Eri WatanabeKyoto Prefectural University of Medicine

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Our Research and Practice of Aromatherapy in Japan

• The essential oil is obtained through plant's scent and flavor.

• Essential oil can be absorbed by human body, and it can have impact to our body, heart, and soul. It can relieve various symptoms.

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Aromatherapy

• Essential oil is often used in aromatherapy, which is a form of alternative medicine.

• Essential oil is obtained from various plants which have strong scent

3Rose Lavender Peppermint Orange Cypress

Aromatherapy

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Aromatherapy

Medical Aromatherapy • Aromatherapy is used in clinical circumstances in France• Essential oil is a type of prescription • Essential oil is on sale in the pharmacy • Medical school offers the courses of “Aromatherapy”

• Both essential oil and medicine are used in clinical circumstances in France

• Contagious diseases and wounds (replace antibiotics)• Relieve pain and itching• Hypnotics · Antidepressant • Hormone

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How is essential oil absorbed through our bodies?

③Oil

②Water6

①Air

①Air

• Drop it on the tissue to inhale • Drop it on the sanitary mask to inhale• Spray in the air • Use essential oil diffuser to diffuse in the

air

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• Essential oil can fight against influenza virus, and various bacteria

• To prevent nursing home’s influenza • Be careful with the concentration and selection of the

essential oil in order to feel comfortable

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②Water• Pour the essential oil into the bathing tub, half tub,

or foot tub• Pour the essential oil into hot water or water, use

the towel to apply hot packing

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Foot tube

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• Medical effect• Hot water improves

the circulation of blood

• Relax• Improve the quality of

sleep• Relieve pain, swelling,

and itching of leg joint

• For long-term bedridden • Add drops of essential oil into the tub, soak the

towel, for body wiping or compressing• Sterilizing and anti-inflammatory for skin• Nerve sedation • Relax the body• Relieve pain• “Hot compressing” joint pain・nerve pain ・

sprain• “Ice compressing” bruise・swelling・

inflammation 11

Body wiping and Compressing

③Oil• Apply oil (base oil) on the skin after

diluting with the water• Aromatherapy treatment

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• Apply the diluted oil on the skin directly,

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• Most ingredients of the essential oil are absorbed by the skin

• Since essential oil can be dissolved in fat, it can be absorbed by the cutaneous plexus in the subcutaneous fat

• Sometimes we use massage and other techniques, they have stronger effect

The Average Life Expectancy of Japanese

14Life period increased from 50 years to over 80 years.

1947 2015

The Average Life Expectancy of Japanese

•Currently, Japan is in the stage of increased aging population

15

5.0%

24.1%

39.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

1950年 2012年 2060年

Over ages 65％

The demand of long-term caring is increasing in Japan • People who need nursing care under nursing-

care system in 2010• Age 65 – 74 3％• Over age 75 21％The main reason for nursing care• Ulcer disease 21.5％• Dementia 15.3％• Elderly weakness 13.7％• Joint disease 10.9％ 16

• Does Aromatherapy really work?• Specific Symptoms • Dementia• Bedsores• Immune Deficiency • Sleeping Disorder/depression• Lumbago/arthralgia• Decline in sensory function • Aromatherapy is good at alleviating the

symptoms comprehensively17

Not only a single symptom, but several symptoms

→Overdose of medicine

Aromatherapy for bedridden people

• Under the condition of bedridden• Blood circulation deterioration →• Bedsores • Immune deficiency • Joint stiff/swelling/pain

• hard to excrete / bath→• It is difficult to keep body clean →

infection18

Cleansing for bedridden person• Using essential oil that has the function of

degermation when cleaning the body.• It can keep body clean.Example• Tea tree oil 2 drops ( degermation/ deodorization)• Cypress oil 2 drops ( degermation / deodorization)• Lemongrass oil 1 drop ( degermation /

deodorization)＋relaxing effect

• Pour hot water and essential oil into washbowl (50-300ml) and use wet towel...etc. to dry off body. 19

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Within the facilitie that is a place of group living:• Immune deficiency due to aging• Various fungi and virus is easy to spread→Infection may become life-threatening

Indoor air deodorization and disinfection • Grapefruit 2 drops ( degermation/ deodorization)• Rosemary 2 drops ( degermation/ deodorization)

• Spray in the space • Use a diffuser

• In addition to the prevention of infectious diseases• The odor of bedsore, body odor and bowel

smell…etc. can be suppressed during nursing care.• Degermation of facilities, bedding…etc.• Effectiveness to refresh your mood.

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If you are bedridden for a long time,The blood circulation of the body‘s bottom part will deteriorate, and it will cause necrosis of surrounding tissues.

Bedsore (pressure ulcer)(Wound and necrosis of bedridden people )

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At present, there is no way to prevent pressure ulcers besides the changing of physical location and disinfection in the affected areas.

Hind Brain

Elbow Sacrum 踝骨部Ankle

Ear ShellShoulder

FemurJoint

內踝部LateralMalleolus

Oracle Bone

Rib CageGut

Supine

Side

Prevent / improve bedsore (pressure ulcers )• Dilute essential oil with base oil and apply it to the

skin• Myrrh (preservative) 2 drops• Pure lavender ( to sterilize and to calm the

inflammation) 1 drop• Tea tree (sterilization) 1 drop• Almond oil 20ml

• To rub into the ulcers of the surrounding skin and the areas that is likely to cause.

• Ointment, poultice, spray 24

Dementia • People with dementia usually have crazy circadian rhythms and

most of them have insomnia.• Use wake-up effects oil in the morning• Sweet orange ( to improve blood flow and wake you up) 2 drops• Rosemary (Wake up by tangy smell) 1 Drop• Palmarosa (To get your brain in gear) 1 Drop

• Use asleep effects oil in the evening • Pure lavender ( to make you fall asleep and calm down ) 2 drops

• Sandalwood ( To get relaxation) 1 drop

• Lemon (Nerve sedation ) 1 drop

25Full body and limbs massage (sweet almond oil 20ml), bath

Melancholia• Elderly people get stressful easily, and the incidence of

depression is high.

• For depression, use essential oils to improve blood flow and rejuvenate your body and mind.

• Rosemary ( to increase blood flow and activate sympathetic nerves) 2 drops

• Sweet orange ( to improve blood flow, refresh feeling) 2 drops• Lemongrass ( refresh feeling) 1 drop

• Mix these essential oils with 20ml almond oil and apply it to the whole body. Full bath, foot bath, and aromatic bath are also available.

• Essential oil with sedative effect (lavender, etc.)

→Do not use for depression 26

Aromatherapy Research

The psychological stress relieving effect of bergamot essential oil

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【Purpose】• Bergamot oil• （Citrus aurantium var.bergamia）

• It is used to eliminate psychological stress and anxiety, but scientific evidence is lacking.

• Main Ingredient：Limonene (to improve blood flow), Linalool, linalyl acetate (sedation effect)

• The purpose of this research is to confirm theendocrine effects and the effects of physiology and psychology when the subjects inhaled the mist with bergamot essential oil.

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【Subject】• Subject consisted of 42 healthy adult

women (Average age is 21.3 ± 1.02, 20-23 years old)

• I fully explained the research content and agreed to take the test in written form.

• I conducted it with the approval of the Medical Ethics Review Committee of Kyoto Prefectural University.

• Tested using a random crossover design.29

【Method】• Set the following three conditions, each of them

was about 15 minutes.• R condition: Do nothing• RM condition: Spray distilled water 80ml• RMB condition: spray distilled water 80ml plus

bergamot essential oil 0.4ml

UltrasonicDiffuser

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Rest

15 min

Rest

(R)

Questio

nnaire10 m

in

Rest

10 min

RestSteam

(RM)Q

uestionnaire

10 min

Rest

10 min

RestSteam

Oil(RMB)

Questio

nnaire 10 min

Rest

10 min

Collect saliva

Procedure of the test

Heart rate changesRandom sequence

Collect saliva

Collect saliva

15 min 15 min 15 min(R) (R) (R) (R)(Q) (Q) (Q)

【Measurement item】• Heart rate variability：• Parasympathetic nervous system index High Frequency

（HF）Frequency Domain Analysis of the Salivary Stress-Related Hormone Cortisol Enzyme-Linked Immunosorbent Assay Questionnaire by Fast Fourier Transform

• Saliva：• Mental stress related hormone cortisol• Enzyme-linked immunosorbent assay (ELISA)• Questionnaire• POMS (emotion), Degree of fatigue • Compare measurement items of 3 conditions (R, RM, RMB)

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0

0.05

0.1

0.15

0.2

R RM RMB

saliv

ary

cort

isol

（μg

/dl) ****

Stress Hormone

n=42, mean±S.E. Bonferroni, p<0.001***, p<0.010**, p<0.050*※ R:Rest M:Mist B: Bergamot odor

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-200

-150

-100

-50

0

50

100

150

A) rest B) rest+D C) rest+D+aroma0

100

200

300

400

500

600

700

A) rest B) rest+DC) rest+D+aroma

HF (m

s2 )

R RM RMB R RM RMB

The changes of HF before and after the present of condition.

*** *

*

n=42, mean±S.E. Bonferroni, p<0.001***, p<0.010**, p<0.050*

Parasympathetic nervous system

※ R:Rest M:Mist B: Bergamot odor34

The average of HF after 10 minutes rest which is after the present of condition.

0

5

10

15

T-A D A-H V F C

POM

S (m

oo

d s

core

)

*

n=42, mean±S.E. Bonferroni, p<0.001***, p<0.010**, p<0.050*

R RM RMB

*

*

Tension/anxiety Depression Anger Vitality Fatigue Disorder

Emotion※ R:Rest M:Mist B: Bergamot odor

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0

5

10

15

body mind body+mind

Fatig

ue (s

core

)

*

R RM RMB

n=42, mean±S.E. Bonferroni, p<0.001***, p<0.010**, p<0.050*

Fatigue

Physical fatigue Mental fatigue36

【Consideration】• When inhaling steam containing bergamot

essential oil,

• Decreased cortisol• Parasympathetic innervation• Improve mood

• It shows that the psychological stress could be alleviated.

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Conclusion•Aromatherapy, a complementary alternative medicine, might be useful in a variety of situationssuch as dementia, nursing care andpalliative care.

• In the future, the research would be progressive and it is alsoexpected to be used in the medical sites and the nursing care sites.

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Examples of using Aromatherapy in thegeriatric health services facility.

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Case 1- using aromatherapy in the geriatric health services facilityFoot bath10 minutes each time, weeklyHot water is 10cm under the kneeThe temperature of the hot water is based on 40 ℃, ± 3 ℃if needed.• Lavender ( linalool, decyl acetate: sedative) 2 drops• Tea tree ( Pantene: antibacterial, sedation)• Sandalwood ( linyl alcohol: sedation )• Grapefruit ( limonene, blood flow promotion)• Add essential oils into the basin between 14:00 and 16:00 daily.• → To Improve blood circulation of the lower extremities to reduce

edema and dry skin.The elderly people actually feel relaxed. 40

1 drop,if needed

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Improve symptoms through foot bath

Improves cold, bruise, red spots, dry skin

• Dilute essential oil with base oil and apply it into the skin

• Leg treatment for 30 minutes (once a month)• Essential oil is ① or ②• ①sweet orange + pure lavender (during sleep )②lemongrass + tea tree ( after wake up )

• Add sweet almond oil 10ml ① or ②• Add 0.05ml (1 drop) of the two essential oils and

mix together, the concentration is set to Use for legs

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Case 2

• Meanwhile, drop citrus series essential oil such as lemon or sweet orange ( to promote circulation)

• 0.05ml (1 drop) on the cotton pad,• Place on the resident's shoulder and chest

for an aromatic bath.Feedbacks from the residents in 3 months • “The leg movements have improved” • “It’s easier to stand up from my

wheelchair?”• “I was fast asleep slept on the day of

aromatherapy” 43

Fragrance bath (1)• Elderly patient of dementia with Alzheimer's disease• Morning: Rosemary ( refreshment effect)

Lemon ( to promote circulation, strong)Evening: Lavender (sedative effect, sleepy effect)

Sweet orange ( to promote circulation)• They smelled the aroma of essential oils

with a diffuser→ Observed the improvements of cognitive function and life rhythm.

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Case 3

Fragrance bath (2)• The uses from the dementia special care unit• It’s hard to stay focused and often leave seats or fall asleep.• When taking deep breaths or doing rehabilitation exercises

like gymnastics.，• To use diffuser to spread the aroma of essential oil in the

rehabilitation room• Put the essential oil on the gauze pad.• →To use diffuser to spread the aroma of essential oil in the

rehabilitation room.• Rosemary, lemon, mint ( wake up, concentrate)• →combine• To continue for 6 weeks.• The moment that the patients leave seats or fall asleep easily

could be reduced. 45

Fragrance bath (3)• Sweet orange ( to promote circulation) 1 drop• Start to use the diffuser ( unheated ) to spread

it into the air just 10 minutes before sleeping.Impacts on the residents• Can feel things that are interesting or feel

joyful• can be relaxed• feel relief• improve sleeping• Anxiety is relieved before sleeping

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Precautions when using essential oils for the elderly and those in need of nursing care

• Choose 100% organic, physiotherapy grade essential oils• High concentration of essential oils may cause burns and

should be used with care.• Essential oils have strong physiological effects and should be

used with care.• Using from low concentration, and to test and observe the

physical conditions and appearances of the users.• Stop using aromatherapy immediately in case of skin redness,

itching, dyspnea, coughing, nausea, and other symptoms.• Please note that there are different taboo essential oils

according to different kings of diseases.• Users should notice that sometimes the kidney function of the

elderly becomes weak and may not be able to break down in the body and exhaust extra essential oil components. 47

Reference

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Various essential oil can be obtained from one kind of plantFor instance, there are 3 kinds of essential oils are obtained from bitter orange

Bitter orange oil

Neroli

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d-limonene (93%)Petit Grain

Fruit Leaf

Flower

Linalyl acetate (48%)Linalool (28%)Terpineol (6%)

Linalool (37%)β-pinene (11%)Limonene (11%)Linalyl acetate (7%)trans-β-ocimen(7%)

What is essential oil? • The ingredient of the scent of a plant is

concentrated to the factor of ten times to thousand times

• The scent of the essential oil is stronger than the scent of the plant

• Ex,It requires 40kg of flower to obtain 10ml of rose essential oil.

• Essential oil has strong effects on body50

True Lavender• Lamiaceae, Low evergreen• Strong antimicrobial effects。• It used to prevent “plague” in Europe during

the middle Age • Ingredients：• Linalool, Linalyl acetate• Strong sedative effect• To calm emotion• Fix insomnia 51

★Commonly used essential oil

Grapefruit• A fruit from subtropical citrus tree• Essential oil can be obtained from its peel• Its ingredient has over 90% of d-limonene• d-limonene is from the peel of citrus genus

(orange, lemon)• Improve blood circulation• Inhabit cells of cancer to increase• To calm and have nerve sedation• Improve the function of liver and kidney 52

Peppermint• Lamiaceae Perennial plant• Country of origin: Europe. Scent of cooling

and chilly • Main ingredient: Menthol, Menthone• Relieve pain• Relieve itching • Cooling• Improve the function of body and heart• Brain refreshing • Antimicrobial 53

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Dropper（to adjust the amount）1 drop appox. 0.05ml

On sale in this type of container

Shading bottle

Steam Distillation

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• Through the steam below to separate the ingredient and essential oil

• Cool the steam, use the water to transform it back to the liquid• Collect the essential oil on the upper layer

※The most common method

Steam andEssential oil

IngredientPlant

Cooler

Essential oil

Steam

Water

FireFloral Water)

56Steam Distillation

Expression• Expression is a method to obtain

essential oil from the citrus peel• Orange, grapefruit, lemon,

tangerine, bergamot, yuzu,et• Use machinery or hands to squeeze • Avoid heating the oil, and it can

obtain the pure natural ingredient• However, the catabolic enzyme has

the residues. Therefore, the obtained essential oil is easy to oxidize. 57

• 5ml/10ml • Label on the bottle

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Name

Scientific Name

Content

Origin, Location, Expiration

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Ingredient Percentage

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（1）Nose

（3）Skin（2）Liver

Essential oil is sent to the brain, and it affects the whole body

panorama

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（１）Nose→Olfactory Nerve →Brain

The message of the scent is sent to thebrain directly

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Olfactory Receptor

Olfactory Nerve

Scent Message

Message, Taste area

The message of the scent is sent to the area which controls emotion and memory

Emotion(Amygdala）Memory（Seahorse）

Scent※The pathway for mesaage of visual and

auditory and others are indirect

Detect scent

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The Limbic System

Hippocampus

海馬旁迴

乳頭體

胼胝體

Fornix

Cingulate gyrus

Amygdala

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（２）Inhale from nose andmouth→liver→blood circulation

Essential Oil

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（３）Skin→Blood circulation （apply on skin）

Ingredient & Brain

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Automatic Nervous System, Endocrine System(adjust hormone), Immune systemLimbic System

Hypothalamus

Brain cutaway sideScent message

Pituitary gland

Brain stem

Spinal cord

Cerebellum

Thalamus

memory·instinct

emotion

Cerebral Neocortex

•Aromatic bath•Drop the oil on the tissue, and put it on the bed or in the bedroom

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• Drop the oil on the sanitary mask, peppermint

• By the function of menthol, it can help with nausea and motion sicknessEucalyptus/Rosemary

• Ingredient1、8-Cineole forlaryngeal mucus r

• Sterilization/anti-inflammatory• Treat cough• Prevent cold and pollen allergy 68

• Dissolve essential oil in the ethanol, dilute with the water, fill into the spray to use

• Spray on beddings• Indoor use, for relax, insect repellent, dust

repellent(cupressus/cedarwood)• Sterilization and deodorization

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• A machinery which can make essential oil molecule diffuse into the air

• Ultrasonic Diffuser• Making water fog to diffuse • No need to heat (safe and the oil

won’t have chemical change)• It‘s easy to have chemical change

after combining with the water • Exchange water daily 70

• Ingredient can be absorbed through breathing

•Essential oil is absorbed throughskin while bathing

•Foot bath/half bath are suggested

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• Use base oil apply the diluted oil on the skin

• The function of the diluted oil works after applying it on the skin

• No smell (almost)• Ex, Jojoba, sweet almond, olive, grape seeds, et• Essential oil skin osmosis • Use professional base essential oil

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• Apply the oil on the skin to promote absorption • Essential oil is from the diluted 1％ to 5％ (3% less

for facial use)of the base oil • The concentration should be less than 1% of the

diluted oil for children and elder• Use more than 1% of the diluted oil for body use• The function of the essential oil uses on the body is

more efficient than uses in the bathing tub• Be cautious with the body while doing

aromatherapy

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