Lepcha is the oldest and the first tribe reported from Sikkim, India; majority of its population inhabiting in Dzongu valley, an officially demarcated reserve for Lepcha community, bordering Khangchendzonga Biosphere Reserve, in north district. Lepchas of Dzongu are known for their retention of rich cultural heritage. In view of the on-going cultural and economic changes brought in by the process of globalization, the immediate need was felt to document in details the under-explored ethnomedicinal practices of Lepchas of Dzongu valley. This paper reports 118 species, belonging to 71 families and 108 genera, under ethnomedicinal utility by the Lepchas for curing approximately 66 ailments, which could be grouped under 14 broad categories. Zingiberaceae appeared as the most used family (8 species and 5 genera). As per use pattern, maximum of 30.50% species are to cure stomach related disorders/ailments, followed by 19.49% for curing cut, wounds, inflammation, sprains and joint pains. Administration of medicine orally is recorded in 75% cases. Root and rhizome harvesting targeted 30 species. The changing scenario over time both at socio-cultural front and passing traditional knowledge interests from older to younger generation and rich ethnomicinal wealth of the oldest tribe of Sikkim are discussed in the light of conservation strategies and techniques to adopt.