Table Of ContentCLINICAL
AROMATHERAPY
Essential Oils in Healthcare
Third Edition
Jane Buckle, PhD, RN
London, UK
3251 Riverport Lane
St. Louis, MO 63043
CLINICAL AROMATHERAPY, ISBN: 978-0-7020-5440-2
THIRD EDITION
Copyright © 2015, 2003, 1997 by Churchill Livingstone, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Permissions may be sought directly
from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804,
fax: (+1) 215 239 3805, e-mail: [email protected]. You may also complete your request
on-line via the Elsevier homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then
‘Obtaining Permissions.’
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or
appropriate. Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to verify the recommended
dose or formula, the method and duration of administration, and contraindications. It is the respon-
sibility of the practitioner, relying on their own experience and knowledge of the patient, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all
appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Editor
assumes any liability for any injury and/or damage to persons or property arising out of or related to
any use of the material contained in this book.
The Publisher
International Standard Book Number: 978-0-7020-5440-2
Senior Vice President, Content: Loren Wilson
Content Strategist: Shelly Stringer
Content Development Specialist: Brandi Graham
Publishing Services Manager: Julie Eddy
Project Manager: Sara Alsup
Designer: Reneé Duenow
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
This book is for those who want to push
the boundaries of clinical aromatherapy within healthcare.
Here is the evidence. Now, it’s over to you.
Foreword
Aromatherapy is possibly the simplest of all complementary therapies to inte-
grate because when we inhale air, we inhale aroma, although we are usually
unaware of it. However, aromatherapy is rarely presented in a cogent, scientific
way; as a result, it has been difficult for physicians, nurses, and others in healthcare
to take the field seriously or to understand how we could integrate it into our prac-
tice. Here is a book written by a PhD nurse with considerable research training and
experience, who writes about aromatherapy in a way that we can identify.
As a small boy growing up in Turkey, I had my own special paradise—my grand-
father’s walled garden—where I became aware of the power of the senses; in particu-
lar, how the fragrance of plants made me feel good. Now, as a cardiovascular surgeon,
I work on repairing the heart. I know the heart is perceived by many to be more than
a pump, the epicenter of emotion, and I continue to be aware of how important our
senses are to our well-being and how feeling good can help recovery. The very smell of
many hospitals is unpleasant, alien, or distressing to our patients. Patients feel at their
most vulnerable in a hospital’s high-tech surroundings, so a familiar and comforting
smell can do much to put them at their ease. In common with several forward-think-
ing hospitals in the United States, we now use aromatherapy at Columbia Presbyte-
rian and we have worked with Jane Buckle on research since 1995.
Our sense of smell is located in the catacombs of the most primitive area of
the brain and is extremely powerful. Smell can produce all sorts of physical reac-
tions, ranging from nausea to napping. The amygdala, the brain’s emotional cen-
ter, is located in the limbic system and is directly connected to the olfactory bulb.
Rage and fear are processed in the amygdala and both contribute to heart disease.
Our studies at Columbia have found that diluted essential oils rubbed on the feet
affected some volunteer’s autonomic nervous system within minutes.
Clinical Aromatherapy, Third Edition, is presented logically, with some neces-
sary background information given at the outset. I expect many readers will go
straight to the clinical section to look at their own specialty. In each specialty, a few
symptoms or problems have been explored and the way in which aromatherapy
might help treat those symptoms or problems is clearly outlined. This third edi-
tion is greatly helped by the addition of many tables. There is also a huge increase
in references. Although the clinical chapters will be of particular interest to readers
working in that clinical specialty, I think the book will also be of great interest to
those who want to know what clinical aromatherapy really is and how it can be used
in a scientific way.
iv
Foreword v
Jane Buckle has surpassed the excellence of the second edition and this does not
surprise me. She was the first nurse to win a postdoctoral NIH-funded research fel-
lowship to study an MSc in Epidemiology & Biostatistics in the School of Medicine
at the University of Pennsylvania. No mean feat! She brings a wealth of knowledge
and clinical experience acquired over 30 years in the field. With a PhD in health
service management, a background in critical care nursing, a teaching degree, and
a fistful of degrees from the world of alternative medicine, she writes authorita-
tively and she speaks from the heart. Jane was a co-presenter with me at The World
Economic Forum in Davos, Switzerland, several years ago. We were invited to talk
about the economics of alternative medicine and its affect on globalization. I was
impressed by Jane’s passion. An underlying question permeated all her presenta-
tions: What can we do to get the caring back into healthcare? When Jane speaks,
people listen.
Jane Buckle is a pioneer and she uses writing, research, and teaching to get her
message across. Her message is one of holism and she inspires those in healthcare to
evaluate how they use simple things like smell and touch to help people heal. In the
United States, many hospitals have integrated clinical aromatherapy and use Jane’s
program. She is still involved in numerous hospital research programs (apart from
our own) and has been a reviewer for NIH grants in the USA and for the NHS in
UK, where she currently lives.
Under her guidance, hundreds of students have carried out small pilot studies
in American hospitals. She has written templates for aromatherapy policies and
protocols that are used by hospitals. Jane Buckle works extraordinarily hard. More
than anyone, she has labored to get the message of clinical aromatherapy across to
health professionals globally, not as a possible add-on, but as a legitimate part of
holistic care.
That achievement alone is remarkable; but she has another string to her bow.
She has pioneered a registered method of touch, called the ‘M’ Technique®. Several
years ago, the ‘M’ Technique was tested in our laboratory at Columbia Presbyterian
and was found to have a pronounced parasympathetic response. While she was
at the University of Pennsylvania, Jane conducted research to compare the effects
of the ‘M’ Technique to conventional massage using brain imaging. The results
showed that the ‘M’ Technique affected a different area of the brain to massage and
the affects appeared to be more relaxing. Today the ‘M’ Technique is used in many
hospitals, hospices, special needs schools, and long-term care facilities because it
is so simple to learn and the effects are measurable in 5 minutes! The technique
definitely is very relaxing (I have experienced it myself!) and eminently suitable for
hospital patients (with or without the use of essential oils), so I am delighted to see
that the ‘M’ Technique has a dedicated chapter in this third edition.
Essential oils offer extraordinary potential from a purely medicinal standpoint.
The infection chapter highlighting studies on MRSA, MDRTB, and other resistant
pathogens shows just how powerful they can be. I think this chapter will be of par-
ticular interest to pharmacists as well as those involved in infection control. When
nausea is relieved through the inhalation of peppermint, insomnia is alleviated
vi Foreword
through the inhalation of lavender or rose, or Candida albicans is killed by tea tree,
we are witnessing clinical results—not just the “feel-good” factor. Aromatherapy
can work at a clinically significant level.
The subject of clinical aromatherapy is vast and will be of interest to anyone
involved in healthcare as well as pharmaceutical companies and aromatherapists
wanting to learn more. I share a goal with Jane Buckle—to enhance patient care
and give the best of what we have to offer, whatever that may be. As a physician, I
believe clinical aromatherapy has an important role to play in integrative medicine.
Jane Buckle gives us a glimpse of the future and it smells good!
Mehmet Oz
Mehmet Oz, MD, is a cardiac surgeon. He is the Director of the Cardiovascular Institute and
Vice Chairman of the Department of Surgery at Columbia Presbyterian Medical Center,
New York, NY. He is the Emmy award-winning host of “The Dr. Oz Show.”
Preface
“The biggest threats and dangers we face are the ones we don’t see—not because
they’re secret or invisible, but because we’re willfully blind.”
Margaret Heffernan, 2011
This book is the first fully peer-reviewed, evidence-based book on clinical aro-
matherapy. The reviewers are professors and experts in their own field from
Australia, Japan, The Netherlands, Turkey, UK, and USA. Their names and affili-
ations are listed with the chapter they reviewed. I am extremely grateful for their
valued input and time, which has enabled this book to be truly ground-breaking.
Aromatherapy is a multifaceted therapy, so it is not surprising that many people
do not know what it really is. The term “aromatherapy” was coined in France by
a chemist (Gattefossé 1937) and then used by a nurse (Maury 1961) and a doctor
(Valnet 1976). Thus, from the very beginning, the term “aromatherapy” was asso-
ciated with healthcare. The definition “Aromatherapy is the use of essential oils”
(Gattefossé 1937) is very specific. In 2013, the global market for essential oils was
estimated to be worth $1000 million (Williamson 2013). Essential oils are used in
household goods, cosmetics, by the food and drinks industry, the beauty world, and
more recently in pharmaceutical production. Some essential oils are also used by
the tobacco industry (Lawrence 1994).
Because my initial training was in nursing care, my focus has always been on the
clinical aspects of aromatherapy. By calling it clinical, I strive to put aromatherapy
back where I feel it belongs—in healthcare.
Mehmet Oz, MD, cardiothoracic surgeon at Columbia Presbyterian Medical
Center and now famous for his “Dr. Oz Show,” was one of the first doctors to
realize the potential of aromatherapy. He wrote, “Aromatherapy appears to impact
perceptions of pain” (Oz 1998). At the World Economic Forum at Davos (1999),
I stated: “aromatherapy makes economic sense.” What other complementary
therapy can be used in so many different ways in healthcare, for so many different
symptoms, is inexpensive, easy to use, and smells good?
Aromatherapy is better known for its soft side—for its caring. Florence Night-
ingale once said: “the cure is in the caring” (Dossey 2000). Clearly, relaxation and
rest are important during illness and following surgery (Nightingale 1859), and the
ability to relax can be greatly enhanced by aromatherapy. However, there is another
side to aromatherapy—the curing side. Tea tree is not used to induce relaxation. It is
vii
viii Preface
used against bacterial, viral, and fungal infections (Carson et al 2006). Currently, the
pharmaceutical industry is struggling to find new drugs to combat resistant infec-
tions and some drugs for chronic conditions are losing their potency. At the Gatte-
fossé Foundation colloquium (2010) held in Gattefossé’s family home, I introduced
the concept of Evolutionary Pharmacology (Buckle 2010). Evolutionary Pharma-
cology (EP) blends a non-standardized essential oil with a conventional drug to
create a medicine that is constantly evolving. I explain more about this in Chapter 7.
This book is about clinical aromatherapy in healthcare and is divided into
three sections. Section I covers the basics of aromatherapy: the evolution of aro-
matherapy, how essential oils work, basic plant taxonomy, extraction, biosynthe-
sis, chemistry, toxicity, and contraindications. This section also covers how clinical
aromatherapy is already being used in integrative medicine and introduces the ‘M’
Technique ® as a method for relaxation (with or without essential oils). Sections II
and III are both clinically focused. Section II, the General Clinical section, covers
infection, insomnia, nausea and vomiting, pain and inflammation, plus stress and
well-being. Section III covers nine key clinical specialties: Care of the Elderly; Criti-
cal Care; Dermatology; Mental Health; Oncology; Palliative, Hospice, and End-of-
Life Care; Pediatrics; Respiratory Care; and Women’s Health.
This book is intended to present an overview of what essential oils could do
in healthcare. It is not meant to be a substitute for training. I believe strongly in
education, preferably in a hands-on class where there can be face-to-face discussion
and debate. There is a need for a clear clinical focus. Safety concerns need to be
addressed and protocols and policies need to be written. With these guidelines in
place, clinical aromatherapy can, I believe, enhance patient care and reduce costs.
“Willful blindness” is the legal term given to information that you should or
could know, but disregard. It is estimated that 85% of companies have willful blind-
ness (Heffernan 2011). Heffernan suggests that at a time when we are supposedly
better informed than ever before, we are guilty of frequent and self-destructive
acts of willful blindness. This includes the healthcare industry. Because we are liv-
ing much longer and because there are no cures for most chronic illnesses, many
healthcare systems are in crisis. Rahm Emanuel (former Chief of Staff at the White
House) said: “Never let a serious crisis go to waste. It’s an opportunity to do things
you think you could not do before (2009).” I believe the healthcare crisis is aroma-
therapy’s big opportunity. Healthcare can choose willful blindness. Or it can choose
to evolve. Clinical aromatherapy could be part of that evolution.
REFERENCES
Buckle J. 2010. Is there a role for essential oils in current and future healthcare? Bulletin Technique
Fondation Gattefossé. 103:95-110.
Carson C, Hammond K, Riley T. 2006. Melaleuca alternifolia (tea tree) oil: a review of antimicrobial and
other medicinal properties. Clin Microbiol Rev. 19(1):50-62.
Dossy B. 2000. Florence Nightingale: Mystic, Visionary, Healer. Springhouse, PA: Springhouse.
Emanuel. R. 2009. www.youtube.com/watch?v=VjMTNPXYu-Y.
Preface ix
Gattefossé R-M. 1937. Aromathérapie: Les Huiles Essentielles Hormones Végétales. Ed. Librairie des Sci-
ences Girardot.
Heffernan M. 2011. Willful Blindness. Walker & Company USA. Ted Talk.
Lawrence B. 1994. Production of Clary Sage Oil and Sclareol in North America. Emes Rencontres Inter-
national. Nyon, France. December 5-7. http://legacy.library.ucsf.edu/documentStore/f/x/d/fxd13c00/
Sfxd13c00.pdf. Accessed March 20, 2014.
Maury M. 1961. Le Capital Jeunesse. Editions de la Tables Rond, Paris.
Nightingale F. 1859. Notes on Nursing: What It Is and What It Is Not. London: Harrison & Sons.
Oz M. 1998. Healing from the Heart. Dutton: New York.
Valnet J. 1976. Aromathérapie: Traitement des Maladies par les Essences des Plantes. Robert Lafont. Paris.
Acknowledgments
First, I would like to give a huge thank you to the chapter reviewers who are listed
on the following page. I would also like to give special thanks to the librar-
ians at Panola College and Texas Health Harris Methodist Hospital, Fort Worth,
Texas, who helped me with the initial literature searches. Thank you to Rhiannon
Lewis, who sent me all the back copies of her excellent journal International Jour-
nal of Clinical Aromatherapy and to Bob Harris, whose aromatherapy database
(http://quintessential.uk.com), helped me find relevant research papers that were
not easily available elsewhere. Thank you to Elsevier for giving me access to the
Science Direct database. Finally, thank you to my family and friends who waited for
18 months.
x
