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Plant-derived essential oils are highly volatile compounds (unlike fixed oils, such as cooking oils comprised of nonvolatile compounds) that have been used since antiquity to treat various health conditions and to promote overall wellness. Hippocrates is reputed to have said that: “The way to health is to have an aromatic bath and scented massage every day.”1 Essential oils used in aromatherapy can also be administered in inhalants, lotions, compresses, and (only under qualified care) internally. See Table 1 for safety guidelines for using aromatherapy. This article reviews recent research on aromatherapy applications, including reduction of anxiety, pain, hypertension, and weight; enhancement of mood and cognition; and antimicrobial action against infections that are becoming antibiotic-resistant. Table 2 provides a summary of this research. Potential mechanisms of action are discussed and studies in progress are mentioned briefly.

Modern Aromatherapy

Modern aromatherapy began in the 1920s, when French chemist Rene-Maurice Gattefosse, PhD (1881–1950), coined the term “aromatherapie” and began studying the therapeutic effects of essential oils. Among the conditions he studied were burns he sustained in a laboratory and successfully treated with Lavandula spp. (lavender) oil. Methods of essential-oil produc-tion include steam distillation, hydrodistillation, water-and-steam distillation, solvent extraction, carbon dioxide extraction, and cold pressing.2

The revived appeal of aromatherapy today has paralleled the growing interest in complementary and alternative medicine (CAM).3 Much is now known about the chemical composi-tion of essential oils, and analytical techniques have revealed that synthetic oils do not contain the full range of compounds found in true essential oils.4

Aromatherapy in Surveys of CAM Usage

Aromatherapy is not always specified among therapies included in surveys of CAM utilization. A national sur-vey of CAM use in England lists aromatherapy among the

most commonly used therapies reported by 7630 respon-dents.5 In a U.K. survey of patients attending a hospital’s general otolaryngology clinic, of 1336 total respondents, 833 reported CAM usage and 133 (16.2%) of them had used aromatherapy in the previous 3 months.6 Aromather-apy was reported to be available in 76.6% of German ob-stetrics departments.7

Aromatherapy was one of the nonmedicinal CAM therapies reported to be used in the preceding year by 51% of 503 chil-dren surveyed in a children’s hospital clinic in Australia, pri-marily for treatment of colds and promotion of general health.8 The annual prevalence of aromatherapy use by children and adolescents in a children’s hospital in Wales was 5%.9

Clinical Studies

Mood and MemorySage (Salvia spp.) has long been associated with improved

mood and memory. In an independent-groups design study, 135 healthy adults were exposed to either the aroma of S. of-ficinalis or S. lavandulifolia (presumably inhaled), or to no aroma. Performance assessed on standard cognitive and mood test battery scales indicated that the aromas of these essential oils, compared with the control condition (no exposure to any aroma), reproduced some of the effects of oral administration of these herbs.10

Olfactory dysfunction has been identified in cases of mild cognitive impairment (MCI) and as a very early symptom in Alzheimer’s disease (AD). In a study of 104 elderly par-ticipants classified into four categories of MCI on the basis of neuropsychologic testing (amnesiac MCI single domain, am-nesiac MCI multiple domain, nonamnesiac single domain, and nonamnesiac multiple domain) and controls. Significant dif-ferences were found between subjects who tested as MCI on multiple domains and the controls. The researchers concluded: “Together with cognitive testing, olfactory testing may more accurately help predict whether or not a patient with MCI will convert to AD in the near future.”11

Evidence suggests that sensory interventions, includ-ing aromatherapy, may reduce neuropsychiatric symptoms in patients with dementia.12,13 In a study of the effects of

DOI: 10.1089/act.2011.17103 • MARY ANN LIEBERT, INC. • VOL. 17 NO. 1 ALTERNATIVE AND COMPLEMENTARY THERAPIESFEBRUARY 2011

Aromatherapy Current and Emerging Applications

Sala Horowitz, PhD

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aromatherapy on dementia, 28 elderly Japanese patients—17 with AD—were exposed to Rosmarinus off icinalis (rosemary) and Citrus limon (lemon) essential oils in the morning and lavender (species not identified) and Citrus sinensis (sweet or-ange) essential oils in the evening for 28 days, after a control period of 28 days. A washout period of another 28 days fol-lowed. Patients were evaluated on standard dementia scales at each study phase. All patients, particularly those with AD, had improvements in cognitive function without any side-effects from the treatment.14

A randomized controlled trial of moderate anticipatory anx-iety was conducted with dental patients (N = 340). Those who were exposed to the odor of an unspecified species of lavender while waiting for their appointments reported significantly lower anxiety at the time when they were surveyed than the control group did.15

Women’s Health

Aromatherapy has long been used for women, particularly in childbirth, to reduce anxiety and pain. While research on aro-matherapy’s use in modern settings frequently involves small sample sizes and combination with other CAM therapies, such as massage, aromatherapy’s use has been shown to be safe and well-accepted by women.16 In addition, some essential oils have been used to fight Candida albicans (see section on Mi-crobes and Superbugs below).

HypertensionA search of a dozen databases for controlled trials test-

ing the effectiveness of aromatherapy for treating high blood pressure yielded one randomized clinical trial and four non-randomized controlled trials. Although all the trials pro-duced positive effects on blood pressure, the reviewers called for further studies with adequate control situations to provide more convincing evidence.17

Microbes and “Superbugs”Eucalyptus (primarily Eucalyptus globulus) is among the

essential oils that have traditionally been used for their anti-inflammatory and expectorant properties to fight re-spiratory and other infections by vapor inhalation. With the alarming spread of methicillin-resistant Staphylococcus aureus (MRSA) in and beyond the hospital setting in recent years (approximately 94,000 cases were reported in 2005),18 research is being conducted into aromatherapy oils as alter-natives to no-longer-effective antibiotics against this po-tentially deadly bacteria.

Moderate doses of eucalyptus oil were found to have broad-spectrum antimicrobial effects against MRSA, as well as C. albicans, the prevalent fungal infection also becoming resistant to a number of widely used drugs.19 Essential oils extracted from lavender (L. angustifolia) produced synergistic effects in inhibiting MSRA.20

In an in vitro study, microbiologists at the University of Brighton, England, found that a proprietary blend (made by Benchmark Oils Ltd., Sussex, England) of Thymus vulgaris

(thyme) oils destroyed MRSA bacteria within 2 hours. The researchers suggested that these oils could be blended into dis-ease-fighting soaps and other hygiene products.21 Thyme and eucalyptus were found to be effective against strains of MSRA infections in another in vitro study.22

Essential oil from Zataria multiflora, a thyme-like plant that grows wild in Iran, acted synergistically with the antibiotic vancomycin against clinical isolates of MRSA. Z. multiflora also appears to serve as a downregulator of MDM2 gene ex-pression in cancer, and therefore has potential as a novel inter-vention for cancer prevention and treatment.23

Scientists conducted an in vitro study of the action of vari-ous essential oils against C. albicans. Cymbopogon citratus (lem-ongrass) produced the strongest antifungal action, followed by Mentha piperita (peppermint) and eucalyptus.24

Weight ControlAromatherapy has been suggested helpful for control-

ling food cravings in persons attempting to lose weight.25 Alan R. Hirsch, MD, FACP,* director of the Smell & Taste Treatment and Research Foundation, Inc, (see Resources), demonstrated that Sensa,® a noncaloric tastant that he de-veloped, led to reduced food consumption and significant weight loss by inducing gustatory-evoked satiety when sprinkled on food.26

Current and Emerging ApplicationsTable 1. Safety Guidelines on Essential Oils

• Tellpatientstouseonlyunderatrainedpractitioner’sguid-ance for ingested, potentially phototoxic, or allergenic oils; for pregnant or nursing women with certain conditions (e.g., high blood pressure, seizure disorders); or together with certain medications (e.g., warfarin).2,*

• Conductpatchtestingonpatientswithsuspected sensitivities.†

• Tellpatientstoobtainproductsfromreputablesources.Oils differ in potency and quality because of plant species, subspecies, and chemotypes (variants of a species having different percentages of components, resulting in varying growing conditions).4

• Advisepatientsnottousetheseoilsinundilutedform on the skin or allow them to get in their eyes; use caution in recommending inhalants to persons with asthma or allergies.

• Tellpatientstokeepessentialoilsandcarrieroilsintightlyclosed glass bottles away from exposure to heat and light.

• Advisepatientstokeeptheseoilscompletelyawayfromchildren and pets.

*Clark M. Essential Oils and Aromatics: A Step-by-Step Guide for Use in Massage and Aromatherapy. Sandy, Utah, Silverleaf Press Books, 2008.†Uter W, Schmidt E, Geier J, et al. Contact allergy to essential oils: Current patch test results (2000–2008) from the Information Network of Departments of Derma-tology (IVDK). Contact Dermatitis 2010;63:277–283.

*For an interview with Dr. Hirsch, see: Mason, R. Exploring the poten-tials of human olfaction: An interview with Alan R. Hirsch, MD, FACP. Altern Complement Ther 2005;11:135–140.

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Research in Progress

The National Institutes of Health is sponsoring several studies on aromatherapy that are currently recruiting volunteer subjects, are due to recruit volunteers, or have recently been

completed. These studies focus on reducing: pain/anxiety re-lated to cancer, childbirth, and cervical colposcopy; chemo-therapy-related symptoms in children with cancer; distress in infants; the need for conscious sedation in colon-cancer screening (completed); and the effects on mood and physical

Table 2. Summary of Essential Oils Used in Cited Research2,4

Essential oil Latin binomial Reference Results CommentsBergamot Citrus bergamia 32 Provided stress Use bergamot (Citrus bergamia) in Bergaptene-free (a relief to healthy adults product) to avoid phototoxicity*

Eucalyptus Eucalyptus 19 Antibacterial against Known for respiratory and germicidal effects globulus MRSA; antifungal against Candida albicans

24 Somewhat effective antifungal against C. albicans in vitro

Lavender Lavandula 14 Improved cognitive Long used for healing skin & improving mood; angustifolia or function in patients anxiolytic & analgesic properties; used in skin care L. officinalis with AD & other forms of dementia

20 Essential oils extracted from lavender produced synergistic effects in inhibiting MSRA

15 Reduced anticipatory anxiety in dental patients

Lemon oil Citrus limon 14 Improved cognitive Olfactory dysfunction has been identified as an function in patients with early symptom of AD; germicidal, astringent AD and other forms of properties dementia

Lemongrass Cymbopogon citratus 24 Effective antifungal Among most allergenic in sample tested3; physical against C. albicans tonic in vitro

Sweet orange Citrus sinensis 14 Improved cognitive Olfactory dysfunction identified as an early symp- function in patients tom of AD; anxiolytic properties; citrus oils can with AD & other forms cause photosensitivity of dementia.

Peppermint Mentha piperita 24 Somewhat effective Used as antiseptic, digestive aid, but may aggravate antifungal against heartburn caused by GERD† C. albicans in vitro

Rosemary Rosmarinus officinalis 14 Improved cognitive Immune system stimulant function in patients with Alzheimer’s disease and other forms of dementia

Sage Salvia officinalis 10 Improved memory & Has reproduced some of effects found with oral or S. lavandulifolia mood in healthy adults herb use

Clary sage Salvia sclarea 35 Antidepressant effect Traditionally used in, women’s health, but contrain- proposed to be closely dicated in pregnancy, nursing, & estrogen-depen- associated with the dent cancers* modulation of dopamine in the brain

Thyme Thymus vulgaris 21 Thyme oils destroyed Phenol in thyme has antibacterial, antifungal & MRSA bacteria within anti-insecticidal properties 2 hours *Clark M. Essential Oils and Aromatics: A Step-by-Step Guide for Use in Massage and Aromatherapy. Sandy, Utah, Silverleaf Press Books, 2008.†Uter W, Schmidt E, Geier J, et al. Contact allergy to essential oils: Current patch test results (2000–2008) from the Information Network of Departments of Dermatology (IVDK). Contact Dermatitis 2010;63:277–283.MRSA, methicillin-resistant Staphylococcus aureus; AD, Alzheimer’s disease; GERD, gastroesophageal reflux disease.

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responses (completed). Most of the study descriptions refer only to aromatherapy or essential oils in general. For the study on the effect of aromatherapy for reducing pain and anxiety during cervical colposcopy, lavender oil or scent is specified.27

Mechanisms of Action

Plants’ essential oils evolved as chemical compounds that are protective against insects and pathogens, many of which also af-flict humans. Humans have receptors for most of the essential oils in the functional chemical groups: alcohols; aldehydes, esters; ethers; ketones; lactones; oxides; phenols; sesquiterpenes, and terpenes.28,29 The complexity of these compounds gives them an advantage over simpler synthetic pharmaceutical compounds to which bacteria (e.g., MRSA) have increasingly have become resistant. Cymbopogon citratus (lemongrass) produces antifungal action against C. albicans, and application of this essential oil re-sults in deleterious changes in cellular structures of the fungi.24

The olfactory sense is intimately linked to brain centers involved in emotions (the limbic system), hunger (the hypo-

thalamus), and memory (the hippocampus). Hippocampal atrophy occurs with aging, especially in patients with AD.30 Patients with anosmia (loss of the sense of smell)—caused by head trauma, illness, or a side-effect of certain medications and radiation treatment for cancer—frequently report that they experience a reduction in memories and emotions associated with smells, and loss of these memories leads to depression.1 An estimated 200,00 people visit a physician for smell and re-lated chemosensory disorders annually.31

Candace Pert, PhD is a pioneer of the field of psychoneu-roimmunology,32 a pharmacologist, and the scientific director of RAPID Pharmaceuticals, Inc., in Rockville, Maryland. She has noted that: “essential oils pass easily through the skin and travel efficiently through the body in a similar fashion to hor-mones and neuropeptides.”29

In a study of the effects of lavender on the endocrinolog-ic stress markers cortisol and chromogranin A in 30 healthy adults, a statistically significant difference was found in stress relief in subjects who were assigned to a lavender-exposure group compared to controls.33 In another study of healthy young adults (N = 114), participants were randomly assigned to groups exposed to inhaled Citrus bergamia, soft music, or both the aroma and music, and a control. Subjects who were

Citrus bergamia (bergamot).

Thymus vulgaris (thyme).

Eucalyptus globulus (eucalyptus).

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exposed to both the aroma and music were assessed as being the most relaxed as indicated by a shift of the automatic ner-vous system balance toward parasympathetic activity.34 In ex-perimental studies, the antidepressant effect of Salvia sclarea (clary sage) has been explained as being closely associated with modulation of the neurotransmitter dopamine in the brain.35

Rachel Herz, PhD, is a visiting professor in psychiatry and human behavior and psychology at Brown University in Providence, Rhode Island. She suggests that the effects of aro-matherapy are the result of learned associations with essential oil aromas or psychologic suggestibility about an oil’s health benefits rather than to inherent properties of the oils.1

Recommended Reading

The Aromatherapy Encyclopedia: A Concise Guide to Over 385 Plant Oils By Carol Schiller and David Schiller; Illustrated by Jeffrey Schiller Laguna Beach, CA: Basic Health Publications, Inc., 2008

Essential Chemistry for Aromatherapy, 2nd Edition By Sue Clarke, PhD Edinburgh: Churchill Livingstone, 2008

International Journal of Clinical Aromatherapy For information visit: www.ijca.net/

American College of Healthcare Sciences (ACHS) 5940 SW Hood Avenue Portland, OR 97239 Phone: (800) 487-8839 Website: www.achs.edu E-mail: admissions@achs.edu

Formerly the Australasian College, an affiliate of a naturopathic college in New Zealand, the ACHS offers accredited on-campus and distance courses, certificate programs, and degrees in aromatherapy and other areas of alternative health care.

Aromatherapy Registration Council (ARC) American College of Healthcare Sciences (ACHS) Phone: (503) 244-0726 Fax: (503) 244-0727 Website: www.aromatherapycouncil.org E-mail: info@aromatherapycouncil.org

Based at the ACHS (listed above), the ARC is an independent, nonprofit corporation established to promote the credibility of, and ac-creditation for, the aromatherapy profession and programs through a voluntary examination and registering of aromatherapists.

National Association for Holistic Aromatherapy (NAHA) P.O. Box 1868 Banner Elk, NC 28604 Phone: (828) 898-6161 Fax: (828) 898-1965 Website: www.naha.org E-mail: info@naha

The NAHA is a nonprofit educational organization dedicated to reviving knowledge of the medicinal use of aromatic plants and essen-tial oils, enhancing public awareness of the benefits of genuine aromatherapy, and promoting high professional standards in aromather-apy education and practice.

Smell & Taste Treatment and Research Foundation, Ltd. 845 North Michigan Avenue, Suite 990W Chicago, IL 60611 Phone: (312) 938-1047 Fax: (312) 649-0458 Website: www.smellandtaste.org E-mail: dr.hirsch@smellandtaste.org

This foundation tests and treats patients with chemosensory disorders, and assesses how the loss of smell affects psychologic well-being.

Essential Oil Resource Consultants (EORC) Au Village 83840 La Martre Provence, France Phone: +33 494 84 29 93 Fax: +33 632 39 58 43 E-mail: essentialorc@club-internet.fr Website: www.essentialorc.com/contactus.php

The goal of EORC is to promote professional and safe use of essential oils and aromatic products. EORC offers in-class training, publica-tions, and distance learning material as well as EORC Aromatic Adventures that run through the summer months in Provence, France.

Organizations

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Conclusion

Research findings to date indicate that the age-old practice of aromatherapy using essential oils is an effective alternative or adjunct to pharmacologic therapies for promoting general well-being and for treating many health problems, including mood and cognitive decline. Essential oils show promise for combating MSRA, C. albicans, and obesity. Given these find-ings to date for this largely safe and pleasant CAM modality, further clinical trials are warranted.

With the long association between essential oils and relax-ation, researchers have also called for well-designed studies on essential oils for treating other prevalent problems, such as insomnia.36 The lack of the ability to smell such aromas has been shown to be an important early clinical sign of AD, so this is another problem that may perhaps respond in some way to aromatherapy. n

References

1. Herz R. The Scent of Desire: Discovering Our Enigmatic Sense of Smell. New York: William Morrow, 2007.2. Schiller C, Schiller D. The Aromatherapy Encyclopedia: A Concise Guide to Over 385 Plants. Laguna Beach, CA: Basic Health Publications, 2008.3. National Cancer Institute. Aromatherapy and Essential Oils: Questions and Answers About Aromatherapy. Online document at: www.cancer.govtop-ics/pdq/cam/aromatherapy/Patient/page2 Accessed November 14, 2010.4. Clarke S. Essential Chemistry for Aromatherapy, 2nd ed. Edinburgh: Churchill Livingstone, 2008.5. Hunt KJ, Coelho HF, Wider B, et al. Complementary and alternative medi-cine use in England: Results from a national survey. Int J Clin Pract 2010; 64:1496–1502.6. Shakeel M, Trinidade A, Jehan S, Ah-See KW. The use of complementary and alternative medicine by patients attending a general otolaryngology clinic: Can we afford to ignore it? Am J Otolaryngol 2010;31:252–260. 7. Münstedt K, Schroter C, Brüggmann D, et al. Use of complementary and alternative medicine in departments of obstetrics in Germany. Forsch Kom-plementmed 2009;16:111–116.8. Lim A, Cranswick N, Skull S, South M. Survey of complementary and al-ternative medicine use at a tertiary children’s hospital. J Paediatr Child Health 2005;41:424–427.9. Crawford NW, Cincotta DR, Lim A, Powell CV. A cross-sectional survey of complementary and alternative medicine use by children and adolescents attending the University Hospital of Wales. BMC Complement Altern Med 2006;6:16.10. Moss L, Rouse M, Wesnes KA, Moss A. Differential effects of the aro-mas of Salvia species on memory and mood. Hum Psychopharmacol 2010; 25:388–396.11. Lehmer J, Pusswald G, Gleiss A, et al. Odor identification and self-report-ed olfactory functioning in patients with subtypes of mild cognitive impair-ment. Clin Neuropsychol 2009;23:818–830.12. Conn DK, Seiltz DP. Advances in the treatment of psychiatric disorders in long-term care homes. Curr Opin Psychiatry 2010;23:516–521.13. Yaffe K. Treatment of neuropsychiatric symptoms in patients with demen-tia. N Engl J Med 2007;357:1441–1443. 14. Jimbo D, Kimura Y, Taniguchi M, et al. Effect of aromatherapy on patients with Alzheimer’s disease. Psychogeriatrics 2009;9:173–179.

15. Kritsidima M, Newton T, Asimakopoulou K. The effects of lavender scent on dental anxiety levels: A cluster randomised-controlled trial. Community Dent Oral Epidemiol 2010;38:83–87.16. Tillett J, Ames D. The uses of aromatherapy in women’s health. J Perinat Neonatal Nurs 2010;24:238–245.17. Hur MH, Lee MS, Kim C, Ernst E. Aromatherapy for treatment of hyperten-sion: A systematic review. J Eval Clin Pract 2010;July 29:e-pub ahead of print.18. Centers for Disease Control and Prevention. MRSA Statistics. Online document at: www.cdc.gov/mrsa/library/ Accessed November 16, 2010.19. Sadlon AE, Lamson DW. Immune-modifying and antimicrobial effects of eucalyptus oil and simple inhalation devices. Altern Med Rev 2010;15:33–47.20. Roller S, Ernst N, Buckle J. The antimicrobial activity of high-necrodane and other lavender oils on methicillin-sensitive and -resistant Staphylococcus aureus (MSSA and MRSA). J Altern Complement Med 2009;15:275–279.21. Anonymous. Aromatherapy oils could kill MRSA. March 18, 2010. On- line document at: www.theengineer.co.uk/news/aromatherapy-oils-could-kill- mrsa/1001428.article Accessed November 12, 2010.22. Tohidpour A, Sattari M, Omidbaigi R, et al. Antibacterial effects of essen-tial oils from two medicinal plants against Methicillin-resistant Staphylococcus aureus (MSRA). Phytomedicine 2010;17:142–145. 23. Mahboubi M, Bidgoli. FG. Antistaphylococcal activity of Zataria mul-tiflora essential oil and its synergy with vancomycin. Phytomedicine 2010; 17:548–550.24. Tyagi AK, Malik A. Liquid and vapour-phase antifungal activities of se-lected essential oils against Candida albicans: Microscopic observations and chemical characterization of Cymbopogon citratus. BMC Complement Altern Med 2010;10:65.25. Harrison L. Master Your Metabolism: The All-Natural (All-Herbal) Way to Lose Weight. Naperville, IL: Sourcebooks, Inc., 2003.26. Hirsch AR. Use of gustatory stimuli to facilitate weight loss. Online docu-ment at: Abstract_Poster_Use_of_Stimuli_for_Weight_Loss.pdf Accessed January 27, 2011.27. U.S. National Institutes of Health. Studies search: Aromatherapy. Online document at: www.clinicaltrials.gov/ct2/results?term=aromatherapy Accessed January 27, 2011. 28. Jones EA. Awaken to Healing Fragrance: The Power of Essential Oil Therapy. Berkeley, CA: North Atlantic Books, 2010.29. Keville K, Green M. Aromatherapy: Complete Guide to the Healing Art, 2nd ed. Berkeley: Crossing Press, 2009.30. Mueller SG, Schuff N, Yaffe K, et al. Hippocampal atrophy patterns in mild cognitive impairment and Alzheimer’s disease. Hum Brain Mapp 2010; 31:1339 –1347.31. National Institute on Deafness and Other Communication Disorders. Quick Statistics About Smell and Taste. Online document at: www.nidcd.nih.gov/health/statistics/smelltaste/stquickstats.htm Accessed November 16, 2010.32. Pert C. The chemical communicators. In: Moyers B, ed. Healing and the Mind. New York: Doubleday, 1993:177–193.33. Toda M, Morimoto K. Effect of lavender aroma on salivary endocrinologi-cal stress markers. Arch Oral Biol 2008;53:964–968.34. Peng SM, Koo M, Yu ZR. Effects of music and essential oil inhalation on cardiac autonomic balance in healthy individuals. J Altern Complement Med 2009;15:53–57.35. Seol GH, Shim HS, Moon, HK, et al. Antidepressant-like effect of Salvia sclarea is explained by modulation of dopamine activities in rats. J Ethnophar-macol 2010;130:187–190.36. Sarris J, Byrne GJ. A systematic review of insomnia and complementary medicine. Sleep Med Rev 2010;June 5:e-pub ahead of print.

To order reprints of this article, e-mail Karen Ballen at: Kballen@liebertpub.com or call (914) 740-2100.

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