124

Diabetes Spectrum Volume 14, Number 3, 2001

Aromatherapy has a long history of
use. Dating back to the time of
Hippocrates, skin problems were
treated with aromatic baths.
1
Since
then, essential oils have been used
continuously not just for their pleas-
ant aromas, but also for their medical
properties.
The renaissance of aromatherapy
occurred in France in the 1940s with
three individuals in the medical field.
Gattefosse, a French chemist, burned
his hand and arm so badly that gas
gangrene set in. At that time, the only
treatment for gas gangrene was ampu-
tation, but Gattefosse used essential
oil of lavender, and his wounds healed
rapidly. He was so impressed that he
dedicated his life to the use of essen-
tial oils for skin problems.
2
Valnet, a
physician, used essential oils on
wounds in the Indo-China war when
antibiotics ran out.
3
Maury, a surgical
assistant, carried out research on how
essential oils helped skin elasticity and
integrity and assisted wound healing.
4
Nurses have also been involved in
aromatherapy. During the past 10
years, nurses have been using aro-
matherapy as an enhancement of
nursing care in Australia, South
Africa, Germany, Switzerland, the
UK, and, more recently, the United
States. The idea that nursing care
could be enhanced with pleasant
smells and gentle touch is not a new
one. Florence Nightingale was famous
for anointing the foreheads of her
wounded soldiers with lavender oil.
Hospitals can be frightening for
many people, and the smells of hospi-
tals can compound their fear. Chronic
slow-healing wounds can mean
repeated hospital visits. A judicious
use of essential oils can put some hos-
pitality back into our hospitals,
reduce the stress of coping for both
staff and patients, improve wound
care, and also reduce the possibility of
chronic infection.
Defining Terms
Clinical aromatherapy is the therapeu-
tic use of essential oils, the efficacy of
which is supported by research data.
In aromatherapy, essential oils are
inhaled or diluted and applied topical-
ly to the skin, depending on the symp-
tom.
Essential oils are steam distillates
obtained from aromatic plants. They
have been used for thousands of years
for a multiplicity of symptoms rang-
ing from insomnia and depression to
poor skin integrity, slow-healing
wounds, and infection. All of these
oils have a fragrance and a chemistry
that can lead to a range of responses
that affect the healing process.
A fragrance stimulates the olfactory
system. The effects of smell result in
an instant reaction. Sometimes, the
mere thought of a smell can trigger
that reaction.
5
A sense of smell plays an important
role in our survival as well as our
quality of life. Many of our actions,
both conscious and subconscious,
depend on smell. Each day we inhale
about 23,040 times and move around
438 cubic feet of air.
6
Various odors
may warn us of a fire, of the need to
eat, or of the desire to get closer to
another person. Babies find their
mothers breast through smell, and
smell is one of the last senses to fade
as we die.
6
Physiological Responses
When we inhale a scent, the chemical
components within it travel via the
nostrils to the olfactory bulb and then
to the limbic part of the brain. This is
an inner complex ring of structures
below the cerebral cortex that are
arranged into 53 regions and 35 asso-
ciated tracts, including the amygdala
and the hippocampus.
7
The amygdala
governs our emotional response to an
aroma. The memory and recognition
of smell takes place in the hippocam-
pus.
7
The hippocampus is also where
chemicals in an aroma trigger our
unique repository of learned memo-
ries.
Essential oils are lipotrophic, which
means they are fat-soluble. The princi-
pal barrier to topical drug therapy is
the keratin-rich cells in the stratum
corneum. However, these cells are
embedded in multiple lipid bilayers.
Recent research
8
has shown that
essential oils increase drug perme-
ation, thus indicating that essential
oils are themselves absorbed.
Therapeutic Use
Pleasant aromatics can raise our spirits
and address specific clinical symptoms.
A few drops of lavender can aid
insomnia
9
or help improve a persons
mood.
10
Torii et al.
11
and Bardia et
al.
12
reported on the psychologically
stimulating effect of jasmine. Manley
13
found lemon, lemongrass, peppermint,
and basil to be psychologically stimu-
lating and bergamot, chamomile, and
sandalwood to be relaxing. Other aro-
mas found to be relaxing were rose
and lavender.
14
Sweet orange essential
oil was found to be effective in both
induction of anesthesia and recovery
time in children.
15
When essential oils are used topi-
cally, they are diluted in a cold-
pressed vegetable oil, called carrier oil.
Cooking oils are not suitable because
they will have been heated to high
temperatures, which alters their chem-
ical constituents and prevents them
from being absorbed. Carrier oils,
which can be purchased from health
food stores, should be kept refrigerat-
ed and discarded when they become
rancid.
Diluted essential oils have been
used with good effect on slow-healing
ulcers or chronic skin conditions, as
summarized in Table 1. Carrier oils
suitable for wound care are shown in
Table 2.
Lifestyle and Behavior
Aromatherapy and Diabetes
Jane Buckle, PhD, MA, RN
125
Diabetes Spectrum Volume 14, Number 3, 2001
The procedure is to dilute 15
drops of essential oil in 1 teaspoon (5
ml) of carrier oil to make a 15%
dilution. Apply this dilution to sterile
gauze and pack the wound lightly.
Cover with a dressing. The carrier oils
will ensure that the dressing does not
stick to the damaged tissue. If the
dressing sticks to the tissue injury,
unnecessary debridement could occur
each time the dressing is replaced.
Essential oils also have antiseptic
qualities and will ensure that a wound
is sterile. An example is thymol,
obtained from essential oil of com-
mon thyme (Thymus vulgaris).
Thymol, discovered by Lister, was the
first antiseptic and is still being used
as such todayhence, Listerine
mouthwash.
Replace the wound dressing twice a
day. In addition to being antiseptic,
all essential oils have some antibacter-
ial activity, although some are more
antibacterial than others.
3
Because
there is a gradient of bacterial concen-
tration in chronic wounds with the
largest amount of bacteria being
found in the ulcer bed,
16
it makes
sense to lightly pack the wound so
that the diluted essential oil will be in
direct contact with the infected area.
The use of essential oils can reduce
inflammation, encourage cell regener-
ation, and eliminate infection. A great
many essential oils are effective
against Staphylococcus aureusand B-
Hemolytic streptococcustwo of the
most common wound infections. A
few essential oils, such as Palma rosa
(Cymbopogon martini),
17
rosemary
(Rosmarinus occicinalis),
18
juniper
(Juniperus communis),
19
and pepper-
mint (Mentha piperita),
20
are effective
against Pseduomanas aeruginosa. Of
these, the safest to use in wound care
would be palma rosa and juniper
because their chemical composition is
gentle. Lavender, juniper, teatree, and
peppermint are also effective against
methicillin-resistant Staphylococcus
aureusand vancomycin-resistant
Enterococcus faecium.
21
Use for People With Diabetes
Whereas there is some evidence that
the oral intake of herbs such as Asian
ginseng (Panax quinquefolius), fenu-
greek (Trigonella foenum-graecum),
and aloe (Aloe vera) may improve glu-
cose tolerance,
22
aromatherapy does
not make this claim. Also, there is no
suggestion that essential oils can cure
diabetes (type 1 or type 2). However,
essential oils can be used to reduce the
side effects of some complications
(i.e., ulcers, loss of skin integrity) and
to reduce infections that often take
longer to resolve than in nondiabetic
patients.
23
Essential oils can also ameliorate
the stress of coping with a lifelong
chronic condition such as diabetes.
24
Aromatherapy has a long history of
use for stress reduction, and aromatics
have been used in many cultures to
enhance quality of life. Nurses have
used inhaled essential oils to help
reduce their patients stress.
25
Essential
oils found to be most effective for
stress are shown in Table 3.
For many years, stress has been
linked to chronic skin problems.
Recent research
26
has shown that
stress affects epidermal permeability
barrier function and is a precipitator
of inflammatory dermatoses. This
means that anything that can alleviate
stress is likely to also have a beneficial
effect on skin integrity.
To use aromatherapy for stress, put
35 drops of an undiluted essential oil
on a handkerchief or cotton ball and
ask the patient to hold the handker-
chief to his or her nose and breath in
slowly for 5 min. This treatment can
be repeated every 4 h or more fre-
quently when necessary.
Touch has been described as the
first and most fundamental means of
communication; people who are
denied touch have been said to suffer
from skin hunger.
27
Research indicates
that many chronically ill people long
to be touched and that touch can
make pain more bearable. Perhaps for
these reasons, aromatherapy appears
to be particularly effective when dilut-
ed essential oils are used with touch,
either in the form of massage or with
the M Technique (Table 4).
Aromatherapy using touch has
been shown in several nursing studies
to reduce stress.
2729
The essential oils
listed in Table 3 are also suitable for
topical use. Dilute them to 15%
before applying topically.
Summary
Aromatherapy holds at least as much
potential for use with people who
Lifestyle and Behavior
Common Name Botanical Name Research
Lavender Lavandula angustifolia Throne
31
Frankincense Boswellia carteri Duwieja et al.
32
Sandalwood Santalum album Dwivedi et al.
33
Teatree Melaleuca aternifolia Hitchin
34
Eucalyptus Eucalyptus globulus Siang
35
Geranium Pelargonium graveolons Walsh
36
German chamomile Matricaria recutitia Glowania et al.
37
Table 1. Essential Oils for Slow-Healing Skin Conditions
Common Name Botanical Name
Sweet almond Prunus dulcis
Tamanu Collophyllum inophyllum
Evening primrose Oenothera biennis
Rosehip Rosa rubiginosa
Olive Olea europaea
Table 2. Cold-Pressed Carrier Oils
Common Name Botanical Name
Roman chamomile Chamomelum nobile
Neroli Citrus aurantium
Petitgrain Citrus amara
Lavender Lavandula angustifolia
Mandarin Citrus reticulata
Geranium Pelargonium graveolens
Rose Rosa damascena
Sweet marjoram Origanum majorana
Table 3. Essential Oils for Stress
126
Diabetes Spectrum Volume 14, Number 3, 2001
have diabetes as for use with those
who do not have diabetes. Health care
professionals can enhance their
patients lives by either obtaining
training in clinical aromatherapy
(Table 4) or referring patients to peo-
ple who have such training.
As discussed above, aromatherapy
can be beneficial either when used in
conjunction with medical treatment
(such as for wound healing) or when
used to encourage general relaxation.
The potential for even greater positive
benefits exists, for as our patients
aches, pains, and stresses are relieved,
so may their physical health be less
challenged, with resultant improve-
ments in their blood glucose levels.
Making our patients more comfort-
able, whether through the healing of
an infection, the amelioration of a
sore muscle, the lessening of neuro-
pathic pain, or the reduction of psy-
chological stress, can improve their
overall quality of life.
References
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2
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1986
Jane Buckle, PhD, MA, RN, is an
adjunct faculty member at The
College of New Rochelle, NY, and at
Bastyr University in Seattle, Wash.
She is director of R J Buckle
Associates, LLC, in Hunter, NY.
Lifestyle and Behavior
M Technique
The M Technique is a trademarked method of gentle touch that uses structured
stroking sequences in a set pattern and at a set pressure and rhythm that can easily
be used on hands, feet, and face. It is gentle enough to use on critically ill or very
fragile people and can add dignity to the dying process.
Clinical Aromatherapy Training
For information about training in clinical aromatherapy and the M Technique, con-
tact the American Holistic Nurses Association, P.O. Box 2130, 2733 E. Lakim
Drive, Suite 2, Flagstaff, AZ 86003-2130. Tel: 1-800-278-AHNA.
Table 4. Information and Resources