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THEME ARTICLES

Aromatherapy: Mythical,
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Magical, or Medicinal?
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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 My soul travels on the smell of perfume like the souls
Assistant Professor of other men on music.
School of Nursing
—Charles Baudelaire
University of Louisville
Louisville, Kentucky Little Poems in Prose: A Hemisphere of Hair (1857)

INTRODUCTION

“How does that make you feel?” Ah, the

quintessential question of mental health pro-
fessionals. Is how we feel complexly re-
lated to or merely subjugated to the simplest
anatomy of the olfactory system? Is aro-
matherapy magical, mythical, or medicinal?
Perhaps the answer will never be clearly de-
fined; 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 can-
dle 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):8–16

°
c 2002 Lippincott Williams & Wilkins, Inc.

8
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in part to trends in cultural communication,
marketing, and product promotion. Also, it is
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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, emo-
tions, 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 no-
tion that many other sensory inputs could
stimulate equally pleasant thoughts or feel-
ings. While the sense of smell enjoys no par-
ticular advantage when it comes to access-
ing 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 can-
not be underestimated; this fact in itself con-
tributes to the difficulty in defining empiri-
cal support. There is a great deal of debate
over the efficacy of aromatherapy. Some ar-
gue that claims for therapeutic value or ben-
efit outweigh the scientific evidence.3,4 Re-
gardless of the side of the debate on which
you fall, the use of CAM therapies, of which
aromatherapy is but one, is gaining contin-
ued attention from consumers and health
care providers.5 This requires nursing to
move forward with research that will sup-
port claims on either side of the debate re-
garding use and benefit of aromatherapy as
one modality of CAM.
Aromatherapy 9
The purpose of this article is to briefly re-
view the definition and history of aromather-
apy, present a summary of current research
related to uses of aromatherapy in various
clinical situations, and discuss ethical impli-
cations 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 pep-
permint 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 var-
ied effects. Most essential oils have anti-
septic properties; some are antiviral, anti-
inflammatory, pain relieving, antidepressant,
or expectorant. Those who use aromathera-
pies may take advantage of other properties
of essential oils such as stimulation, relax-
ation, 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 Re-
naissance Europe. Ayurveda is India’s tradi-
tional, 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 in-
cludes the use of aromatic oils in rejuvenat-
ing and healing recipes.
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10 HOLISTIC NURSING PRACTICE/OCTOBER 2002

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Table 1. Essential oils and effects

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Essential oil Effect

Basil Uplifting, refreshing, clarifying, aiding concentration

Bergamot Refreshing, uplifting
Chamomile Refreshing, relaxing, calming, soothing, balancing
Cedarwood Sedating, calming, soothing, strengthening
Clary sage Warming, relaxing, uplifting, calming, causing euphoria
Cypress Relaxing, refreshing, providing astringent qualities
Eucalyptus Head clearing, providing antiseptic and decongestant properties, invigorating
Fennel Providing carminative properties, easing wind and indigestion
Frankincense Relaxing, rejuvenating, easing breathing, dispelling fears
Geranium Refreshing, relaxing, balancing, harmonizing
Hyssop Providing decongestant properties
Jasmine Relaxing, soothing, building confidence
Juniper Refreshing, stimulating, relaxing, promoting diuresis
Lavender Refreshing, relaxing, providing therapeutic qualities, calming, soothing
Lemon Refreshing, stimulating, uplifting, motivating
Lemongrass Toning, refreshing, fortifying
Marjoram Warming, fortifying, sedating
Melissa Uplifting, refreshing
Myrrh Toning, strengthening, rejuvenating, providing expectorant properties
Neroli Relaxing, dispelling fears
Orange Refreshing, relaxing
Patchouli Relaxing, enhancing to sensuality
Peppermint Cooling, refreshing, head clearing
Petitgrain Refreshing, relaxing
Pine Refreshing, providing antiseptic properties, invigorating, stimulating
Rose Relaxing, soothing, enhancing to sensuality, building confidence
Rosemary Invigorating, refreshing, stimulating, clarifying
Sandalwood Relaxing, warming, building confidence, grounding
Tea tree Acting as antiseptic, strengthening to immune system
Thyme Acting as antiseptic, refreshing, strengthening to immune system
Ylang ylang Relaxing, soothing, enhancing to sensuality

The medieval physician Avicenna is medicine, used aromatherapy baths and

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 cosmet-
ics. Wigs often were scented with oils to
mask the stench of unsanitary streets and
bodies. Hippocrates, the father of modern
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 René
Maurice Gattefosse discovered the benefits
of lavender oil when it healed his burned
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hand without leaving scars. He then started
investigating the effects of other essential
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oils for healing.7 During World War I,
French army surgeon Dr Jean Valnet ex-
perimented 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 sub-
stances. 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 avail-
able as ointments, lotions, creams, soaps,
shampoos, bath salts, massage oils, com-
presses, vaporizers, personal mists, room
diffusers, room mists, incense, and candles.
Most aromatherapy products are “delivered”
to the body via massage or inhalation. His-
torically, aromatherapy must be acknowl-
edged as a timeless intervention, growing
and evolving as practitioners use scientific
rigor to explore its effects.
RESEARCH
A review of the literature suggests ma-
jor gaps in the knowledge related to the
clinical application of aromatherapy in re-
lation to issues of dosage, methods of ad-
ministration, and therapeutic effects.9 There
is a paucity in both quantitative and quali-
tative studies pertinent to aromatherapy as
a specific modality of complementary ther-
Aromatherapy 11
apy. There are many peripherally relevant
articles that address anecdotal practice stan-
dards, opinions, or philosophical beliefs as
they relate to the practice of complemen-
tary or alternative therapies. No randomized,
controlled, double-blind studies were found.
One problem encountered with this litera-
ture review is that there appeared to be many
studies related to aromatherapy. However, on
further examination most of these studies ac-
tually 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 as-
signed 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 re-
ports of psychological distress by these
patients. Methodological flaws were pre-
empted by use of visual analog scales and
semi-structured interviews using psychome-
trically valid measures of mental health
and personal adjustment. In addition, nurses
were unaware of which type of therapy
was being administered to participants un-
til completion of the study. As a result
of this study, regular baseline assessments
for all new patients and post-intervention
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evaluations have been implemented as stan-
dard practice.10
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Tate11 attempted to establish efficacy of
peppermint oil as treatment for postoper-
ative 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 ei-
ther 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 im-
prove postoperative nausea in gynecologic
patients.11 Further studies with varied post-
operative 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 re-
ceive massage, aromatherapy using essential
oil of lavender, or a period of bed rest. As-
sessments before and after included phys-
iologic stress indicators and patients’ self-
report of anxiety levels, mood, and ability to
cope with the ICU experience.
Of the 122 initial participants, 77% were
able to complete subjective assessments. Re-
sults suggest that patients who received aro-
matherapy 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 fol-
lowing the therapy, although this effect was
not sustained or cumulative.12 The results
of this study cannot be generalized; how-
ever, 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 ran-
dom population telephone sample of adults
aged 18 to 50 with a self-report of a physi-
cian diagnosis of asthma or rhinosinusi-
tis. The study objective was to determine
prevalence of specific CAM use, includ-
ing aromatherapy. Structured telephone in-
terviews 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 sta-
tistical differences in the frequency of herbal
use, overall or by subcategory, among those
with asthma compared with those with rhi-
nosinusitis. This also was true for acupunc-
ture, aromatherapy, and various forms of
massage.
In a small pilot study by Komori and
colleagues,13 12 depressed men were ex-
posed to citrus fragrance in the air and com-
pared with 8 patients not exposed to the fra-
grance. 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. Accord-
ing to this study, it is not possible to draw
any clear conclusions about the value of aro-
matherapy for depression.
Using a quasi-experimental design with a
convenience sampling method, Brownfield14
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selected nine patients diagnosed with
rheumatoid arthritis. Each participant was
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placed in one of three groups. The con-
trol group completed pre- and posttests only.
Group 2 completed pretests and were mas-
saged for two nights with no oil, then com-
pleted 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 fol-
lowing massage or aromatherapy massage.
However, data generated by interview re-
vealed that those patients receiving the mas-
sage with lavender oil were able to decrease
intake of analgesia due to perceived reduc-
tion in pain perception. Investigators report
this contradictory finding may be due to pa-
tients with rheumatoid arthritis having diffi-
culty distinguishing pain from stiffness, and
patients may define pain differently at differ-
ent 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 ma-
jority of respondents in this study (83%,
n = 5) expressed a desire to receive fur-
ther 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 inher-
ent limitations using a quasi-experimental
design.
Aromatherapy 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 alope-
cia 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 eval-
uated treatment success using sequential
photographs. Likewise, degree of improve-
ment 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 ob-
servers on sequential photographs and was
shown to be reproducible with good interob-
server agreement (kappa = 0.84). The degree
of improvement on photographic assessment
was significant (p = .05). Demographic anal-
ysis showed that the two groups were well
matched for prognostic factors. Results sug-
gest aromatherapy is a safe and effective
treatment for alopecia areata.
Hay and coworkers15 reported that treat-
ment with these essential oils was signif-
icantly more effective than treatment with
the carrier oil alone. A potential limitation
to this study lies in the fact that the investi-
gators did not clearly delineate their process
for randomization.
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While all of the research studies discussed
indicate encouraging information about the
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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 prac-
ticed, as well as other forms of complemen-
tary 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 con-
sider incorporating or facilitating various
complementary therapies to benefit patients.
Along with this responsibility comes an ac-
countability to ensure an appropriate, sound
knowledgebase and clinical savvy.
Trends in modern medicine have been re-
ductionistic in nature and have assumed that
patients seek only to be cured. This has
occurred slowly over time and is increas-
ing 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 can-
not be ignored.
Some may argue that nursing, in contrast,
focuses on a caring approach using compas-
sionate caring skills to help move a patient to
a healthier state of mind, body, and spirit.18
Watson’s19 caring theory of nursing main-
tains 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 (re-
gardless of professional discipline), if we
are truly dedicated to the benefit and well-
being of our patients, we may opt to em-
brace both. As we move away from the
traditional paternalistic model of health care
where “provider knows best,” perhaps we
can truly begin to demonstrate uncondi-
tional respect for and encourage the auton-
omy of our patients within the health care
system.
For practitioners using various functions
or applications of aromatherapy, patient suf-
fering may seem to diminish. Relief, if only
briefly, is often welcomed by those suffering
from physiologic or emotional pain and suf-
fering. Frequently, modern health care prac-
titioners sacrifice contact with patients in the
name of efficiency. Sadly, this lack of con-
nection or contact hurts both the patient and
the practitioner.
The most powerful therapeutic or seem-
ingly magical cures occur due to the time
a practitioner and patient are able to spend
getting to know each other.20 Often, the sub-
tleties that occur during seemingly “unim-
portant” conversation can hold the key to
therapeutic interventions.
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If you do not connect with your patients
they may never tell you the simple things
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that work for them, such as an herbal bath,
a scented candle, or a massage with laven-
der oil. While these things may not, in and of
themselves, “cure,” they may certainly make
someone feel better. Often the most effica-
cious therapy is one that is not quickly dis-
cernible 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 labo-
ratory tests or brain waves. Maybe it is only
measurable by report of our patients. Maybe
this is what we should listen to most. Isn’t
that why we do what we do as nurses?
CONCLUSION
Currently there is a lack of sound evidence
regarding the appropriate use of aromather-
apy in a variety of health care settings. Anec-
dotal 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 rea-
son may be the lack of available funding
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