4 (Part I) Traditional use, modern research
Different approaches to the healing of people have always existed and today they are generally viewed as being complementary and supplementary to each other rather than alternative or antagonistic. The use of essential oils as part of traditional plant-based medicine has led to the accumulation of a large body of empirical knowledge about their effectiveness in different conditions. This chapter looks at their therapeutic properties, and shows where modern science confirms traditional usage.
The predominant contemporary approach is that of allopathic medicine, where illness is regarded as being due to an outside agent. Throughout the ages this concept has been looked upon in various ways and illness attributed to ‘evil spirits’, ‘ill will’ or ‘microbes’, and nowadays to ‘bacteria’ and ‘viruses’. The aim has always been to target and exterminate this outside agent, freeing the body from attack.
This focusing on the causative agent has brought about an enormous increase in the knowledge of the separate bodily systems, resulting in specialization, and it is left to the general practitioner to preserve an overview of the whole person.
For many decades now medicine and pharmacy have focused on analysis and simplification, as evidenced in the production of medicines, mostly composed of a single well-defined molecule whose structure and therapeutic action are well understood. This style of analysis and simplification is the heritage of Descartes, who said that to know the body better it was necessary to divide it into its constituent parts.
An aromatherapist looks at the whole person to ascertain the cause of the illness, and the treatment that follows aims to strengthen the body’s natural defence system to cope with attacks by pathogens. The weakness is then considered in relation to the body as a whole and studied in the context of the living environment, then the aromatherapist chooses the essential oils for healing.
I had seen the miracles of modern medicine in Intensive Care; in daily practice it was not the same. Sick people fell ill again; sick people suffered side effects; new sicknesses appeared when I treated them with chemical medicines. But what struck me most of all was the complete absence of the human dimension.
A century ago many medicines were based on plants and plant extracts because of their easy availability: in a rural environment people could gather plants and process their own medicines – necessary because money was scarce, there was little state assistance and private health insurance was practically unknown. Dr Jean-Claude Lapraz made this observation (quoted in Griggs 1997).
When I was a boy my grandfather had a farm in the country, and I noticed that everybody used plants: they drank them in infusions, they made an oil to treat burns – Oh yes, plants worked, I saw that clearly. But later, in all the years I spent in medical school, nobody ever mentioned plants. Not a single one.
After the Second World War, orthodox medicine took advantage of developments in science and technology, resulting in a shift from natural medicines to rapidly acting drugs. At this time state medicine was introduced in some Western European countries (including the UK), to the great benefit of individuals and society. This wonderful step forward struck a near-mortal blow to folk/plant medicine because, with the availability of free treatment, the knowledge of centuries was discarded, or at best put to one side. People were no longer content with plants which were slow both to prepare and to heal. They had great expectations of the new synthetic drugs, which appeared then to produce immediate and startling results without any real effort on the part of the sufferer.
In the 1960s and 1970s there was a resurgence of caring for the ecological balance of nature, the use of natural as opposed to synthetic products, and the eating of organically grown foods. This new outlook also encompassed the field of medicine, and as a result many alternative (as they were viewed then) approaches to healing took root and flourished. These are now known as parallel or complementary approaches, where much attention is paid to a holistic style of treatment.
Plant remedies are popular for small problems (such as headaches) which are too insignificant to warrant visiting a doctor, as well as for chronic complaints, which by definition are not susceptible to orthodox treatment. People are prepared to try alternative procedures at their own expense for ‘must learn to live with it’ conditions. The most popular and successful aromatherapy treatments are, in the editors’ experience, for stress and chronic conditions such as arthritis and rheumatism.
Studies suggest that about half of the adult population in industrialized countries use complementary/alternative treatments to ward off or treat a wide variety of health problems. Should doctors bother with this strange aromatherapy? It is understandable that ‘unproven’ complementary treatments and medicaments are viewed with a certain amount of caution. The editors hope that this book will convince doubters that there is something of substance to be looked into, something which can be used alongside orthodox treatments. The attitude of health professionals to alternative and complementary therapies is changing for the better, and over the years the intrinsically safe practice of aromatherapy has grown and is finding acceptance in many hospital departments today, as shown by the surveys quoted below.
1986 Although most general practitioners knew little about the techniques of complementary medicine (CAM), a majority found that they had been useful to their patients. Most had referred patients for this type of treatment during the previous year even though they felt that complementary practitioners needed statutory regulation (Wharton & Lewith 1986).
1994 A survey of Israeli doctors found that 60% of all physicians had made referrals to CAM practitioners at least once (Borkan et al. 1994). A survey of UK doctors revealed that 93% of all general practitioners (GPs) and 70% of hospital doctors had suggested a referral to alternative treatment at least once; 20% of GPs and 12% of house doctors practised an alternative therapy (Perkin, Pearcy & Fraser 1994), and Fisher & Ward (1994) reported that harmonization of training and regulation in Europe was an urgent requirement for the immediate future.
1995 A review of 12 surveys of doctors found that 46% considered CAM to be effective, but noted that young doctors were significantly more in favour than were older doctors (Ernst, Resch & White 1995) [the experience of the editors also]. In Canada 73% of doctors surveyed wanted to know more about the major CAM; they believed that these therapies were most needed for chronic conditions and musculoskeletal disorders (Verhoef & Sutherland 1995b). Many GPs believed that alternative medicine had ideas and methods from which conventional medicine could benefit (Verhoef & Sutherland 1995a), and in a questionnaire 73% of physicians felt that they should have some knowledge of the most important alternative treatments (Verhoef & Sutherland 1995b). In a survey of USA doctors over 70% indicated that they would like to learn more about CAM (Berman et al. 1995).
1998 A comprehensive review suggested that large numbers of physicians either refer to or practise some of the well-known forms of CAM, and that many believed the therapies to be both useful and efficacious (Astin et al. 1998).
1999 The situation in Japan lags behind Europe and North America: the majority of Japanese doctors practise kampo (Chinese herbal medicine) but only 8% practise other forms of CAM, among which is aromatherapy (Imanishi et al. 1999).
2003 An increasing number of GPs were practising CAM to treat their NHS patients. Analysis revealed that GP therapists identified positive clinical gains associated with their direct integrative practice, e.g. successfully treating conditions for which conventional medicine proved ineffective, and providing safer techniques in medical cases where the practitioner suspected or anticipated potential side effects from conventional treatments. The positive gains experienced should not be ignored by those considering the future provision and practice of CAM within the general practice environment (Adams 2003).
2005 More than 70% of the developing world population still depended on the CAM systems of medicine. Evidence-based CAM therapies have shown remarkable success in healing acute as well as chronic diseases. Alternative therapies have been used by people in Pakistan as the first choice for many problems, and Shaikh and Hatcher (2005) concluded that a positive interaction between CAM and the orthodox systems had to be harnessed to work for the common goal of improving the health of the people.
2006 In New Zealand 300 general practitioners completed a questionnaire which revealed that 20% practised a form of CAM (most commonly acupuncture), 95% referred patients to CAM (most commonly chiropractic), 32% had had formal training, 29% were self-educated in one or more CAM therapies, and 67% felt that an overview of CAM should be included in conventional medical education. Some CAM therapies are on the border of acceptance by the medical profession, whereas others that have little evidence behind them are still viewed with much scepticism (Poynton et al. 2006).
2007 Although there has been a marked increase in the use of CAM in the UK in recent years, many doctors believe that CAM lacks scientific evidence, and such perceptions may remain a significant barrier to greater integration of CAM within the NHS (Maha & Shaw 2007). In France, medical doctors prescribe essential oils for internal use in capsules, diluted in alcohol or in suppositories and pessaries, as well as externally in dressings, inhalations, ointments and in foot, hand or whole body baths; massage is not used, although topical application in low dilution (40% or more) is used occasionally. The original concept of aromatherapy in England was to use the essential oils highly diluted (0.5–2%) in a fixed vegetable oil in massage only; this unfortunately led to the belief that that is all there is to it, and the editors have been active in trying to correct this image. UK training now includes inhalation, baths, compresses, and in some schools intensive and internal use (including pessaries, suppositories, gargles, capsules) is taught on aromatology courses. Essential oil therapy has now been introduced into many hospitals, hospices and clinics, and many GPs respect their patients’ decision to use CAM while encouraging them to continue with standard treatment; in most cases the doctor–patient relationship is not affected. Health professionals need to take a greater interest in essential oils and use their skills with these active agents to their fullest capabilities. The editors have tried to address the question of proof with regard to aromatherapy, although it is still as much tradition as science.
These are predominantly synthetic (but may include isolated natural components) and are used mostly symptomatically. Unwanted side effects (iatrogenic disease) are always present to some degree, which may necessitate further medication. Antidepressants (e.g. fluoxetine) can cause side effects including nausea, vomiting and diarrhoea, and this may be the reason for the continued use of tricyclic drugs (e.g. dothiepin hydrochloride) despite the risks shown by research. The clinical testing of drugs is rigorous but carried out over a comparatively short timescale compared with traditional plant usage, and are usually available only on prescription; less powerful drugs and tablets are available over the counter.
Side effects not only come from the drug itself but are due also to additives such as colouring. Pollock et al. (1989) carried out a survey of 2204 orthodox drugs and found 419 different additives present in 930 formulations; these additives may cause a variety of reactions in some people, e.g. nettle rash, watery eyes and nose, blurred vision, oedema, bronchoconstriction (Bowker undated), hypersensitivity reactions and photo allergy (Lawrence 1987). Nothing is added to essential oils.