Annalepam: Detailed Procedure, Benefits, Contra Indications

Article by Dr Raghuram Y.S. MD (Ay)
Annalepanam is a unique type of Ayurvedic treatment done for rejuvenation, strengthening the tissues and preventing degeneration and also to treat emaciation and wasting of body.

Annalepam is a variant of Shashtika Shali Pinda Sweda or Navarakizhi. The procedure is done in the same way as Shashtika Shali Pinda Sweda or Navarakizhi.

Difference between Shashtika Shali Pinda Sweda and Annalepana: The only difference is that in Shashtika Sweda the Shashtika rice (special type of rice grown and harvested in 60 days) which is cooked in the milk processed with herbal roots (roots of bala Sida cordifolia) is tied in bolus and the bolus is rubbed or stroked over the body or desired part of the body which is intended to receive fomentation. In annalepam, the rice is cooked and prepared in a similar way but is not tied in a bolus. The cooked rice is directly applied over the body of the patient.

In Annalepana, just as in Shashtika Shali Pinda Sweda, milk processed with medicinal herbs and a special type of rice are combined together to be used as an effective external therapy which is used to provide strength and nutrition to the body tissues, especially bones, muscles and other soft tissues.

Annalepana is a form of Pradeha (treatment where in medicines are applied over the body) or Upanaha (poultice with herbal pastes)

Annalepa is predominantly used in combating the diseases caused by morbid Vata and Rakta (blood), degeneration and inflammatory conditions, diseases accompanied by depletion of tissue, loss of strength and fatigue, emaciation and in all musculoskeletal and neuromuscular conditions which are accompanied by loss of movements

Annalepana is used in providing unparalleled relief in pain, swelling and stiffness associated with many systemic diseases, especially in rheumatological conditions like Amavata vis-à-vis Rheumatoid arthritis, Sandhigata Vata (Osteoarthritis), Kati Shula (Low back pain), Mamsagata Vata (Myalgia, Fibromyalgia etc.

Annalepa is thus used as a strengthening therapy. It gives nutrition to the tissues which are undergoing depletion and degeneration. It is a time tested treatment administered to those ailing from musculoskeletal and neuromuscular diseases.

Table of Contents

Introduction

What is Annalepana?
The term Annalepana is made up of 2 words – Anna means rice (Shashtika Shali or a special type of rice grown and harvested within 60 days in this case), Lepana means application.

Thus Annalepana is a type of treatment in which Shashtika Shali cooked in the milk which has already been processed with Bala Kashayam (decoction or liquid extract prepared by boiling the roots of Sida cordifolia with water) is rubbed against the body of the patient or person selected for treatment.
Note – Shashtika Shali is a type of rice which is harvested in 60 days and is used for treatment purposes in Ayurveda

The target people are those in whom the nutrition to the tissues has to be improved and the strength of the person has to be enhanced.
The treatment is also used in emaciation and fatigue, wasting diseases, painful and or degenerative conditions like Osteoarthritis, Myalgia, GB Syndrome, Fibromyalgia, and various types of Neuro-muscular and Musculoskeletal diseases.

Thus Annalepanam is basically a strengthening and nutritious treatment. It also has an extraordinary relaxing and analgesic effect.
This treatment is generally done in the absence of ama (circulating or tissue toxins which get adhered in the cells due to their sticky nature, block the channels of the body and cause pain and stiffness) or done after getting rid of ama through treatment procedures like Valuka Sweda (sand bolus fomentation) or Udwarthana (massage in an upward direction usually done with herbal powders).

Deepana medicines (medicines which can enhance the metabolism) and Pachana medicines (medicines which digest or expel the ama – toxins blocking the cells and channels) can also be administered before the treatment procedure. Disease modifying drugs can also be given (Some of these medicines will be enlisted at the end of the article)

Annalepana is an unparalleled treatment in Vata, Pitta and Rakta (vitiated blood) morbidity or any disease or painful conditions caused by morbid Vayu, Pitta and Rakta, usually degenerative and inflammatory diseases or diseases caused due to contamination of blood.

Indications

In which conditions is Annalepana?
Annalepana is done in all conditions in which Shashtika Shali Pinda Sweda is done.
Annalepana is used mainly to provide strength and rejuvenate the tissues and also to provide relief from pain, inflammation, and stiffness (catch) associated with bone, joint, neuromuscular and or musculoskeletal pains. Annalepa also acts as a disease-modifier. It is more effective when combined skilfully with Abhyanga (massage with herbal oils), Kati Vasti (oil pooling for low back pains), Greeva Vasti (oil pooling for neck pains) etc treatments. Annalepam can be done in a later period of these treatments to strengthen the nerves, joints and soft tissues and enhance blood flow to the affected area.

Annalepanam is used in the treatment of –
Osteoarthritis (Sandhigata Vata) – It results from the breakdown or damage of protective joint cartilage and underlying bone. OA can affect and damage any joint in the body. The most common symptoms are joint pain and stiffness. Joint swelling and decreased range of movements are also present in many cases. Annalepana will help in preventing the degeneration process from progressing and strengthens the joints and muscles.

Rheumatoid Arthritis (Amavata) – It is a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet and ankles. Annalepana will be useful in the chronic stages of RA (Jeerna or pravruddha Amavata) wherein the inflammation has subsided but pain has been left over. This will serve the purpose of rejuvenating and strengthening the joints, muscles and soft tissues. It can also be applied when RA has developed complications in the later stages. It will help in improvising the movements.

Low back pain or Lumbago (Lumbar spondylosis) and Sacroiliac Joint Syndrome or Sacroiliac Joint Dysfunction (Kati-shula / Kati-graha)

Cervical spondylosis – Neck pain due to damage of neck bones and joints or osteoarthritis of neck bones (Greeva-shula, Greeva-stambha)

Sciatica (Gridhrasi) – Pain affecting the back, hip and outer side of the leg caused by compression of a spinal nerve root in the lower back is called Sciatica. It happens due to the effect of degeneration of intervertebral disc or discs causing compression on the Sciatic nerve.

Intervertebral disc protrusion or prolapsed (IVDP) – is impinging or compressing on the nerves supplying the lower limbs. It presents with pain, numbness, pain extending down the limbs, pain worsening at night, muscle weakness, tingling, aching or burning sensations in the neck, back, legs and arm etc depending on the site of prolapse.

Note: In Sciatica and IVDP, Annalepana should be done with caution and should be done after the acute symptoms of nerve irritation and inflammation have been reduced after administration of suitable medications and treatments. This will help in strengthening the joints and muscles of the back.

Spondylolisthesis – is a forward displacement of a vertebra, especially a 5^th lumbar vertebra. Generally it occurs following a fracture. It presents with back stiffness, tight hamstrings, leaning forward posture, waddling gait and generalized lower back pain with intermittent shooting pain from buttocks to the posterior thigh and or lower leg via sciatic nerve.

Ankylosing Spondylitis – It is a form of arthritis which primarily affects the spine. It causes severe inflammation of the vertebrae that might eventually lead to chronic pain and disability. The disease will cause pain and stiffness in other parts of your body. Other large joints such as the shoulders, hips and knees can be involved as well.

Polymyalgia Rheumatica – It is an inflammatory disorder that causes pain and stiffness in various parts of the body. It commonly affects neck, shoulders, arms, thighs and hips.

Fibromyalgia – It is a rheumatic condition characterized by muscular or musculoskeletal pain with stiffness and localized tenderness at specific points on the body

Guillain Barre Syndrome – It is a rare condition in which your immune system attacks your nerves leading to muscle weakness and even paralysis. There is a rapid onset of muscle weakness as a result of damage of the peripheral nervous system

Paralysis – It is the loss of muscle function in part of your body (one or more muscles). It can be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage as well as motor. It happens when something wrong happens with the way messages pass between your brain and muscles. It can be complete or partial, can occur on one or both sides of your body. (Hemiplegia – paralysis of one side, Diplegia – Paralysis affecting symmetrical parts of the body, Facial paralysis etc)

Hemiparesis – It is the weakness of the entire left or right side of the body.

Poliomyelitis – It is a highly contagious disease caused by a virus that attacks the nervous system. Children younger than 5 years are the victims. (The disease has been largely eradicated)

Paraplegia – It describes complete or incomplete paralysis affecting the legs and possible also the trunk, but not the arms. It is usually caused by spinal cord injury or a congenital condition such as spina-bifida that affects the neural elements of the spinal canal.

Spinal stenosis – It is a condition in which the spinal column (backbone or spine) narrows and starts compressing the spinal cord. It is a gradual process. The symptoms include leg or arm weakness, lower back pain while standing or walking, numbness in legs or buttocks and balance problems.

Spina bifida (occulta) – It is a birth defect where there is an incomplete closing of the backbone and membranes around the spinal cord. It presents with leg weakness and paralysis, club foot, hip dislocation, bladder and bowel control problems etc
Coccydynia – Tail bone pain

Frozen Shoulder – Chronic pain and stiffness of the shoulder joint with limitation of range of movements, also known as adhesive capsulitis

Iliotibial band syndrome – The ilio-tibial band is a band of rough tissue that runs from your hip down to the outer part of your knee. If it is irritated by overuse or other problems, it becomes inflamed and cause pain on the outer side of the knee.

Patello-femoral pain syndrome (Chondromalacia patellae) – This often results from issues associated with muscle imbalance, tightness and alignment of the legs, rather than an injury. Pain is present between the patella and the underlying thighbone (femur).

Other conditions:

Old (chronic) joint injuries which was not properly treated, sprained ligaments, cartilage tears, sports injuries, sprains and strains
Musculo-skeletal pains as in myalgia and or fibromyalgia (Mamsagata Vata)
Pains and catches in the joints and spine (especially neck and low back) due to bad postures
Pain due to repeated trauma of bones, joints, muscles, soft tissues
Elbow pain due to various conditions like Tendinitis, Olecranon bursitis, elbow sprain, cellulitis, arthritis, nerve entrapment etc
Neuromuscular diseases and various musculoskeletal disorders
Emaciation / Wasting diseases (Karshya, Shosha)
Breathing disorders (Shwasa)
Diseases caused by contamination / morbidity of blood (Rakta Prakopaja Roga)

Procedure

How is Annalepana done?
Annalepanam is done in the below said method –

Purvakarma

Purvakarma (Pre-treatment procedures): This includes –
Preparation of the patient:

The patient is thoroughly examined. The Prakriti (basic constitution) and Vikriti (details of morbidity) are documented in detail. The disease is also examined. After careful assessment, it is decided if Annalepana is suitable to the disease and diseased or not. The treatment line-up, materials and medicines which need to be used are enlisted.

Preparation for the treatment:
Materials needed for the treatment are collected beforehand. They are:

Shashtika Shali – A special type of rice harvested in 60 days
Milk
Balamula – Roots of Sida Cordifolia
Water
Big vessels – to prepare Kashayam and to cook rice in processed milk
Spoons
Stove for heating
Sterile napkins or tissue papers for wiping
For Abhyanga (massage) – Taila (medicated oil), Ghee (medicated ghee) or both suitable to the disease and diseased are collected and stored beforehand. Some effective oils used for Abhyanga are

For Shiro-Abhyanga (Head Massage): Ksheerabala Taila, Chandanabala Lakshadi Tailam, Shatavari Tailam, Lakshadi Tailam etc

For Sharira Abhyanga (body massage): Sahacharadi Taila, Ksheerabala Taila, Chandanabala Lakshadi Tailam, Dhanwantara Tailam, Mahanarayana Tailam, Balashwagandhadi Tailam, Karpasastyadi Tailam, Panchaguna Tailam etc keep in view the body constitution, morbid doshas and nature of morbidity involved

Preparation of the Medicine:
Bala mula (roots of Sida cordifolia) is taken in a quantity of 3 pala (12tola=144 grams)
The roots should be washed with sterile water thoroughly so as to remove the dirt, mud and dust from them
The roots should then be cut into small pieces
The roots should now be put in a vessel consisting of water in the quantity of 3 prastha (192 tola=2304 grams of water)
The contents are boiled until 48 tola of liquid (48 tola=576 grams) remains i.e. ¼ of the taken content should remain
The solid part is filtered out
The Bala kwatha (decoction of bala) is prepared now
To this equal quantity of milk of cow (48tola=576 grams) is added and kept for heating on the stove. This makes the total liquid quantity 96 tola (1152 grams)
In this mixture of Kashayam and milk, Shashtika Shali (Shashtika rice) is added in a quantity of 1 kudava (16 tola=192 grams) and cooked thoroughly
Once the rice is cooked properly, it is grinded into soft mass

Abhyangam (Herbal oil massage)
The patient is made to sleep on the table made and meant for conducting massage. Holy hymns are recited and the almighty is worshiped for the welfare of the patient and success of the treatment in terms of providing good relief to him or her.

Massage is an essential part of Annalepanam. First of all a head massage is given with one of the above said oils. Later a full body massage is given with one of the above mentioned oils. Overall the massage is done for 30-40 minutes.

Annalepana can be performed generally to the whole body or partially to the affected parts or joints like in osteoarthritis of knee or low back pain of lumbar spondylosis.

Pradhana karma

Pradhana Karma (Treatment proper):
We need at least 4 attendants or masseurs to carry on the treatment in a synchronized and uninterrupted way on either side of the patient. Even 2 masseurs who are well trained can manage the show because the procedure doesn’t need more manual labour as is needed in Shashtika Shali Pinda Sweda. SSPS needs 4+1 or 4+2 people to carry out the treatment procedure and it take a lot of energy on the part of the masseurs to conduct the treatment in a synchronized way, which is not needed in Annalepana. Still the presence of 4 masseurs, 2 to attend the right side of the body and 2 for the left side of the body including 1 helper would make the job easy.

The rubbing or stroking of the rice over the body on both sides of the body (left and right) should be done in a rhythmic way by both or all the 4 masseurs. They should be trained in such a way that they should be able to efficiently carry out the treatment procedure. 2 masseurs should stand on one side of the patient and the other 2 on other side. We need a 5^th person as helper for any help if needed. The masseurs should not only be skilled but also should be compassionate towards the patient.

The grinded rice should now be rubbed against the body of the patient in the procedure of Udwarthana or rubbing from below upwards. The masseurs take the rice from the bowl or vessel in their hands and rub against the body. The rice is rubbed in upward direction (opposite to the direction of body hairs). Two masseurs should take in charge of rubbing and stroking the rice against the body of the patient in a gentle way and cover the lower portion of the body i.e. one masseur should attend the hip, buttock, anterior and posterior portions of thigh, leg, knee, ankle and lumbo-sacral area on the right side and the other masseur on the left side.

The other 2 masseurs should carry on the procedure simultaneously on the upper portion of the body. One among them should cover the abdomen, chest, sides of the chest, flanks, upper back, neck (nape), shoulder, elbow, wrist and small joints of the hands, arm and forearm of the right side and the other masseur should cover the left side of the body.

The treatment should be carried out in a skilful and synchronized way on both left and right sides of upper and lower portions of the body by all the 4 masseurs in an uninterrupted way.

The strokes are given from below upwards from the low back area towards the nape of the neck and the masseurs attending the lower portion of the body will give ascending stroke by rubbing the rice from the foot towards the hip covering the whole of lower limb.

The strokes are done in a circular and clockwise fashion while covering joints of the body. Similar method is followed while conducting the treatment on the upper limbs. While rubbing the part with the rice in right hand, the masseur can move his left hand over the body part following the direction of the hand rubbing the rice and give a soothing stroke. Circular strokes can be given over the joints and vertical strokes from below upwards on the back and limbs.

The traditional way of rubbing as done in SSPS i.e. from above downwards can also be followed in some cases.

The application of rice in Annalepana procedure should reach all parts of the body. To achieve this, the procedure should be carried out in all the 7 postures in which Abhyanga (herbal oil massage) is done.

The 7 postures of doing Shashtika Shali Pinda Sweda are, patient in –

Sitting posture
Sleeping by facing the roof (supine position)
Sleeping in left lateral position (towards left)
Sleeping on tummy (prone position or face downwards)
Sleeping in right lateral position (towards right)
Sleeping back by facing the roof
Sitting posture

The treatment procedure is carried out for 10-15 minutes in each posture. Thus the time duration of the treatment ranges from 70-105 minutes.

Paschat karma

Paschat Karma (Post-treatment procedures):

After this, the rice is wiped out with the help of tissue or sterile cloth. Traditionally the leaves of coconut tree or castor plant can also be used to wipe off the remnants on the patient’s body.
Sponging should be given with a sponge or sterile cloth dipped in hot water so as to remove the oil from the body and head. This is followed by hot water shower.
Alternatively, a light massage is once again given after the procedure followed by hot water shower. Patient is advised to take a refreshing hot water bath after going home or after a few hours if the patient is being handled as in-patient
Nitya Virechana – Daily metered dose of purgation with purgative decoctions or oils like Gandharvahastadi Kashayam, Gandharvahastadi Eranda tailam, Nimbamritadi Eranda Tailam etc can be administered if a small amount of detoxification is essential on a daily basis or if morbid Dosha’s need to be tackled (optional and strictly based on the decision of the doctor)
Discharge – The patient is discharged on daily basis (out-patient) or after the course has been completed (in-patient) after giving proper lifestyle and diet advices along with suitable medicines (oral). The patient is also advised to undergo the treatment twice or thrice in a year.

Duration, benefits

Duration of the course –

The number of days of treatment varies from 7-21 days depending on the nature and intensity of the disease

Benefits of Annalepa–

Provides strength to the tissues, mainly muscle tissue
Rejuvenates and energizes the body
Prevents wasting of muscles and degeneration of joints and soft tissues
Relieves pain, stiffness and swelling associated with arthritis and other painful conditions mentioned above
Pacifies the morbidity of Vata, Pitta and Rakta in the skin, afflicted joints, muscles and soft tissues
Causes sweating and brings about lightness and a feeling of health in the afflicted joints, muscles and soft tissues
When combined with Nitya Virechana, Annalepam eliminates the body toxins, establishes health and tones up the joints and soft tissues
Improves the movements of the joints and enhances flexibility of the body
Soothes the nerves and improves blood circulation
Removes stress, relaxes mind
Improves circulation to skin, improves colour and complexion

Contraindications

Contra-indications of Annalepanam –

Diabetes mellitus (can be done for a short period with caution, giving proper medicines to treat diabetes or in controlled and uncomplicated diabetes to enhance strength and immunity)
High blood pressure (Hypertension) – SSPS can be done for local problems in joints and soft tissues, but under supervision
Severe varicosity of veins
Deep vein thrombosis
Fractures
Fever
Severe inflammation

Limitations of Annalepam –
Annalepam relieves stress and provides good immunity. It is also highly nutritious. It provides good strength and energy. It is one of the best Ayurvedic treatments which is used in providing relief from pain and associated conditions related with Osteoarthritis, Rheumatoid arthritis, Low back pain, Sciatica etc conditions. But on the other hand it is not a sole remedy in these conditions. Parallel to it we might have to add some disease modifying drugs and or compounds and effective treatments for better relief. Along with this some oral medications which enhance strength and stability should be included along with some immune-modulators, anti-ageing medicines and rejuvenators.

Parallel Ayurvedic medicines

Parallel Medications to expel morbid Doshas, strengthen and rejuvenate the joints and soft tissues (Diseases modifying medications) –

Kashaya’s (Herbal decoctions):

Maharasnadi Kashayam
Punarnavadi Kashayam
Guggulutiktakam Kashayam
Sahacharadi Kashayam
Sahacharabaladi Kashayam
Kokilaksham Kashayam
Guluchyadi Kashayam
Gandharvahastadi Kashayam
Drakshadi Kashayam

Asava / Arishtam (herbal fermented liquids):

Ashwagandharishtam
Balarishtam
Dashamuraishtam
Punarnavasavam
Devadarvarishtam etc

Lehas and Rasayana’s (rejuvenators, herbal confections, anti-ageing medicines, immune-modulators) –

Ashwagandha Rasayanam
Ajashwagandhadi Rasayanam / Leham
Kushmandam Rasayanam
Chyavanaprasham
Brahma Rasayanam etc

Ghritam and Tailam (medicated ghee and oils):

Guggulutiktakam Ghritam
Varanadi Ghritam
Rasnadi Ghritam
Dhanwantaram Ghritam
Shunti Ghritam
Ksheerabala tailam 101
Dhanwantaram tailam 101
Maharajaprasarini Tailam

Vati and Gulika (Tablets):

Kanchanara Guggulu
Kaishora Guggulu
Yogaraja Guggulu
Trayodashanga Guggulu
Mahavata vidhwamsini Ras
Vatagajankusha Ras
Shallaki etc

Just before finish,
Annalepanam is the best treatment which Ayurveda provides for enhancing strength, immunity and nutrition to the tissues. It is also used to prevent degeneration and inflammation, to tackle pain, swelling and catches related to Arthritis, Neuromuscular and Musculoskeletal disorders. All the benefits of Annalepana are similar to uses of Shashtika Shali Pinda Sweda. Remember to consult your Ayurvedic doctor for being properly diagnosed and to know if the treatment really is suitable to you or not.
Click to Consult Dr Raghuram Y.S. MD (Ayu)