http://www.levensboom.com/heerlijk.htm
Special aromatic extracts meet special needs in patients in palliative and end of life care
© Madeleine Knapp Hayes-Wellhüner
In The Netherlands aromatherapy in hospitals and home care, in nursing homes and hospices is
widely known as “aromacare”. Dutch physicians are apprehensive about the word “therapy”,
because it would imply treatments with the purpose to cure, rather than care. The word
aromacare, which I already used as far back as 2001 is more and more used to express what we as
nurses do with complementary interventions: to care, rather than treat.
In my 20 years of working with natural medicine and aromatherapy, I have seen and experienced
the power of aromatic plants and their extracts to the fullest. In this booklet I will introduce some of
the most special extracts to you. But let me first tell you a little bit about myself.
Nursing
In the late1970’s I started my training to become a nurse. Being from a family of care givers with
both my mum and sister being nurses and dad being in health insurance, the step was logical and I
was very excited to become a good nurse and take care of the sick, old and dying. I soon found
out that all nurses of my year would be laid off, due to cutbacks in health care.
The most important reason however to leave the profession was that I found it hard not to care for
the whole person in a more holistic approach. Although I had learnt from my mother and sister that
nursing was not all I hoped it would be, having to see patients as diseases rather than persons with
physical, emotional and spiritual needs really did me in, so to speak.
I left the hospital and got a job as a pharmacist, mainly to earn a living, but I kept looking around
to see how I could put my passion for holistic medicine into practice. Finally, in 1992 I visited the
Black Sea Coast, where I met an equally passionate physician who worked at a natural health
clinic. People from all over Europe went there to be treated for rheumatic diseases, lung problems
and other complaints such as exhaustion. This great woman stimulated me into studying herbalism,
aromatherapy, hydrotherapy and other effective interventions, such as electrotherapy, working
with mud, minerals and other substances to serve as complementary care techniques. I enrolled
into courses and master classes. I met inspiring people and spent six rewarding and memorable
years there, before returning to The Netherlands.
A few years later, I completed an additional study at the Kneipp School in Bad Wörishofen,
Germany, the only school that is accredited by the Kneipp Association. I qualified as a
hydrotherapist and learned even more about the possibilities of working with water as
complementary intervention, called aquacare.
Quality of living & quality of dying
When I returned to The Netherlands, I started a practice and followed in-depth classes on nutrition
to be able to advise patients to the fullest on the right nutrition, complemented by supplements,
aromatic treatments, massage and hydrotherapy. In my practice I met many patients with serious
illnesses such as cancer, who came to seek additional advice and treatment, whilst being treated
by the hospital for their illness. I found it immensely rewarding to see how much stronger and
empowered these patients became in their struggle to beat their cancer, or to improve their
quality of life with cancer. I also found that my holistic treatments, addressing physical, emotional
and spiritual needs – just as I dreamed of doing for all those years – not only greatly enhanced
quality of life, but also the quality of dying for patients and their families.
As a complementary therapist with a nursing background, it was a logical step to start advising
and training home care, hospital, nursing home and hospice staff, who were greatly inspired by
the results that were booked with patients in their care. To make a long story short: In the last 20
years I slowly but surely built up De Levensboom as a school for complementary therapies and train
health care workers how to work with aromacare, massage, aquacare, relaxation, guided
visualisation, etc.
I am accredited by the Dutch Board of Nursing. This has been an important achievement because
it not only meant that the board considered the quality of my school and its programs as being of
the high standards they had set, it also meant that complementary care techniques were
considered valuable by the board. In The Netherlands we are still in the early stages of accepting
complementary techniques into main stream medicine and care.
After meeting Ian Brealey in 2010 he honoured me by asking me to join the teaching team of the
Shirley Price Academy. I am the chair person of the Knowledge Institute of Complementary Care,
a body where health care staff can exchange expertise and best practices. I am also a member
of the board of the FAROMA Foundation which promotes professional aromatherapy and – care in
The Netherlands.
I advise and train staff in home care, hospitals and nursing homes, hospices and palliative care
units. I give lectures and advice, write articles and organise conferences on complementary care.
I am specialised in complementary care for the elderly, people with special needs such as
Huntington’s disease, Korsakov, cancer and in palliative and end of life care. I also love teaching
on skin care and child care.
I work with conventional essential oils, but have also become quite a specialist on the use of CO2
extracts. I would like to introduce you to CO2 extracts and some of the great effects that they
have, or have had, on patients with cancer, in palliative and in end of life care.
Mr. & Mrs. Janssen
A few months ago I was in the Hospice Laurens Cadenza in Rotterdam, a big teaching hospice
with 20 beds. Although it is a modern building and the biggest hospice in The Netherlands, there is
a good and homely atmosphere.
That day I was there to teach nurses and volunteers. They had been taught basic complementary
care techniques by me in the months before and were about to have an in-depth one day
seminar about complementary care on the subject of anxiety, depression and sleeplessness.
I usually arrived at the hospice some time before any seminar would start so I could answer any
questions the staff might have. The head nurse told me about an elderly couple, let’s call them Mr.
and Mrs. Janssen. Mrs. Janssen had been admitted a couple of weeks earlier, suffering from bowel
cancer. Her life expectancy at the time of my visit was approximately one week. Mrs. Janssen also
suffered from dementia, which left her confused and unable to express her fears, pains and
worries. Although the staff tried everything to make her feel as comfortable as possible, she
remained restless, disorientated and confused.
They were both in their late 80’s and spent day and night together. They had been married for over
50 years and it was very difficult for him to let her go. Mr. Janssen hardly left the room, afraid that
his wife would pass when he wasn’t around, or would become even more unsettled when she
sensed his absence. He was very distraught about his wife. It was extremely hard for him to see her
deteriorate in this way. After all the years that they had been together, he could not face living
without her.
The sleepless nights were difficult for both of them. Mrs. Janssen was very restless and hardly slept
at all. As a consequence, Mr. Janssen did not get any sleep either.
Nurse Ellen and I decided to choose a blend of essential oils to diffuse in the room to make the
couple more comfortable. Mandarin was chosen for its positive effect on anxiety and sleeplessness
and for its friendly sunny smell that brings sunshine in your heart and which would also appeal to
Mrs. Janssen’s inner child. Lavender “Fine” from the Haute Provence was chosen, because the
couple both loved lavender. This special type contains high amounts of linalyl acetate and linalool,
being one of the most calming en soothing lavenders of all.
Furthermore frankincense CO2 extract was chosen for its unique scent and it’s relatively high
contents of incensole acetate. This extract from the pure white Boswellia carterii resin from Somalia
is by far the greatest of all if you ask me. It is said that frankincense helps you to look beyond
earthly matters and to let go of grief and old pains without having to go through all the motions
again, something that this couple was not able to do anymore. Frankincense is also one of the oils
that can bring a deep sense of calm and rest, especially to confused and restless patients. It also
helps to deepen and calm patients breathing patterns, contributing even stronger to the sedative
effect.
Mr. Janssen was quite overwhelmed that we thought of such a personal blend. He also reminisced
with tears in his eyes that his wife had loved the scent of frankincense from fond memories of going
to church. This particular pure frankincense reminded him strongly of days gone by. He simply
loved the combination of the three oils. His wife could not respond verbally when we offered her
the blend but she showed in no uncertain ways how it made her feel. To make a long story short,
this lovely couple found a sense of peace and slept like babies during the last three days of Mrs.
Janssen’s life.
The thing that made the biggest impression on me was that we not only achieved to bring peace
and calm to both Mr. and Mrs. Janssen, but more so that we managed to turn around Mr.
Janssen’s memory of his wife’s passing. Mr. Janssen was deeply thankful that his wife was able to
come to rest and die in peace. That made the hardest thing he ever had to do just a little bit
easier: letting go and retaining only the best memories of his beloved wife until the time came for
him to join her.
Photo
Super Critical CO2 extraction.
So what is it that makes CO2 extracts so special?
CO2 extracts, also known as supercritical CO2 extracts, are extremely pure plant extracts that are
very similar to the original plant material. CO2 extracts are increasingly used in the flavoring and
herbal medicine industries, as well as in perfumery and aromatherapy. Using CO2 extracts in
aromatherapy requires extensive knowledge of medicinal plants, their active components and the
way they influence body, mind and spirit. Sometimes the extracts contain substances still unknown
in aromatherapy, simply because the extraction method was not available in aromatherapy when
most books were written. The first person (to my knowledge) who wrote about CO2 extracts –
ginger - was Eliane Zimmerman, who inspired me greatly with her book for health professionals. In
The Netherlands I was the first one to use CO2 extracts on a large and professional scale in
complementary aromacare. I work with at least 30 extracts, of which most are used the same way
one would use essential oils, where others are used as base oils.
Here is how it works:
Essential oils have traditionally been derived by steam or hydro distillation, or extracted using
chemical solvents such as hexane, toluene or ethanol.
CO2 extraction uses pressurised carbon dioxide that is pumped into a vessel filled with plant
matter. When carbon dioxide is subjected to a pressure of 73 bar it becomes "supercritical" and
has liquid properties while remaining in a gaseous state. Because of these liquid properties, carbon
dioxide starts behaving like a solvent, extracting essential oils and other substances such as
pigments and resins from the plant material. By altering the amount of pressure, more or less
substances are extracted. The temperature involved in the supercritical extraction process is only
around 31°C. By lifting the pressure after extraction, the carbon dioxide will turn into gas again and
the extract remains, with no residue whatsoever. This process ensures that the different substances
are unchanged.
There are two kinds of CO2 extracts:
CO2 select and CO2 total
CO2 select. The result of this method can be compared to steam or hydro distillation. A lower
pressure is used to extract mainly volatile CO2 soluble components. This often results in oils that are
in many ways superior to distilled essential oils.
CO2 totals. Here, a higher pressure is used. This extract will contain all CO2 soluble components,
such as waxes, resins, pigments, fatty acids, etc. The end result resembles a concrete, with as
biggest advantage the absence of solvents residues. These Totals are almost identical to the plant
they are derived from. They in turn are soluble in essential oils or in vegetable plant oils. Some need
gentle warming to approximately 30°C to become fluid before adding them to any base product.
Pure plant
The scent of these extracts is as pure as the plant material itself. There is an almost unlimited
potential to use CO2 extracts in psycho-aromatherapy.
In The Netherlands, especially in end of life care, guided visualisation is utilised as a pleasant
complementary technique that helps patients to unwind and to “go places” that bring fond
memories or a sense of peace. Smelling the scent of blue chamomile CO2 extract instantly brings
one to a chamomile field, and the extract of ginger wets your appetite for an Indian curry straight
away. Many patients, especially those with cognitive issues respond extremely well to the pure
scents of cinnamon bark, star anise, vanilla or frankincense.
Pure medicine
CO2 extracts are pure, stable and completely free of chemical solvents such as hexane, pesticides
or other unwanted substances. Production is environmentally friendly and nowadays very safe.
The medicinal properties are extensive and the extracts can be very effective. Generally speaking
CO2 extracts are richer and more intense, because more components of the plant material are
present in the end product. Even small percentages (0.5-1%) can be extremely effective as
additions to massage oil, creams, ointments or essential oil blends. It is vital however that
indications, contra-indications, possible side effects and interactions with medication or other
substances are carefully considered, just like we would do with conventional essential oils. Once
you have gained enough knowledge about the different components and their possible uses and
limitations in medicine, you will find that they can give great results and be cost-effective at the
same time.
A very good example is marigold (Calendula officinalis). In my garden I grow marigolds for
maceration. I macerate the flowers in sweet almond oil or in jojoba for different purposes. In many
the skin care products I prepare on request for use in health care facilities I use marigold.
Since I discovered how extremely valuable the CO2 extract of marigold is, I add a certain
percentage to the macerate, the exact amount depending on its use in my end product. We
know that marigold flowers are rich in faradiol esters. The higher the percentage is, the higher the
anti-inflammatory potential, especially on sensitive and damaged skin. The marigold CO2 extract
contains 27.5% faradiol esters, as well as carotenes and over 3% of essential oil.
It is easy to prepare your own standardized calendula oil, by adding any percentage of the CO2
extract to any base carrier oil, thus creating a specialised product. Mix with tamanu for psoriasis,
rosehip for burns, evening primrose CO2 extract for eczema, sea buckthorn CO2 extract for burns
and wounds, as well as for damaged mucous membranes, or avocado oil for ultra dry skin.
Photo
Differences between distilled essential oils and CO2 extracts
CO2 extracts can be quite different from essential oils.
So can they be used in the same manner as essential oils? Sometimes they can, sometimes they
can not.
One of the differences, influencing the end product is the extraction temperature. As we all know
the heat of hot steam will alter some of the components in essential oils. Whether this is an
advantage or not depends on the plant material in question. Extraction by carbon dioxide is done
at low temperatures, approximately 31°C, whereas steam distillation involves hot steam at 100°C.
This fact can also have a great impact on the end product, most dramatically shown by the
difference between the distilled oil of blue chamomile and its CO2 extract.
I was very excited when I looked closer at the analysis of this great extract with its pure scent of
chamomile fields. It made me realize that what I had always believed about the way the
sesquiterpene chamazulene was formed should be looked at in a different light. From the analysis
it emerges that the CO2 extract contains quite high amounts of chamazulene, well over 6%. In
addition the extract also contains matricine, the precursor of chamazulene. This apparently means
that at least part of the matricine is already turned into chamazulene at low temperatures.
The CO2 extract looks different from distilled oil, is very viscous and needs to be gently warmed in a
warm water bath of up to 30°C to make it easier to mix into any blend. It has a yellowish brown
colour, whereas the distilled oil is distinctly blue, the color that one would expect from any good
blue chamomile oil.
According to some sources matricine has greater potential as an anti-inflammatory constituent
than chamazulene, but there is no consensus on this matter. Using the CO2 extract will give both,
and I feel that the two enhance each other greatly.
This extract has proved to be one of the best natural ingredients for any blend for eczema,
neurodermitis and other inflammatory skin diseases, psoriasis and dry, flaky and itchy skin.
Photo
Philip
Father Philip was a retired priest, who died a few months ago at the age of 90. He suffered from
several ailments, as older people often do. This devoted servant of the Lord and I had known each
other for almost 50 years. He baptised me when I was a baby, and ever since we kept in touch,
sometimes more frequently than others. He lived in a monastery for retired priests. Although life
wasn’t bad, he felt very alone in his last years and was often depressed and disheartened. He
actually looked forward to moving on and to be with his Lord.
In the last year of his life I took more time out to help him combat his depression and many
ailments. Because I lived quite far away, I asked my good friend Ina, also a palliative care nurse, to
look in on him regularly. She one day reported that Philip suffered from an itching skin, which drove
him crazy, especially at night.
When I visited him, Philip confirmed that he could hardly sleep because of the agonising itch. His
skin was extremely dry and flaky at places. The air in the home was also very dry because of the
central air conditioning system. This could not be altered.
Ina and I also noticed that Philip took many kinds of medication and probably suffered from some
side effects of polypharmacy. Unfortunately Philips GP was unwilling to reassess the situation, but
we did get permission to use an alternative to the cream that was being used up till then, which
contained high amounts of paraffin and other mineral substances.
I made up a moisturising cream and added base oils such as evening primrose and borage CO2
extracts, as well as aloe vera and wheat germ CO2 extract. The added essential oil blend
contained essential oils of everlasting, spearmint, lavender “fine” and the CO2 extract of blue
chamomile. In just two days all of the itching had gone and in less than a week, Philip’s skin
dramatically improved in feel and condition. This made his quality of life so much better! He was in
a better mood, enjoyed himself when friends came to visit and he was generally less depressed
and lethargic.
One morning at the end of June, my dear old friend and confidant gently moved on, passing
away peacefully in his sleep.
Another difference between distilled oils and CO2 extracts is that CO2 extraction uses almost
exclusively dried plant material. These differences are shown clearly when we look at the essential
oil and the CO2 extract of melissa (Melissa officinalis). Both extracts have a very different smell,
chemical composition and different potential in medicinal use.
Melissa, especially the oil of the citral chemotype, contains high amounts of citral (up to 70%). The
CO2 extract contains much less citral, just 41%. Is it less valuable therefore? No, not at all, it is just
different and has different properties!
This extract contains more of the antispasmodic and immune modulating caryophyllene (over 21%)
and caryophyllene oxide (23%) than the essential oil. The scent is earthy, warm and kind. A
wonderful smelling addition to any soothing blend that helps to wrap your body, mind and soul in a
warm blanket in times of deep sadness and sorrow. I add this exclusive extract to blends in end of
life care. In contrast my equally exclusive English essential oil is added to blends for nausea around
chemotherapy and lip balms for the treatment of cold sores.
Photo
CO2 extracts contain components with a greater molecular weight. Take ginger for example. In
the CO2 extract 6-gingerol and a fair amount of shogoal is found. These components are not
present in the distilled ginger oil, because they are too heavy to travel upwards with the hot steam.
6-gingerol has powerful pain relieving and antispasmodic properties, making this extract very
valuable in colon massages. I have seen great results in patients who are treated with ginger CO2
extract for opiate induced constipation. Gingeroles and shogoal are quite pungent substances
however. This requires taking great care in using this extract on the skin. I use solutions with 0.25-1%
of ginger CO2 extract in sesame oil for colon massage, the dosage strictly depending on skin
sensitivity. When massage is not possible, I advise to rub the mixture lightly onto the abdomen,
followed by applying a warm compress.
Ginger CO2 extract is also very effective in blends for aching joints and muscles. One of my blends
for these kinds of pains contains a powerful combination of ginger and bay CO2 extracts, sweet
marjoram, lemongrass and geranium. Base oils are tamanu and sweet almond oil.
Ginger CO2 extract has proven to be effective in blends for nausea.
Photo
Henk
Henk used to be a high ranking naval officer. He is 56 years of age, happily married and has two
daughters of 20 and 24. Just after his retirement of Her Majesty’s Royal Navy, he was diagnosed
with bowl cancer. He never suffered any real symptoms until it was too late to have any treatment.
Any complaints he dismissed as being part of the limitations and stress of life in the Navy.
Henk has been admitted to a high care hospice in the capital of The Netherlands, due to his
complex medical situation.
On an emotional level Henk is very distressed. He devoted his whole life to the safety of his country,
had almost no chance to see his girls grow up, and spent far too little time with his beloved wife.
There is virtually nothing left of the stocky figure that once stood proudly on his ship. Although the
emotional pain of having to say goodbye to his loved ones is very difficult for him to deal with,
Henk is fortunate enough to hardly suffer any physical pain. The medication he is on works well,
which leaves Henk and his family some quality time together. Henk does suffer from nausea
however, due to the tumor pressing against structures in his abdomen that in turn upset his
stomach. Medication is not very effective, due to the suddenness of every onset.
Henk has one big wish. He wants to go to the seaside and take a last good look at the sea he
spent most of his life on, surrounded by his loved ones. The “Ambulance Wish” Foundation is called,
the day planned and carefully prepared. Henk is given an Arominhaler® by the nurses, filled with a
special essential oil blend, which should help him through the day without nausea. In this blend I
mixed ginger CO2 extract, lavender “fine”, spearmint and lemon. Henk uses the inhaler every time
he feels the onset of a nausea attack. The vapours quickly calm his stomach, and Henk and his
family can fully enjoy their hours at the seaside. Henk now always has his Arominhaler® at hand,
which greatly improves his quality of life.
Photo?
Some CO2 extracts are not soluble in alcohol or fat. Most of them are soluble in oil. Chemically this
is due to the difference in polarity. CO2 gas has a different polarity than hexane or toluene which
makes some components difficult to mix. Quite a few CO2 extracts are very viscous and need to
be warmed in a warm water bath before adding them to any base product. This is the case with
extracts of blue chamomile, as we discussed before, but also with sea buckthorn.
Sea buckthorn deliveres two different extracts, a viscous fluid extract from seed, as well as an even
more viscous extract from the fruits. Both extracts contain high amounts of fatty acids, but in
different compositions. The seed extract contains mainly linoleic acid (omega-6), alpha-linolenic
acid (omega-3), oleic acid and relatively limited amounts of palmitic acid.
Sea buckthorn seed extract is extremely valuable for wound and burn healing. Studies have shown
that the oil is significantly more powerful in promoting circulation in and around burns than
dexpanthenol-bepanthene. Other studies confirmed the significant wound healing properties in
patients with diabetes when the oil was blended with aloe vera and curcuma extract*, as well as
in treating wounds on the skin of rats.
The seed extract is also an important analgesic and anti-inflammatory addition to any blend for
pain and inflammation, especially for the skin. Used as a food supplement the oil helps the
recuperation of the muscles after exercise and in rehabilitation.
In caring for cancer patients the extract is the best choice in promoting the healing process after
radiation therapy. I mix it on a base cream in a 2-3% solution, together with quite high levels of
lavender CO2 extract and the essential oil of niaouli.
The sea buckthorn fruit extract, in comparisson, contains rather low levels of linoleic acid and
alpha-linolenic acid, but high amounts of palmitic acid. The extract contains also high levels of
omega-7 fatty acids, such as palmitoleic acid (almost 40%) and vaccenic acid (over 5%).
The presence of some 45% omega-7 fatty acids makes sea buckthorn fruit extract the best extract
to help protect and heal damaged mucous membranes in the whole of the digestive tract.
Foto
Ineke
Ineke, a farmer’s wife of 45 years old, has been diagnosed with breast cancer. She receives
treatment on an outpatient basis and has come in to receive her 5th course of chemotherapy after
having a tumor removed from her left breast. Besides suffering from hair loss and fatigue, Ineke
suffers badly from oral mucositis.
Mucositis can occur anywhere along the digestive tract from the mouth to the anus. Oral Mucositis
is probably the most common, debilitating complication of cancer surgery, chemotherapy and
radiation. It occurs in 20-40% of patients treated with chemotherapy alone and up to 50% of
patients receiving combination radiation and chemotherapy. Drugs such as doxorubicin,
paclitaxel, and capecitabine are commonly used in breast cancer and frequently associated with
oral and GI mucositis.
Chemotherapy can affect the ability of cells to reproduce, slowing the healing process of the oral
mucosa. Patients with damaged oral mucosa and reduced immunity are prone to opportunistic
mouth infections. Unfortunately, Ineke does not respond to medication for nausea as well as
everybody hoped. Due to nausea and vomiting, as well as the pain in her mouth, maintaining
adequate nutrition is a real challenge for Ineke. She has lost quite a lot of weight in the last few
months. The treatment is very exhausting and the constant fatigue leaves her unable to exercise or
enjoy walks outdoors.
Ineke has been told that reducing medical treatment may prevent side effects, but may also
reduce her chances to combat her illness. The protocol for oral mucositis is strictly followed, but
Ineke does not seem to respond very well. One of the nurses, just being back from my
comprehensive course in complementary aromacare for cancer, knows I prepare special blends
for oral mucositis and other problems with infections of the mouth.
The base of the blend consists of fresh aloe vera gel (as opposed to factory made) and the CO2
extract of sea buckthorn fruit. Essential oils of everlasting, lemongrass, spearmint and both distilled
oil and the CO2 extract of blue chamomile are added, all with their own properties to enhance
the effect of the base and give an acceptable and fresh taste.
Although Ineke’s perception of smell and taste is altered, she quickly gets used to the taste of the
product, called MucoCare®. The gel forms an almost undetectable film on the mucous
membrane that allows all ingredients to do their job and protects the mucous membrane, as well
as moisturising the dry mouth.
Through her nurse, I advise Ineke to try aromatherapy for her nausea and also take the CO2
extract of sea buckthorn fruit to help protect and heal the lining of the GI tract. The extract can be
added to juices, yoghurt or any other liquid or semi-liquid form of nutrition.
Both the gel and the intake of sea buckthorn fruit extract help Ineke through her treatment. Ineke
uses the Arominhaler® with ginger CO2 extract, spearmint and lavender for her nausea. Her food
intake increases, she feels less fatigued and generally stronger. She is also more optimistic about
the future.
I sincerely hope that Ineke will fully recover.
I also hope that I have been able to show you some great new ways of working with some of
Mother Nature’s greatest gifts to help improve the quality of life in patients with cancer, in palliative
and end of life care.
If you have any questions, you can find me through madeleine@levensboom.com.
Kind regards,
Madeleine Knapp Hayes-Wellhüner.
References:
Effect of aromatherapy on patients with Alzheimer s disease. Jimbo D, Kimura Y, Taniguchi M, Inoue M, Urakami
K. Psychogeriatrics. 2009 Dec;9(4):173-9
The effect of lavender aromatherapy on cognitive function, emotion, and aggressive behavior of elderly with
dementia. Lee SY. Taehan Kanho Hakhoe Chi. 2005 Apr;35(2):303-12
Stimulative and sedative effects of essential oils upon inhalation in mice. Lim WC, Seo JM, Lee CI, Pyo HB, Lee
BC. Arch Pharm Res. 2005 Jul;28(7):770-4
Medicinal plants for insomnia: a review of their pharmacology, efficacy and tolerability. Wheatley D. J
Psychopharmacol. 2005 Jul;19(4):414-21
The influence of odorants on respiratory patterns in sleep. Arzi A, Sela L, Green A, Givaty G, Dagan Y, Sobel N.
Chem Senses. 2010 Jan;35(1):31-40. Epub 2009 Nov 16
Effects of aroma hand massage on pain and state anxiety and depression in hospice patients with terminal
cancer. Chang SY, Taehan Kanho Hakhoe Chi. 2008
A randomized controlled trial of aromatherapy massage in a hospice setting. Soden et al, Palliat Med. 2004
Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an
increased sense of well-being. Louis M, Kowalski SD. Am J Hosp Palliat Care. 2002 Nov-Dec;19(6):381-6
Aromacare with special extracts in Dutch palliative care, M. Knapp Hayes-Wellhüner, Aromatherapy Times, 12-
14, aug 2011.
Effect of German chamomile oil application on alleviating atopic dermatitis-like immune alterations in mice.
Lee SH, Heo Y, Kim YC. J Vet Sci. 2010 Mar;11(1):35-41
Management of oral mucositis during local radiation and systemic chemotherapy: a study of 98 patients. J
Prosthet Dent. 1991 Carl W, Emrich LS. Sep;66(3):361-9
An integrative approach to eczema (atopic dermatitis). Holist Nurs Pract. 2003 Jan-Feb;17(1):56-62. Ross SM.
What's new in atopic eczema? An analysis of the clinical significance of systematic reviews on atopic eczema
published in 2006 and 2007. Clin Exp Dermatol. 2008; Treatment of childhood eczema. Granlund H, Paediatr
Drugs. 2002
The effect of the volatile oil from ginger rhizomes (Zingiber officinale), its fractions and isolated compounds on
the 5-HT3 receptor complex and the serotoninergic system of the rat ileum. Riyazi A et al, Planta Med. 2007
Apr;73(4):355-62;
Aromatherapie für Pflege- und Heilberufe (2006) by Eliane Zimmermann;
Standardized ginger (Zingiber officinale) extract reduces bacterial load and suppresses acute and chronic
inflammation in Mongolian gerbils infected with cagA + Helicobacter pylori. Kristen Gaus et al 2009;
Efficacy of ginger for nausea and vomiting A systematic review of randomized clinical trials. Ernst E, Pittler MH, Br
J Anaesth. 2000 Mar;84(3):367-71.
Hippophae rhamnoides L. and dexpanthenol-bepanthene on blood flow after experimental skin burns in rats
using 133Xe clearance technique. Seven B et al, Hell J Nucl Med. 2009;
A poly-herbal formulation accelerates normal and impaired diabetic wound healing. Gupta A, Wound Repair
Regen. 2008
Influence of sea buckthorn (Hippophae rhamnoides L.) flavone on dermal wound healing in rats. Gupta et al,
Mol Cell Biochem. 2006
Liposomes encapsulating Aloe vera leaf gel extract significantly enhance proliferation and collagen synthesis in
human skin cell lines. J Oleo Sci. 2009;58(12):643-50. Takahashi M, Kitamoto D, Asikin Y, Takara K, Wada K.
Final report on the safety assessment of Aloe Barbadensis Leaf, Aloe Barbadensis Leaf Extract, Aloe Barbadensis
Leaf Juice,aloe Barbadensis Leaf Polysaccharides, Aloe Barbadensis Leaf Water; AloeAndongensis Extract,
Aloe Andongensis Leaf Juice,aloe Arborescens Leaf Extract, Aloe Arborescens Leaf Juice, Aloe Arborescens
Leaf Protoplasts, Aloe Barbadensis Flower Extract, Aloe Ferox Leaf Extract, Aloe Ferox Leaf Juice, and Aloe Ferox
Leaf Juice Extract. Int J Toxicol. 2007;26 Suppl 2:1-50. Cosmetic Ingredient Review Expert Panel.
Antibacterial Activities of Crude Extract of Aloe barbadensis to Clinically Isolated Bacterial Pathogens. Appl
Biochem Biotechnol. 2009 Mar 5. [Epub ahead of print] Pandey R, Mishra A.
Composition and applications of Aloe vera leaf gel, Review. Molecules. 2008 Aug 8;13(8):1599-616.
Hamman JH.
Effects of Helichrysum italicum extract on growth and enzymatic activity of Staphylococcus aureus. Nostro et
al. Int J Antimicrob Agents. 2001 Jun;17(6):517-20
Anti-inflammatory and antioxidant properties of Helichrysum italicum. J Pharm Pharmacol. 2002 Mar;54(3):365-
71. Sala A, Recio M, Giner RM, Máñez S, Tournier H, Schinella G, Ríos JL.
Flavones from Helichrysi flos syn. Zhongguo Zhong Yao Za Zhi. 2009 Jun;34(11):1381-3.
Anxiolytic effect of aromatherapy massage in patients with breast cancer. Imanishi et al. Evid Based
Complement Alternat Med. 2009 Mar;6(1):123-8. Epub 2007 Jul 4
Helichrysum italicum extract interferes with the production of enterotoxins by Staphylococcus aureus. Lett Appl
Microbiol. 2002;35(3):181-4. Nostro A, Cannatelli MA, Musolino AD, Procopio F, Alonzo V.
Antiradical activity of hydrolyzed and non-hydrolyzed extracts from Helichrysi inflorescentia and its phenolic
contents. Z Naturforsch C. 2004 May-Jun;59(5-6):363-7. Sroka Z, Kuta I, Cisowski W, Dryś A.
In vitro activity of the essential oil of Cymbopogon citratus and its major component (citral) on Leishmania
amazonensis. Parasitol Res. 2009 Nov;105(6):1489-96. Epub 2009 Aug 11. Santin MR, Dos Santos AO.
Toxicity and gastric tolerance of essential oils from Cymbopogon citratus, Ocimum gratissimum and Ocimum
basilicum in Wistar rats. Food Chem Toxicol. 2008 Jul;46(7):2493-7. Epub 2008 Apr 13. Fandohan P, Gnonlonfin B,
Laleye A, Gbenou JD, Darboux R, Moudachirou M.
Antinociceptive effect of the essential oil from Cymbopogon citratus in mice. J Ethnopharmacol. 2000
Jun;70(3):323-7. Viana GS, Vale TG, Pinho RS, Matos FJ.
Effect of myrcene on nociception in mice. J Pharm Pharmacol. 1990 Dec;42(12):877-8. Rao VS, Menezes AM,
Viana GS.
Effectiveness of Cymbopogon citratus L. essential oil to inhibit the growth of some filamentous fungi and yeasts.
J Med Food. 2009 Feb;12(1):193-7. Irkin R, Korukluoglu M.
Anti-Candida albicans activity of essential oils including Lemongrass (Cymbopogon citratus) oil and its
component, citral. Nippon Ishinkin Gakkai Zasshi. 2003;44(4):285-91. Abe S, Sato Y, Inoue S, Ishibashi H,
Maruyama N, Takizawa T, Oshima H, Yamaguchi H. Teikyo.
Fungitoxicity of essential oils against dermatophytes. Mycoses. 1993 May-Jun;36(5-6):211-5. Kishore N, Mishra AK,
Chansouria JP
The effect of Mentha spicata and Eucalyptus camaldulensis essential oils on dental biofilm. Int J Dent Hyg. 2009
Aug;7(3):196-203. Rasooli I, Shayegh S, Astaneh S.
Chemical composition of essential oils of Thymus and Mentha species and their antifungal activities. Molecules.
2009 Jan 7;14(1):238-49. Soković MD, Vukojević J, Marin PD, Brkić DD, Vajs V, van Griensven LJ.
Comparison of essential oils from three plants for enhancement of antimicrobial activity of nitrofurantoin
against enterobacteria. Chemotherapy. 2007;53(1):21-5. Epub 2006 Dec 28. Rafii F, Shahverdi AR.
Inhibition by the essential oils of peppermint and spearmint of the growth of pathogenic bacteria.
Microbios. 2001;106 Suppl 1:31-9. Imai H, Osawa K, Yasuda H, Hamashima H, Arai T, Sasatsu M.
Antinociceptive activity of (-)-carvone: evidence of association with decreased peripheral nerve excitability.
Biol Pharm Bull. 2008 May;31(5):1017-20. Gonçalves JC, Oliveira Fde S, Benedito RB, de Sousa DP, de Almeida
RN, de Araújo DA.
Mentha L. species (Lamiaceae) as promising sources of bioactive secondary metabolites. Curr Pharm Des.
2008;14(29):3141-50. Mimica-Dukic N, Bozin B.
