CAM use in the past
12 months. Results indicated that, in this
population, herbal use was reported by 24%
of participants. However, there were no statistical differences in the frequency of herbal
use, overall or by subcategory, among those
with asthma compared with those with rhinosinusitis. This also was true for acupuncture, aromatherapy, and various forms of
massage.
In a small pilot study by Komori and
colleagues,13 12 depressed men were exposed to citrus fragrance in the air and compared with 8 patients not exposed to the fragrance. Both groups were taking prescribed
antidepressants. It was reported that the dose
of antidepressants in the experimental group
could be significantly reduced. However, the
study was not randomized and included a
small number of participants with varying
dose and type of antidepressants. According to this study, it is not possible to draw
any clear conclusions about the value of aromatherapy for depression.
Using a quasi-experimental design with a
convenience sampling method, Brownfield14

Aspen Pub./HNP

AS130-02

August 13, 2002

20:14

Char Count= 0

Aromatherapy

selected nine patients diagnosed with

rheumatoid arthritis. Each participant was
placed in one of three groups. The control group completed pre- and posttests only.
Group 2 completed pretests and were massaged for two nights with no oil, then completed the posttest, followed by two nights
of massage with lavender oil. Group 3 did
the reverse of group 2. The variables being
investigated were pain perception, sleep, and
well-being.
Quantitative results about pain, generated
from the Visual Analog Scale (VAS), did
not reveal any reduction in pain levels following massage or aromatherapy massage.
However, data generated by interview revealed that those patients receiving the massage with lavender oil were able to decrease
intake of analgesia due to perceived reduction in pain perception. Investigators report
this contradictory finding may be due to patients with rheumatoid arthritis having difficulty distinguishing pain from stiffness, and
patients may define pain differently at different times.
No improvement in sleep was noted in the
VAS recordings. Once again, the interview
responses showed that the use of massage
with lavender oil affected sleep patterns in a
positive manner.
The VAS data suggest that perceptions of
the massage containing lavender oil showed
enhanced perception of well-being. This also
was reflected in the interviews.14 A majority of respondents in this study (83%,
n = 5) expressed a desire to receive further massage containing lavender oil if the
treatment was to be available to them in
the hospital. An obvious limitation to this
study is the study sample size and the inherent limitations using a quasi-experimental
design.

13

In a study conducted by Hay and

associates,15 the efficacy of aromatherapy
in the treatment of patients with alopecia
areata was examined using a randomized,
double-blind, controlled trial of 7 months
duration, with follow-up at 3 and 7 months.
The study was conducted in a dermatology
outpatient department. There were 86 invited
participants, all diagnosed as having alopecia areata. The 86 patients were randomized
into two groups. The active group massaged
essential oils (thyme, rosemary, lavender,
and cedarwood) in a mixture of carrier oils
(jojoba and grapeseed) into their scalp daily.
The control group used only carrier oils for
their daily scalp massage.
Two dermatologists independently evaluated treatment success using sequential
photographs. Likewise, degree of improvement was measured by two methods: a
6-point scale and computerized analysis of
traced areas of alopecia. Results indicated
that 19 (44%) of 43 patients in the active
group showed improvement compared with
6 (15%) of 41 patients in the control group.
An alopecia scale was applied by blinded observers on sequential photographs and was
shown to be reproducible with good interobserver agreement (kappa = 0.84). The degree
of improvement on photographic assessment
was significant (p = .05). Demographic analysis showed that the two groups were well
matched for prognostic factors. Results suggest aromatherapy is a safe and effective
treatment for alopecia areata.
Hay and coworkers15 reported that treatment with these essential oils was significantly more effective than treatment with
the carrier oil alone. A potential limitation
to this study lies in the fact that the investigators did not clearly delineate their process
for randomization.

Aspen Pub./HNP

AS130-02

14

August 13, 2002

20:14

Char Count= 0

HOLISTIC NURSING PRACTICE/OCTOBER 2002

While all of the research studies discussed

indicate encouraging information about the
use and potential benefits of aromatherapy,
there must be considerable effort to conduct
experimental research to further the fund
of knowledge needed for evidence-based
practice.
IMPLICATIONS FOR PRACTICE
AND ETHICAL CONSIDERATIONS
Even though aromatherapy is widely practiced, as well as other forms of complementary or alternative therapies, there still exists
a lacunae of empirical support on which to
base practice. Existing evidence is mainly
based on anecdotal claims in the absence
of well-designed case studies or randomized
control trials.12,16 Nurses must continue to
evaluate the benefit, or lack thereof, of CAM
techniques (such as aromatherapy), ensuring
sound evidence-based practice that will hold
up to rigorous scrutiny and not be rebuffed
as the trend or therapy of the month.
Norton17 suggests that nurses must consider incorporating or facilitating various
complementary therapies to benefit patients.
Along with this responsibility comes an accountability to ensure an appropriate, sound
knowledgebase and clinical savvy.
Trends in modern medicine have been reductionistic in nature and have assumed that
patients seek only to be cured. This has
occurred slowly over time and is increasing due to a highly technological approach,
which often emphasizes interventions such
as surgery and medication. It is beyond the
scope of this article to discuss the impact of
insurance and managed care on the increased
focus on curing versus caring. However,
this is a powerful contributing factor and cannot be ignored.

Some may argue that nursing, in contrast,

focuses on a caring approach using compassionate caring skills to help move a patient to
a healthier state of mind, body, and spirit.18
Watsons19 caring theory of nursing maintains that caring is one of the intrinsic factors
needed to guide holistic nursing practice that
truly integrates the physical, psychosocial,
and spiritual needs of the patient. Many
of the nursing theorists, such as Levine,
Neuman and Roy, support this and reflect
the importance of a holistic approach.
While it may be simple to choose one
or the other of these philosophical leanings
toward the medical or nursing model (regardless of professional discipline), if we
are truly dedicated to the benefit and wellbeing of our patients, we may opt to embrace both. As we move away from the
traditional paternalistic model of health care
where provider knows best, perhaps we
can truly begin to demonstrate unconditional respect for and encourage the autonomy of our patients within the health care
system.
For practitioners using various functions
or applications of aromatherapy, patient suffering may seem to diminish. Relief, if only
briefly, is often welcomed by those suffering
from physiologic or emotional pain and suffering. Frequently, modern health care practitioners sacrifice contact with patients in the
name of efficiency. Sadly, this lack of connection or contact hurts both the patient and
the practitioner.
The most powerful therapeutic or seemingly magical cures occur due to the time
a practitioner and patient are able to spend
getting to know each other.20 Often, the subtleties that occur during seemingly unimportant conversation can hold the key to
therapeutic interventions.

Aspen Pub./HNP

AS130-02

August 13, 2002

20:14

Char Count= 0

Aromatherapy

If you do not connect with your patients

they may never tell you the simple things
that work for them, such as an herbal bath,
a scented candle, or a massage with lavender oil. While these things may not, in and of
themselves, cure, they may certainly make
someone feel better. Often the most efficacious therapy is one that is not quickly discernible to the researcher. It is reasonable to
consider that this may be in part due to the
neurobiologic foundation of aromatherapy,
which is not easily studied in live humans.
Comfort or relief from suffering may be so
subtly induced it is not measurable by laboratory tests or brain waves. Maybe it is only
measurable by report of our patients. Maybe
this is what we should listen to most. Isnt
that why we do what we do as nurses?
CONCLUSION
Currently there is a lack of sound evidence
regarding the appropriate use of aromatherapy in a variety of health care settings. Anecdotal accounts are plentiful, however, they
are not supported by randomized, controlled,
double-blind studies. In fact, such studies
have not been performed. Part of the reason may be the lack of available funding

15

for this area of research as opposed to the

vast resources available to pharmaceutical
companies. Thus, in order to practice in a
manner that is morally and ethically responsible, nursing must systematically evaluate
any new therapeutic modalities such as aromatherapy that have the potential to do harm
as well as good.
With this in mind, perhaps the question
initially posed in the article title is not yet
readily answered. It may well depend on
the practitioner or the patient, the day, the
mood, the scent, or even the intentionality
of the provider. Maybe the enigma of the
essence of aromatherapy serves as a guiding
premise to the answer. To some, it is myth,
because there is no real empirical evidence
in the volumes necessary to be counted. For
others, perhaps the magic is the belief or faith
that it will work. Yet, for others, it may be
clear and simple: a medicinal approach to
distress, illness, or health promotion. It is
clear that clinical studies must be conducted
to garner support for effectiveness as well
as determine potential dangers to patients. It
seems that whatever argument we use to answer this question, the end result will vary in
degree by circumstance, context, and inherent belief of individuals.

REFERENCES
1. Avis A. Aromatherapy in practice. Nurs Stand. 1999;
13(24):1415.
2. Shauer M. Alternative approach. Lavandula Veraan
introduction to aromatherapy. VA Nurs Today. 1998;
6(3):14.
3. Cerrato PL. Aromatherapy: is it for real? RN. 1998;
61(6):5152.
4. Nelson NJ. Scents or nonsense: aromatherapys benefits still subject to debate. J Natl Cancer Inst. 1997;
89(18):1334.
5. Blanc P, Trupin L, Earnest G, Katz P, Yelin E,
Eisner M. Alternative therapies among adults with a re-

ported diagnosis of asthma or rhinosinusitis: data from a

population-based survey. CHEST Cardiopulm Crit Care
J. 2001;120(5):14611467.
6. Flemming K. Review: aromatherapy massage is associated with small transient reductions in anxiety. EvidenceBased Nursing 2000;3(4):118.
7. Holistic-online. Aromatherapy infocenter. http://www.
holisticonline.com/Aromatherapy/hol aroma.htm. Accessed March 24, 2002.
8. Precious aromatherapy. About aromatherapy. http://
www.aromatherapy.com/about.html. Accessed March
24, 2002.

Aspen Pub./HNP

AS130-02

16

August 13, 2002

20:14

Char Count= 0

HOLISTIC NURSING PRACTICE/OCTOBER 2002

9. Ching M. Contemporary therapy: aromatherapy in the

management of acute pain. Contemp Nurs. 1999;8(4):
146151.
10. Walsh E, Wilson C. Contemporary therapies in longstay neurology in-patient settings. Nurs Stand. 1999;
13(32):3235.
11. Tate S. Peppermint oil: a treatment for postoperative nausea. J Adv Nurs. 1997;26(3):543549.
12. Dunn C, Sleep J, Collett D. Sensing an improvement: an
experimental study to evaluate the use of aromatherapy,
massage and periods of rest in an intensive care unit. J
Adv Nurs. 1995;21(1):3440.
13. Komori T, Fujiwara R, Tanida M, Nomura J, Yokoyama
MM. Effects of citrus fragrance on immune functions
and depressive states. Neuroimmunomodulation. 1995;
2:174180.
14. Brownfield A. Aromatherapy in arthritis: a study. Nurs
Stand. 1998;13(5):3435.

15. Hay IC, Jamieson M, Ormerod AD. Randomized trial of

aromatherapy. Successful treatment for alopecia areata.
Arch Dermatol. 1998;134(11):13491352.
16. Vickers A. Massage and AromatherapyA Guide for
Health Professionals. London: Chapman & Hall Publishers; 1996.
17. Norton L. Complementary therapies in practice: the ethical issues. J Clin Nurs. 1995;4(6):343348.
18. Norred CL. Minimizing preoperative anxiety with alternative caring-healing therapies. AORN J. 2000;72(5):
838843.
19. Watson J. Carative factors in nursing. In: Nursing: The Philosophy and Science of Caring. Boulder,
CO: Colorado Associated University Press; 1985:7
21.
20. Adams P. When healing is more than simply clowning
around. JAMA. 1998;279(5):401.

Copyright of Holistic Nursing Practice is the property of Lippincott Williams & Wilkins -- Nursing and its
content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.