臺灣博碩士論文加值系統

大葉蝴蝶蘭是培育香味蝴蝶蘭重要的親本之一，它的花香主要成份為單萜類的 芳樟醇以及香葉醇。在逐漸受到重視的替代醫學領域中，薰衣草的芳香療法已應用在放鬆和緩解情緒焦慮等症狀。本研究為探討大葉蝴蝶蘭精油對腦部功能與情緒改變的影響，進行臨床人體試驗。首先四十名健康受試者隨機分成兩組，在性別組成、年齡分佈、教育年數、婚姻狀態、心跳血壓、身體質量指數兩組之間背景皆相近，經過 精神科醫師評估確認沒有罹患生理、心理或神經性疾病，受試者分別吸入大葉蝴蝶蘭精油或作為對照組的芳樟醇。本試驗使用三種情緒量表探討不同芳香療法對於情緒 改變的影響，包括心率變異性分析以評估芳香療法調節自主神經系統的潛力，並以 威斯康辛卡片分類測試和司楚卜實驗評估芳香療法對於前額葉皮質活化的程度。 實驗結果顯示大葉蝴蝶蘭精油組的受試者對於情緒量表疼痛、抑鬱的感受顯著降低，對於平靜、愉快的感受顯著提升。分析自主神經系統功能的心率變異性，兩組受試者呈現交感神經活性下降、副交感神經活性上升的趨勢，顯示以大葉蝴蝶蘭精油或 芳樟醇進行芳香療法皆具有幫助受試者放鬆的潛力。在評估前額葉功能表現的威斯 康辛卡片分類測驗中，兩組受試者持續性錯誤的表現有顯著下降，表示在管理認知、情緒、行為調節的前額葉功能受到提升。此外，在評估認知功能靈活性的司楚卜 測驗中，兩組受試者完成測驗所需的總時間顯著下降，和芳香療法前測驗相比反應也較為快速。在分析芳香療法與認知功能對心率變異性的交互作用和相關性中，發現 大葉蝴蝶蘭精油與認知功能提升的程度對血壓具有交互作用並呈現正相關性。並以 線性回歸分析觀察到認知功能提升能力受限部分的原因乃與受試者血壓偏高有關。 總結本篇研究首次將大葉蝴蝶蘭精油應用於臨床人體試驗上，發現大葉蝴蝶蘭精油 具有調節情緒的效果，並能提升前額葉認知功能，可作為替代醫學領域另一選擇。

Phalaenopsis bellina is an important breeding parent for scented Phalaenopsis cultivars. The major scented components of P. bellina are monoterpenes, including linalool, geraniol, and their derivatives. Recently, many evidences have shown that lavender aromatherapy could bring anxiolytic and relaxation effects, therefore complementary and alternative medicine has been considered to be an important research issue. Here, we investigated the effects of P. bellina essential oil on brain functions and emotional changes. This study was a clinical human trail by recruiting forty healthy subjects that were separated into two groups randomly. The characterizations of individuals participating in the study were similar, including gender, age, education years, marital status, blood pressure, heartbeat, and BMI. The subjects were evaluated by an experienced psychiatrist prior to the test, and showed that they are without any physiological, psychological or neurological problems. The treatment of linalool odorant alone was deemed as the control group, while the essential oil extracted from P. bellina floral scent was the experimental group. We performed three questionnaires to evaluate the emotional changes for subjects undertaken these two aromatherapies. Heart rate variability (HRV) was evaluated for the autonomic nervous system activity modulated by aromatherapy. Both Wisconsin card sorting test and Stroop tests were applied to assess the performance of cognitive functions. We found that the essential oil of P. bellina could significantly decreased the feeling of pain, reduced the degree of depression, and brought the positive emotional status for the subjects. P. bellina essential oil also could regulate the parasympathetic activity. As for cognitive performance, the subjects’ prefrontal cortex function was enhanced by the P. bellina essential oil inhalation and improved the ability of problem-solving, error-monitoring, and strategy-shifting. Furthermore, we analyzed the interactions of aromatherapy and cognitive performance with HRV indexes. Those subjects inhaled P. bellina essential oil produced lower cognitive enhancement was significantly correlated to high-normal blood pressure. Taken together, our results showed that the P. bellina floral scent could affect emotional modulation and cognitive improvement. These findings are the first report for orchid floral scent and can be served as another choice for complementary and alternative medicine.

TABLE OF CONTENTS

中文摘要 ......................................................................................................... I
ABSTRACT ................................................................................................... III
致謝 ............................................................................................................... V
TABLE OF CONTENTS .............................................................................. VI
LIST OF TABLE ........................................................................................... IX
LIST OF FIGURE ........................................................................................... X
LIST OF APPENDIX FIGURE ..................................................................... XI
ABBREVIATIONS ...................................................................................... XII
1. BACKGROUND ........................................................................................01
1.1 Phalaenopsis orchids .....................................................................01
1.1.1 The distribution of Phalaenopsis orchids .......................................01
1.1.2 Phalaenopsis orchids in Taiwan .....................................................01
1.2 The floral scent of Phalaenopsis bellina ................................................02
1.3 Terpenoids .............................................................................................02
1.3.1 Structure and classification of terpenoids .......................................02
1.3.2 Medicinal application of terpenoids ...............................................03
1.4 Current treatments of anxiety disorders .................................................04
1.4.1 Diagnosis of anxiety disorders ........................................................04
1.4.2 Pharmacotherapy for anxiety disorders and their side effects .........04
1.5 Therapies of mental health management ...............................................05
1.5.1 Complementary and alternative medicine ......................................05
1.5.2 Aromatherapy ……………………………………………………06
2. PURPOSES .................................................................................................07
3. MATERIALS and METHODS ...................................................................08
3.1 Research certification ............................................................................08
3.2 Aromatic intervention ............................................................................08
3.2.1 Preparation of P. bellina essential oil and linalool odorant ................08
3.2.2 Treatment groups and oscillating diffuser .......................................09

3.3 Participants ............................................................................................10
3.3.1 Informed consent form ...................................................................10
3.3.2 Participants interview, inclusion and exclusion criteria ..................10
3.4 Stress questionnaires .............................................................................11
3.4.1 Chinese health questionnaire (CHQ) ..............................................11
3.4.2 Taiwanese depression questionnaire (TDQ) ...................................12
3.4.3 Visual analogue scale (VAS) ...........................................................12
3.5 The measurement of heart rate variability (HRV) ..................................13
3.6 Cognitive tests ......................................................................................14
3.6.1 Wisconsin card sorting test (WCST) ...............................................14
3.6.2 Stroop tests .....................................................................................15
3.7 Blood samples measurement .................................................................16
3.8 Statistical analysis ................................................................................17
4. RESULTS ....................................................................................................18
4.1 Effects of aromatherapy on stress questionnaires …............................18
4.1.1 Chinese health questionnaire (CHQ) ..............................................18
4.1.2 Taiwanese depression questionnaire (TDQ) ...................................18
4.1.3 Visual analogue scale (VAS) ...........................................................18
4.2 The activity of heart rate variability (HRV) ...........................................19
4.3 Cognitive function performance ............................................................19
4.3.1 Wisconsin card sorting test (WCST) ...............................................19
4.3.2 Stroop tests .....................................................................................20
4.4 Blood sample level measurement ..........................................................20
4.5 Spearman's rho correlations between cognitive performance and HRV indexes ................................................................................................21
5. DISCUSSION .............................................................................................22
5.1 The beneficial effects of aromatherapy on brain and autonomic nervous system (ANS) ........................................................................................22
5.2 The capacity of mood regulation by P. bellina essential oil .............22
5.3 Correlations between cognitive performance and HRV indexes ............23
5.4 The therapeutic properties of P. bellina essential oil ..............................24
5.5 Limitations in this study ........................................................................25
6. CONCLUSION and PERSPECTIVES .......................................................26
7. REFERENCES ...........................................................................................27






























LIST OF TABLE

Table 1. Characterization of individuals participating in the present study ......32
Table 2. Evaluation the effects of aromatherapy on CHQ ................................33
Table 3. Evaluation the effects of aromatherapy on TDQ ................................33
Table 4. Evaluation the effects of aromatherapy on VAS .................................34
Table 5. Evaluation the activity of HRV indexes .............................................34
Table 6. The cognitive performance assessed by WCST .................................35
Table 7. The flexibility of cognitive function evaluated by Stroop tests ..........35
Table 8. The analysis of blood sample level .....................................................36
Table 9. Interactions of aromatherapy and WCST with HRV indexes and
Spearman’s rho correlations between WCST and HRV indexes in
aromatherapy groups with linalool and P. bellina odorant .............37
Table 10. Interactions of aromatherapy and Stroop tests with HRV indexes and
Spearman’s rho correlations between Stroop tests and HRV indexes
in aromatherapy groups with linalool and P. bellina odorant ...........38
Table 11. Correlations between P. bellina essential oil and HRV indexes in
subjects with different cognitive enhancement levels evaluated by
Stroop tests ....................................................................................39






LIST OF FIGURE

Fig. 1. Chinese health questionnaire ................................................................40
Fig. 2. Taiwanese depression questionnaire .....................................................41
Fig. 3. Visual analogue scale ...........................................................................42
Fig. 4. The activity of heart rate variability indexes .........................................45
Fig. 5. The cognitive performance of Wisconsin card sorting test ...................46
Fig. 6. The cognitive flexibility of Stroop tests ................................................47
Fig. 7. The analysis of blood sample level .......................................................49
Fig. 8. Correlations between Stroop tests and blood pressure in subjects with
P. bellina aromatherapy .....................................................................51














LIST OF APPENDIX FIGURE

Appendix Fig. 1. Structure and classification of terpenoids ............................52
Appendix Fig. 2. Research certificates ............................................................53
Appendix Fig. 3. Chinese health questionnaire ...............................................54
Appendix Fig. 4. Taiwanese depression questionnaire ....................................56
Appendix Fig. 5. Visual analogue scale ...........................................................57

7. REFERENCES
1.Christenhusz, M.J.M., Byng, J.W, 2016. The number of known plants species in the world and its annual increase. Phytotaxa, 261: 201-217.
2.Sut, S., Maggi, F., Dall'Acqua, S, 2017. Bioactive secondary metabolites from orchids (Orchidaceae). Chemistry ＆ Biodiversity, 14: 1-14.
3.Hsiao, Y.Y., Jeng, M.F., Tsai, W.C., Chuang, Y.C., Li, C.Y., Wu, T.S., Kuoh, C.S., Chen, W.H., Chen, H.H, 2008. A novel homodimeric geranyl diphosphate synthase from the orchid Phalaenopsis bellina lacking a DD(X)2-4D motif. The Plant Journal, 55: 719-733.
4.Tissier, A., Morgan, J.A., Dudareva, N, 2017. Plant Volatiles: Going 'In' but not 'Out' of Trichome Cavities. Trends in Plant Science, 22: 930-938.
5.Natalia, D., Antje, K., Joëlle, K.M., Ian, K, 2013. Biosynthesis, function and metabolic engineering of plant volatile organic compounds. New Phytologist, 198: 16-32.
6.Hsiao, Y.Y., Tsai, W.C., Kuoh, C.S., Huang, T.H., Wang, H.C., Wu, T.S., Leu, Y.L., Chen, W.H., Chen, H.H, 2006. Comparison of transcripts in Phalaenopsis bellina and Phalaenopsis equestris (Orchidaceae) flowers to deduce monoterpene biosynthesis pathway. BMC Plant Biology, 6: 14-28.
7.Pichersky, E., Raguso, R.A, 2018. Why do plants produce so many terpenoid compounds? New Phytologist, 220: 692-702.
8.Tholl, D, 2015. Biosynthesis and biological functions of terpenoids in plants. Advances in Biochemical Engineering-Biotechnology, 148: 63-106.
9.Schwab, W., Davidovich-Rikanati, R., Lewinsohn, E, 2008. Biosynthesis of plant-derived flavor compounds. The Plant Journal, 54: 712-732.
10.Wajhul, Q., Abdul, Q.K., Rehan, K., Abdul, L., Mir, T., Muneeb, U.R., Farrah, A., Sarwat, S, 2011. Benzo(a)pyrene-induced pulmonary inflammation, edema, surfactant dysfunction, and injuries in rats: Alleviation by farnesol. Experimental Lung Research, 38: 19-27.
11.Xue, Z., Zhang, X.G., Wu, J., Xu, W.C., Li, L.Q., Liu, F., Yu, J.E, 2016. Effect of treatment with geraniol on ovalbumin-induced allergic asthma in mice. Annals of Allergy, Asthma ＆ Immunology, 116: 506-513.
12.Matsumoto, T., T. Kimura., T. Hayashi, 2017. Does Japanese Citrus Fruit Yuzu (Citrus junos Sieb. ex Tanaka) Fragrance Have Lavender-Like Therapeutic Effects That Alleviate Premenstrual Emotional Symptoms? A Single-Blind Randomized Crossover Study. The Journal of Alternative and Complementary Medicine, 23: 461-470.
13.Pimenta, F. C., Alves, M. F., Pimenta, M. B., Melo, S. A. de Almeida, A. A., Leite, J. R., Pordeus, L. C., Diniz Mde, F. de Almeida, R. N, 2016. Anxiolytic effect of Citrus aurantium l. on patients with chronic myeloid leukemia. Phytotherapy Research, 30: 613-617.
14.Wu, Q., Yu, L., Qiu, J., Shen, B., Wang, D., Soromou, L.W., Feng, H, 2014. Linalool attenuates lung inflammation induced by Pasteurella multocida via activating Nrf-2 signaling pathway. International Immunopharmacology, 21: 456-463.
15.Ma, J., Xu, H., Wu, J., Qu, C., Sun, F., Xu, S, 2015. Linalool inhibits cigarette smoke-induced lung inflammation by inhibiting NF-kappaB activation. International Immunopharmacology, 29: 708-713.
16.Lee, M., Lim, S., Song, J.A., Kim, M.E., Hur, M.H, 2017. The effects of aromatherapy essential oil inhalation on stress, sleep quality and immunity in healthy adults: Randomized controlled trial. European Journal of Integrative Medicine, 12: 79-86.
17.Lillehei, A.S., Halcon, L. L., Savik, K., Reis, R, 2015. Effect of inhaled lavender and sleep hygiene on self-reported sleep issues: a randomized controlled trial. The Journal of Alternative and Complementary Medicine, 21: 430-438.
18.Soto-Vásquez, M.R., Alvarado-García, P.A.A, 2017. Aromatherapy with two essential oils from Satureja genre and mindfulness meditation to reduce anxiety in humans. Journal of Traditional and Complementary Medicine, 7: 121-125.
19.Harada, H., Kashiwadani, H., Kanmura, Y., Kuwaki, T, 2018. Linalool odor-induced anxiolytic effects in mice. Frontiers in Behavioral Neuroscience, 12: 241-249.
20.Cheng, B.H., L.Y. Sheen., S.T. Chang, 2015. Evaluation of anxiolytic potency of essential oil and S-(+)-linalool from Cinnamomum osmophloeum ct. linalool leaves in mice. Journal of Traditional and Complementary Medicine, 5: 27-34.
21.López, V., Nielsen, B., Solas, M., Ramírez, M.J., Jäger, A.K, 2017. Exploring pharmacological mechanisms of lavender (Lavandula angustifolia) essential oil on central nervous system targets. Frontiers in Pharmacology, 8: 280-288.
22.Locke, A.B., Kirst, N., Shultz, C.G, 2015. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American Family Physician, 91: 617-624.
23.Maron, E., Nutt, D, 2017. Biological markers of generalized anxiety disorder. Dialogues in Clinical Neuroscience, 19: 147-158.
24.Bao, Y., Kong, X., Yang, L., Liu, R., Shi, Z., Li, W., Hua, B., Hou, W, 2014. Complementary and alternative medicine for cancer pain: an overview of systematic reviews. Evidence-Based Complementary and Alternative Medicine, 2014: 170396-170378.
25.Linck, V. M., da Silva, A. L., Figueiro, M., Caramao, E. B., Moreno, P. R., Elisabetsky, E, 2010. Effects of inhaled linalool in anxiety, social interaction and aggressive behavior in mice. Phytomedicine, 17: 679-683.
26.Ikei, H., Song, C., Miyazaki, Y, 2015. Physiological effect of olfactory stimulation by hinoki cypress (Chamaecyparis obtusa) leaf oil. Journal of Physiological Anthropology, 34: 44-51.
27.Chioca, L. R., Ferro, M. M., Baretta, I. P., Oliveira, S. M., Silva, C. R., Ferreira, J., Losso, E. M., Andreatini, R, 2013. Anxiolytic-like effect of lavender essential oil inhalation in mice: participation of serotonergic but not GABAA/benzodiazepine neurotransmission. Journal of Ethnopharmacology, 147: 412-418.
28.Sienkiewicz, M., Glowacka, A., Kowalczyk, E., Wiktorowska-Owczarek, A., Jozwiak-Bebenista, M., Lysakowska, M, 2014. The biological activities of cinnamon, geranium and lavender essential oils. Molecules, 19: 20929-20940.
29.Mathew, B.K., Suzanne, K.C., Jill, C., Brandon, d’E., Stuart, W, 2016. Aromatherapy for the treatment of PONV in children: a pilot RCT. BMC Complementary and Alternative Medicine, 16: 450-456.
30.Yang, M.H., Lin, L.C., Wu, S.C., Chiu, J.H., Wang, P.N., Lin, J.G, 2015. Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation. BMC Complementary and Alternative Medicine, 15: 93-101.
31.Igarashi, T, 2013. Physical and psychologic effects of aromatherapy inhalation on pregnant women: a randomized controlled trial. Journal of Alternative and Complementary Medicine, 19: 805-810.
32.Shellie, R., Mondello, L., Marriott, P., Dugo, G, 2002. Characterisation of lavender essential oils by using gas chromatography-mass spectrometry with correlation of linear retention indices and comparison with comprehensive two-dimensional gas chromatography. Journal of Chromatography A, 970: 225-234.
33.Chamine, I., Oken, B.S, 2016. Aroma effects on physiologic and cognitive function following acute stress: a mechanism investigation. The Journal of Alternative and Complementary Medicine, 22: 713-721.
34.Cavanagh, H.M., Wilkinson, J.M, 2002. Biological activities of lavender essential oil. Phytotherapy Research, 16: 301-308.
35.Bae, D., Seol, H., Yoon, H.G., Na, J.R., Oh, K., Choi, C.Y., Lee, D.W., Jun, W., Youl Lee, K., Lee, J., Hwang, K., Lee, Y.H., Kim, S, 2012. Inhaled essential oil from Chamaecyparis obtuse ameliorates the impairments of cognitive function induced by injection of beta-amyloid in rats. Pharmaceutical Biology, 50: 900-910.
36.Chang, K.M., Shen, C.W, 2011. Aromatherapy benefits autonomic nervous system regulation for elementary school faculty in taiwan. Evidence-Based Complementary and Alternative Medicine, 2011: 946537-946554.
37.Chien, L.W., Cheng, S.L., Liu, C.F, 2012. The effect of lavender aromatherapy on autonomic nervous system in midlife women with insomnia. Evidence-Based Complementary and Alternative Medicine, 2012: 1-8.
38.Chang, W.H., Lee, I.H., Chi, M.H., Lin, S.H., Chen, K.C., Chen, P.S., Chiu, N.T., Yao, W.J., Yang, Y.K, 2018. Prefrontal cortex modulates the correlations between brain-derived neurotrophic factor level, serotonin, and the autonomic nervous system. Scientific Reports, 8: 2558-2567.
39.Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., Dunbar, G.C, 1998. The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59: 22-33.
40.Lee, C.S., Yang, Y.C, 1997. Screening for psychiatric morbidity using chinese health questionnaire. Taiwanese Journal of Psychiatry, 11: 368-378.
41.林育臣 and 陳展航, 2006. 綜合醫院非精神科門診病患情感表達不能特質. 臺灣精神醫學, 20: 272-278.
42.Lee, Y., Yang, M.J., Lai, T.J., Chiu, N.M., Chau, T.T, 2000. Development of the taiwanese depression questionnaire. Chang Gung Medical Journal, 23: 688-694.
43.Suther, K.R., Hopp, E., Smevik, B., Fiane, A.E., Lindberg, H.L., Larsen, S., de Lange, C, 2018. Can visual analogue scale be used in radiologic subjective image quality assessment? Pediatric Radiology, 48: 1567-1575.
44.Toichi, M., Sugiura, T., Murai, T., Sengoku, A, 1997. A new method of assessing cardiac autonomic function and its comparison with spectral analysis and coefficient of variation of R–R interval. Journal of the Autonomic Nervous System, 62: 79-84.
45.Guidelines, 1996. Heart rate variability: standards of measurement, physiological interpretation and clinical use. European Heart Journal, 17: 354–381.
46.Malliani, A., Lombardi, F., Pagani, M., Cerutti, S, 1990. Clinical exploration of the autonomic nervous system by means of electrocardiography. Annals of The New York Academy of Sciences, 601: 234-246.
47.Chiu, E.C., Wu, W.C., Hung, J.W., Tseng, Y.H, 2018. Validity of the Wisconsin card sorting test in patients with stroke. Disability and Rehabilitation, 40: 1967-1971.
48.Stratta, P., Daneluzzo, E., Prosperini, P., Bustini, M., Mattei, P., Rossi, A, 1997. Is Wisconsin card sorting test performance related to ‘working memory’ capacity? Schizophrenia Research, 27: 11-19.
49.Daniel, F., Kapoula, Z, 2016. Binocular vision and the Stroop test. Optometry and Vision Science, 93: 194-208.
50.Alipour, H., Goldust, M, 2016. The association between blood pressure components and cognitive functions and cognitive reserve. Clinical and Experimental Hypertension, 38: 95-99.