Beyond Aromatherapy - An Introduction to the Principles of Aromatic Medicine 

Proceedings Keynote: Ron Guba | The World of Aromatherapy IV Conference Proceedings 

Originally published September 5-8, 2002

"Coming from a University background in health sciences, Ron began his study and practice of natural therapies in the early 1970's in the USA. He has specialised in the area of Aromatic Medicine (or the more medicinal uses of essential oils in the context of herbal medicine) since the early 1980's. Emigrating to Australia in 1986, Ron studied and worked with the renowned French Aromatherapy physician, Dr. Daniel Pénöel, who lived in Australia until 1988. 

Completing his diploma in Phyto-aromathérapie in 1988 in France, Ron began Essential Therapeutics, a company devoted to providing therapeutic-quality essential oils to health practitioners and the Centre for Aromatic Medicine, to provide training in the practice of Aromatherapy. 

Ron was a founding member and past chairman of the International Federation of Aromatherapists (Australia) and a founding member and present chairman of the Australian Aromatic Medicine Association. 

Ron has lectured extensively on Aromatherapy topics throughout Australia and overseas. He presents in a lively and humorous style and has the capacity to make even quite technical subjects easily understandable."  

As someone who has been passionate about the efficacy of Aromatic Medicine for over sixteen years now, I would like to offer you all this overview regarding the practice of Aromatic Medicine and it's future. 

Firstly, what exactly is Aromatic Medicine? 

The term itself appears to have been 'coined' by the French physician, Dr. Daniel Pénöel, about ten years ago, and the name has 'stuck'.¹ In France, the practice of 'Aromatherapie' has primarily been in the domain of physicians and naturopathic practitioners. 

Aromatic Medicine is the therapeutic use of essential oils and aromatic extracts in the context of herbal medicine. In this regard, any route of administration may be utilized: oral ingestion, topical, vaginal, eye, ear, nose and throat applications, etc. An established tradition among French practitioners - medical and naturopathic - aromatic medicine tends to exploit the more physiological, dose-dependent effects of essential oils. 

Aromatic medicine is not separate from other aspects of aromatherapy practice. In this case, it is a good descriptive name that helps to describe this approach in its similarity to herbal medicine and how the two are a good 'blend' of modalities. 

Aromatic Medicine is also an appropriate name in that it helps to set apart the therapeutic use of essential oils from 'Aromatherapy', which as a name has unfortunately been exploited for all sorts of inappropriate mass-marketed consumer products. 

We do not find the use of herbs called 'Herbatherapy' or 'Nasty Tasting Alkaloid Therapy'! Aromatic Medicine and herbal medicine - or 'phyto-aromatherapie' - make a good marriage. 

Whatever we name this more herbal medicine-like approach, it can be used either as a symptomatic treatment or more truly as a holistic one - as in the use of essential oils according to traditional Chinese or Ayurvedic medicine. 

Encompassing the 'internal' use of essential oils, Aromatic Medicine has often been controversial among practitioners of 'holistic' aromatherapy as commonly practiced in English-speaking countries. However, aromatic medicine is in fact an extremely useful modality that, if properly taught, can be legally and safely practiced. 

In terms of further training, it is a logical next step for any interested aromatherapist. 

In relation to Herbal Medicine, the primary difference with Aromatic Medicine is that it utilises only aromatic extracts - essential oils derived from steam distillation and extracts from solvent extraction (notably super-critical carbon dioxide extracts). 

In France, where the use of "Aromatherapie" has been most fully employed, it has often been in the context of "phyto-aromatherapie", where herbal extracts (tinctures, spray dried extracts, etc.) are used in conjunction with essential oils.² This is an excellent 'marriage' that to date has not been utilised to any significant degree by herbal medicine practitioners, trained in either Western or Eastern medicine systems. 

The Three Aromatherapy Philosophies 

On what levels do essential oils work? Dr. Daniel Pénöel created a simple overview entitled 'the Aromatic Tryptic', which I have found useful in helping to explain the different approaches within the practice of Aromatherapy.³ 

We can say that essential oils exert their effects on three different levels: matter, energy and information. 

Consider an equilateral triangle, with three points: 

MATTER – French 

ENERGY – English 

INFORMATION – German 

Matter: This aspect relates to the physical, dose-dependent effects of essential oils. As in the context of herbal medicine and pharmaceutical drugs in general, a sufficient dose must be taken to have effects. Prime examples of this would be treating an infection or dealing with muscular complaints, such as cramps. A dose of essential oils may be prescribed for oral ingestion for the infection; a relatively high concentration (10% or more) of essential oils would be applied topically to the area of cramping for best effect. Utilising these more 'physical' effects is more in the realm of French 'Aromatic Medicine'. 

Essential oils also have an indirect physical action on the 'terrain' of the body. During the time of Louis Pasteur the argument raged between the "germ theory", which held that all disease states were due to invasion by microorganisms as compared to the theory of the "terrain" which holds that the state of the body is of paramount importance. 

Even though in the present day the germ theory still pretty much holds sway especially at the level of general medical practice which is very symptom oriented, it is also clear that the terrain is extremely important at the level of the proper functioning of our immune system. Of course this efficiency is mediated by many things including our emotional and mental states as well as a proper diet, rest, exercise etc. 

Just as there are many direct effects of essential oils we also find that essential oils as well as herbal medicine in general have a very noticeable effect on the terrain of the body. Although we could become more complicated and describe some of the French approaches to this indirect action, based on the pH (relative acidity or alkalinity) and electrical resistivity (for this you can see The Practice of Aromatherapy by Dr. Jean Valnet), it is simplest to say that essential oils have been shown in a number of studies to have immunomodulant properties. 

This means that they can either stimulate the effectiveness of the immune system or conversely, in the case of allergies and auto immune disorders, they can help reduce the hyperactivity or non-specificity of the immune system (ie the immune system doesn’t recognise itself and begins attacking various organ systems etc). 

This positive effect on the terrain of the body is quite different for example than the effect of the conventional fungal or bacterial based antibiotics which often will have a negative effect on the bodily terrain, leading to such things as fungal and yeast overgrowth. 

This ‘physical’ approach is not only for ‘symptomatic’ treatment. The same ‘energetic’ considerations as brought to herbs in Chinese medicine (where significant ‘physical’ doses of herbs are prescribed) and other traditions, can be used with essential oil therapy at this level. 

Energy: This relates most specifically to the ‘energetic’ or ‘vibrational’ qualities of essential oils. As in the case of homeopathic remedies and flower essences (in which there is basically no content of a ‘physical’ drug - only the ‘energy’ of the substance), essential oils can be used at quite low dosages to stimulate and harmonise ‘energy’ flows in the body. These ‘energy’ patterns might be the meridian system, moving Qi throughout the channels, stimulating reflex points, as on the feet, or working with the major energy plexuses, known as chakras, and on. Whether applied as part of a specific system of treatment (as in acupressure massage or shiatsu) or more generally (as part of a general massage treatment, in baths and the like), this low dose (generally less than 2.5% concentration in a ‘carrier’ base) approach has been more typical of English ‘Holistic Aromatherapy’.⁴ 

This approach is not pure ‘energy’ medicine, as in the case of homeopathy. With topical applications, a physical dose is absorbed, but the dose is generally quite small. One could not expect to primarily deal with an infection such as cystitis by applying a 2% dilution of essential oils in a massage treatment. 

Hence, the beneficial effects are primarily via a secondary action - on energy patterns and the ‘terrain’ of the body/mind. 

Information: This relates to the fragrance effects of essential oils generated via olfaction - or the sense of smell. This level of action is unique to the use of essential oils - and is part of the overall effects of essential oils on the ‘energy’ level. However, we must also take into account the physiological effects of odour, such as the hormonal influence of essential oils such as Clary Sage, acting first upon the pituitary gland and secondarily influencing the ovaries via the action of gonadotrophic hormones.⁵ 

Beyond the most obvious effects of inhaled essential oils, including that of stimulation and sedation, essential oils have been utilised specifically as ‘fragrance medicine’: “...However, the one traditional system that has made most use of the psychotherapeutic effects of fragrance is traditional Greek medicine in its Islamic phase. This is one of the three classic medical systems still used today, which is extensively practised throughout the Middle East and India. It is known in Arabic as al tibbe alyunaani and in Hindi as tibb unnani. The famous textbook of the Persian physician-alchemist Ibn Sina (Avicenna), for example, the Al qanun, contains a significant chapter entitled ‘A Treatise on the Breath’, where we read: ‘The natural breath/energy has a desire for aromaticity and is invigorated and refreshed by such’. The effect of fragrance on body and soul was empirically researched and well understood. Aromatherapy was an integral part of the medieval Islamic doctor’s training and practice. 

More specifically, between the ninth and eleventh centuries, some Persian physicians and aromatherapists, on a purely empirical basis, observed and classified the psychological effects of different natural fragrances on their patients. They wrote books documenting their findings, singlehandedly developing a holistic, energetic system of aromapharmacology. This was despite the fact that they also laid the foundations for chemistry, as we know it today, through developing distillation and other alchemical equipment. Their energetic approach to understanding and using natural fragrances is little known, but for modern aromatherapy I think it’s extremely important: it provides us with a theoretical basis as well as a recorded historical precedent for using essential oils as an energy medicine.”⁶ 

We will also see Gabriel Mojay using this ‘fragrance energetics’ approach using the tradition of traditional Chinese medicine. 

This is described as a ‘German’ approach - as some German professors (and perfume companies!) like to argue that only the fragrance effects should be called ‘Aromatherapy’. 

Obviously, the tradition is more than ‘German’ it covers all the possible aspects of ‘fragrance as medicine’. 

Each “philosophical approach” has argued for supremacy as being the “one true way” to use essential oils for therapeutic purposes. However, it can rightfully be said that all these approaches together represent the possibilities of “Aromathérapie”. 

In Australia... 

And English-speaking countries in general, it is the “English-style” 

Aromatherapy that has been taught, promoted and written about, almost to exclusion. Over the years of development of this approach, some additional “baggage” has been added (with the best of intentions), that has been repeated so many times from author to author, that such “baggage” can be often considered as “fact”. 

The “baggage” that I am referring to relates primarily to statements regarding safety concerns, safe dosage levels and methods of application. 

Absolutely erring on the side of caution is a laudable ideal. However, when such “safety” recommendations (such as concerning the use of essential oils during pregnancy, with high blood pressure conditions, etc.) are made based on exaggerated and even false information, we now can see negative results as in the case of Aromatherapy being accepted into traditional health care settings.⁷ ⁸ 

Such “safety” concerns have also been instrumental, in my personal observation, in the general perception amongst the Aromatherapy community that “Aromatic Medicine” is a “dangerous” practice that should be avoided and even suppressed. 

Concerns Regarding Aromatic Medicine... 

Following are concerns relating to the practice of Aromatic Medicine that have been voiced over the years: 

“The oral ingestion of essential oils is dangerous and likely to cause harm...” 

We must remember that essential oils have been prescribed in oral and other applications (vaginally, rectally, etc.) safely and effectively since the 1930’s in modern times, and since the 15th century in Europe. Certainly in the 20th century, safe dosages for such applications have been experimented with and accepted. This has been primarily through the work of French medical and naturopathic practitioners (as well as practitioners in Switzerland, Belgium, Germany and elsewhere). 

The key is about appropriate dosages. Essential oils are highly concentrated as in contrast to their aromatic herbs traditionally used in herbal medicine. Hence, dosages of essential oils are generally prescribed in milligrams (one ‘drop’ being approximately 25 mg), not millilitres (1mL equals approximately 900mg of essential oil) or ounces! Herbal preparations, because of their general dilution, are typically used in larger amounts. 

There have been cases of naturopathic practitioners and people “self medicating” in recent years that have used the logic that “if a small amount of an essential oil is good, a large amount must be better” that have led to toxic outcomes.⁹ ¹⁰ 

However, as in the case of almost all medicines, natural or synthetic, this logic is not true! 

Once you are trained in the use of appropriate dosages and understand the common “toxicity myths” of essential oils, one can confidently apply the principles of Aromatic Medicine. 

To give you two prime examples of how high a dose of essential oils that have been prescribed: 

· Both Australian Sandalwood (S. spicatum) and Indian Sandalwood (S. album) were commonly prescribed at dosages up to five grams (or 5,000 mg) per day for extended periods for the treatment of urinary tract infections, prior to the development of modern antibiotics.¹¹ 

· Recent ‘phase 2’ clinical trials in the US for the treatment of advanced breast and colon cancers utilized up to ten grams per day of pure d-limonene. Limonene is the major constituent of essential oils derived from the rind of many Citrus species.¹² 

It should be noted with the two examples above is that with Sandalwood oil or Citrus oils rich in limonene, is that the compounds they contain have no specific toxicity in the body. Some essential oil compounds, such as camphor (as in Rosemary camphor-type), 1,8 cineole (as in many Eucalyptus species) and thuyones (as in Sage - Salvia officinalis) do have a specific toxicity and much lower doses than those mentioned above would be prescribed. 

“Only medical doctors can prescribe essential oils internally...” 

In France, medical practitioners (generally studying complementary therapies after medical school) prescribe the bulk of essential oil preparations. Naturopaths, such as Nelly Grosjean¹³ do so as well, but naturopaths and the like are not formally recognized in France. “Aromatherapists”, as in English-speaking countries, are not to be found. 

Consider the United States. Can only medical practitioners offer herbal preparations? Homeopathic remedies? Nutritional supplements? Obviously, this is not the case, and this applies to Aromatic Medicine as well. 

Complementary therapists are not allowed by law to prescribe for ‘prescribed’ conditions, such as serious acute infectious illnesses. This does not prevent them, however, from utilizing Aromatic Medicine for a wide variety of common ailments, as well as ‘complementing’ allopathic medical treatment regimes. 

In English-speaking countries, there are very few doctors that have anything to do with Aromatic Medicine. They would be up against legal problems the same as anyone else, should they try to withhold ‘proper, conventional treatment’ for any serious illness and prescribe complementary therapies - and the patient is further damaged or dies. It would be malpractice. 

You won’t find any legal statutes in the USA, Australia, etc. that specifically allow physicians to ‘prescribe essential oils’. 

The most appropriate way to introduce aromatic medicine will be the introduction of training standards to bring complementary therapists to a level of knowledge and recognition, so that it will be enmeshed within the practice of herbal medicine. 

“Using essential oils internally is illegal...” 

Taking the prohibition regarding the treatment of ‘prescribed’ conditions into account, the ingested use of essential oils is not illegal. When the Therapeutic Goods Act was introduced in Australia, Herbal Oils (that is, essential oils) were included under the heading of “herbal medicine”. There is no specific prohibition to using essential oils in ingested preparations that I can see, in either the US or Canada. 

In fact a licensed medical practitioner would be in a dilemma, should they refuse the patient the conventional emergency care required for serious illnesses in deference to complementary therapies, and the patient expired... 

Recognized training in the applications of Aromatic Medicine is the key, however, to the acceptance of therapists by the TGA (Therapeutic Goods Administration) to offer such preparations to clients and to be able to receive more in-depth information regarding the therapeutic uses of essential oils than the ‘lay public’. 

The United States has it’s own unique requirements. We can say, however, that if essential oils are used with discrimination and without too much promotional / marketing ‘hype’ (which the US appears to be a world leader in!), we would not expect the FDA to be concerned. This is presently the case with the cornucopia of herbal supplements, nutritional supplements, etc. on offer to the public today. 

To this end, the Australian Aromatic Medicine Association is working to complete training standards for Aromatic Medicine in 2002. Such training will include the prerequisites of basic health sciences (as in herbal medicine and naturopathy) such as extended anatomy and physiology, pathophysiology, basic chemistry (inorganic, organic and biochemistry), botany and on, in addition to the training in Aromatic Medicine. 

Full insurance coverage has already been offered to such practitioners qualified in Aromatic Medicine here in Australia. 

The Benefits of Aromatic Medicine... 

The low-dose, more “energetic” applications of Holistic Aromatherapy can be efficacious for many common conditions. However, it should be considered when it is most effective to use higher dosages for topical use (above 2.5%) and ‘ingested’ applications. 

As examples: 

· Gastrointestinal complaints — such as nausea and diarrhoea. In cases such as this, oral ingestion is the most effective method of application. 

· Infectious illnesses — such as cystitis, vaginitis (‘thrush’) due to Candida albicans and topical infections, such as Herpes simplex ‘cold sores’. Cystitis is best treated by the oral ingestion and ‘high-dose’ (10% concentration and above) topical application of essential oils. “Thrush” is best treated by vaginal preparations, along with oral ingestion, if needed. Herpes simplex infections are best dealt with ‘high-dose’ topical applications. 

· Muscular and joint problems — such as muscular pain and cramping, and rheumatoid arthritis. ‘High-dose’ topical applications will be the most effective. 

This is but a short list of the treatment possibilities using Aromatic Medicine principles. Combined with other complementary approaches, Aromatic Medicine is a powerful therapeutic tool. 

How do I learn to practice Aromatic Medicine? 

The establishment of real training standards is the key. The Australian Aromatic Medicine Association has vowed to complete a training package this year (2002). We look forward to working with other interested parties in completing this task and to see if the possibility of internationally accepted standards can be accomplished. 

To begin with, those who are Aromatherapy practitioners will generally need to upgrade their training in basic health sciences. As with herbal medicine and naturopathic training requirements, prerequisites in basic chemistry, anatomy & physiology, nutrition and pathophysiology will be required. 

Other subjects will be included as part of the Aromatic Medicine training. 

For complementary therapists such as medical herbalists and naturopaths, these prerequisites and more will have been done. They would approach Aromatic Medicine as a form of post graduate training. 

In summary, I find it unfortunate that the concepts of Aromatic Medicine have all too often been labeled as ‘controversial’ and ‘it can’t be done’. I have personally practiced Aromatic Medicine as a major part of my therapy practice for over sixteen years, and I continue to be impressed with its’ safety and efficacy. 

I do hope that any ‘philosophical’ arguments that have been brought up over the years can be inspected and gone beyond. Aromatic Medicine is a real and ‘doable’ approach that deserves an enlightened and discriminative embrace for the good of all. 

I warmly invite all those who have the desire to be involved in this modality to make yourselves known! Your involvement will be happily received and there is much work to be done... 

References 

1. Pénöel, D., editor (1998) Integrated Aromatic Medicine Proceedings from the First International Symposium Essential Science Press USA  

2. Belaiche, P., (1979) Traite de Phytotherapie et d’Aromathérapie — tomes 1, 2 & 3 Maloine SA editeur France  

3. Pénöel, D., (1998) Natural Home Health Care Using Essential Oils Editions Osmobiose France pp 25-28  

4. Guba, R. (2000) Toxicity Myths — the Actual Risks of Essential Oil Use International Journal of Aromatherapy Vol 10 Nos. 1/2 p 39

5. Ibid. pp 42-43

6. Holmes, P. The Energetics of Western Herbs Artemis Press USA

7. Young, J. (1998) Complementary Therapies in Nursing Care Presented at Austrailian Holistic Nurses Conference in Sydney Austrailia. 

8. Tisserand, R. (1999) Editorial Comment International Journal of Aromatherapy Vol 9 No 3 p3

9. Webb, N. and Pitt, R. (1993) Eucalyptus Oil Poisoning in Childhood: 41 cases in SE Queensland Journal of Pediatrics and Child Health Austrailia pp 368-371

10. Tisserand, R. and Balacs, T. (1995) Essential Oil Safety Churchill Livingstone, UK p 68

11. Penfold, A. (1937) Australasian Journal of Pharmacology 18 pg 154

12. Vigushin, DM et all 1998 Phase 1 and pharmacokinetic study of d-limonene in patients with advanced cancer Cancer Chemother Pharmacol 42: 111-117

13. Grosjean, N. (1993) Aromatherapy from Provence CW Daniel Co. UK pp 23-25

 

Ron Guba 
Essential Therapeutics 
www.essentialtherapeutics.com.au