Introduction
In the United States, one of the least used aspects of pancha karma is the application of lepas. lepas are medicinal plasters used in the treatment of disease and as supportive therapies for many different problems. According to the Ayurvedic Encyclopedia, the lepa procedure can take three forms:

1. Pralepa: These are medicinal pastes that are thin and cold. They most frequently restore deranged blood and Pitta.
2. Pradhena: These plasters can be thick or thin but they are most often of the non-absorbing variety. They reduce Vayu and Kapha excess as well as treating ulcers and swellings
3. Alepa: These pastes are specific to ulcers. They are most commonly astringent in nature. These are used to stop bleeding, draw pus as well as relieving pain and burning sensations.

 
The ingredients and procedures used with lepas vary widely from practitioner to practitioner and school to school. A comprehensive paper on lepas is beyond my scope but I wanted to take a moment and share what I have learned from my recent clients regarding a more general lepa use.

In my own practice I almost always use lepas in conjunction with acupressure and herbal therapy.  This is because I found lepas work best when combined with other forms of therapy (unless the lepa is being applied to an overt exterior skin condition). In my own practice, it was found that lepas (specifically the forms I will talk about in a moment) alone and have a significant impact. But overall, you would be best served by utilizing them as a supportive therapy in a much larger picture. With this in mind, we will begin.

The form of lepa therapy I would like to talk about here is the use of lepas on the Nabhi Marma. Nabhi is the navel and the marma point is centered in the navel and includes an area of approximately four fingers in width. As such it is a rather large marma point.

This marma controls the third chakra as well as the digestive, blood, and circulatory systems. With this wide-spread impact, it is the main energy center for digestion, blood and overall energy balance of the body. It is also the primary point for Pitta in the body as a whole.

Applying a lepa to Nabhi is very easy. The procedure I use is as follows:

1. Clean the navel with alcohol. This cleans impurities from the skin as well as opening the pores for better absorption.
2. Using sesame oil, massage the area using a circular motion for several minutes. Sesame oil is not your only choice. You can use an oil specific to the dosha of the individual but I have found that sesame is least likely to cause a skin reaction which is a concern with some clients. You do not have to massage Nabhi but again, it helps the body to receive and use the lepa, as well as having salutary effects on the above-mentioned systems related to Nabhi.
3. Wipe any access oil from the navel itself.
4. In a mortar, grind the herbs you will be using for the lepa and pour them directly into Nabhi. There is no correct amount of herbs to use as everyone?s navel is unique. My only advice is to not fill it to the top. Leave some space to work with.
5. Once the herbs are in place, pull enough cotton from a cotton ball to cover the navel. When this cotton is in place use a small brush to add water to the herbs through the cotton. You don?t want to add to much as this will produce poor results and the herbs will drain and leak. Add just enough to make the herbs damp. This takes some practice and judgment.
6. Once the herbs are damp they are effectively a lepa and you need to cover the area with first aid tape. This process also takes some learning. People have different skin sensitivities and you should always be aware of this. I personally use a large piece of paper tape to cover the whole area and then tape over this with a more adhesive tape for security and to prevent the loss of the liquid.
7. If client feels any discomfort or itching, have them remove the lepa and wash the area thoroughly. If they experience no discomfort, leave the lepa in place for no more than two days. They will need to use there own intuition regarding when to remove it. And advise them that when they do remove it, to wash thoroughly.

This same procedure has been effectively used when applying a lepa anywhere on the body. The only change is the technique you use to secure the lepa. I personally use a base of some kind on the marma or problem I am working with. This base can be a simple layer of oil on the skin but I like to use one of several Ayurvedic pain relief ointments as my base. I use a pain relief ointment because it has properties that open the pores and allow for absorption.

Once the base is on the area I apply the lepa.  Then, pulling cotton from a cotton ball, I form it into a thin but flexible strip. The cotton is place to encircle the base, creating perimeter around the area. This type of lepa technique can only be applied to areas of 1 inch in diameter or less. Anything larger becomes difficult to secure. Herbs are placed on the base and within the cotton perimeter. Next, a thin cover of cotton is placed over the herbs and then the herbs are dampened through the cotton. Again, excess water will cause the lepa to liquefy and overflow. Once this is complete tape it just as I discussed earlier.

 
Herbs & Nabhis
This covers the lepa technique, now the herbs are discussed. The choice of herbs is dictated by the health issue in question. When applying a lepa to Nabhi I have observed it strongly impacting digestion, blood, and circulation. This impact on blood, as well as the direct access to the primary energy balance of the body, also allows for easy immune system boosting through Nabhi. Client results confirmed that excess Pitta is also balanced in the process. Nabhi has a strong impact on digestion, which is of course the seat of all illness, and the immune system. So it is a very easy way to restore digestion, boost immunity, and thereby remove illness and promote rejuvenation.

The herbs that I have found most useful, alone and in combination, are the following.

• Amalaki ? for general Pitta balance, immune system boost and digestive problems associated with acid.
• Ashoka ? I use this for female clients with problems related to the uterus and ovaries. As well as repeated UTI and yeast infections.
• Ashwaganda- this is one of the best herbs to use to boost the immune system and balance the bodies overall energy flow. I have regularly used Ashwaganda as a lepa with clients undergoing chemotherapy. This helps to restore the immune response that has been diminished as a result of the chemotherapy.
• Bala- use for weak heart and immune system boost.
• Bibhitaki- use for digestive problems such as diarrhea.
• Bilwa- use for any digestive problem.
• Brahmi- use for overall energy balance and immune boost.
• Gokshura- use for any genital-urinary problem.
• Manjistha- use for blood purification and pitta balance.
• Musta- use for women?s health, PMS, yeast and hormone balance.
• Shankh Pushpi- use for overall energy balance and immune boost.
• Shatavari- use for immune boost

In addition I have also used Nabhi to directly address difficult urination due to prostate enlargement. The formula I use includes, finely chopped fresh ginger, finely chopped fresh green onion and finely chopped fresh garlic. Using these ingredients as the lepa have resulted in partial relief and greater ease of urination.

I have found the use of lepas with Nabhi marma to be a powerful adjunct therapy that can be used for any condition. The more supportive therapies I use with my clients the more relief they experience and the more powerful the overall treatment effect.