{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T13:29:02Z","timestamp":1789046942494,"version":"build-2803163510"},"reference-count":48,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Research & Development Centre, Link Natural Products (Pvt) Ltd","award":["NIL"],"award-info":[{"award-number":["NIL"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Integrative and Complementary Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>\n                      According to the Ayurveda Pharmacopeia of Sri Lanka, the fruit of\n                      <jats:italic toggle=\"yes\">Phyllanthus emblica<\/jats:italic>\n                      L. (PE) and the stems of\n                      <jats:italic toggle=\"yes\">Tinospora cordifolia<\/jats:italic>\n                      (Willd.) Hook.f. and Thomson (TC) are prescribed for skin diseases such as Kushta (eczema) and Visharpa (spreading inflammatory lesions). Classical Ayurvedic texts, Charaka Samhitha and Sushruta Samhitha, describe PE and TC as \u201celixirs of life\u201d (\n                      <jats:italic toggle=\"yes\">Rasayana<\/jats:italic>\n                      ) and widely incorporated them into formulations for dermatological disorders. Their therapeutic effects have been attributed to a range of bioactive phytochemical constituents identified in herbal extracts. Acne leads to poor quality of life (QoL), and available treatment protocols are varied and suboptimal and often lead to adverse events. The aim of the study was to evaluate the efficacy and safety of a herbal formulation comprising PE and TC in patients with mild to moderate acne.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>An investigator-initiated, randomized, double-blind, placebo-controlled, dose-ranging clinical trial. Eighty-eight volunteers with postadolescent acne were randomized to receive the standardized oral PE and TC formulation named Link Natural Swastha Amurtha (LNSA) at doses of 300 mg, 400 mg, or 500 mg daily, or a placebo, for 12 weeks. The primary endpoint of the study was the change in total acne lesion counts from baseline to 12 weeks. Secondary endpoints included changes in inflammatory and noninflammatory lesion counts, acne severity, sebum production, and QoL. Safety was assessed through hematological, hepatic, and renal laboratory parameters, along with monitoring of adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A dose-dependent reduction in acne lesion counts was observed in participants receiving LNSA; however, differences between the treatment and placebo groups did not reach statistical significance. All three LNSA dosage groups demonstrated statistically significant improvements in QoL compared with baseline. Laboratory safety parameters remained within normal reference ranges throughout the study, and no serious or treatment-related adverse events were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      LNSA was found to be safe and well tolerated, with dose-related beneficial effects. The significant improvement in patient-reported QoL is a noteworthy outcome. Further adequately powered studies are warranted to explore the clinical efficacy of LNSA as a standalone or adjunctive therapy in acne management and laboratory studies to determine the mode of action of these plant constituents. (The study was registered in the Clinical Trials Registry in Sri Lanka (International Clinical Trial Registration Platform: SLCTR\/2022\/025), a member of the Primary Registry of the World Health Organization.\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/slctr.lk\/trials\/slctr-2022-025\">https:\/\/slctr.lk\/trials\/slctr-2022-025<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/27683605261469317","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T07:23:38Z","timestamp":1784791418000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Phyllanthus Emblica and Tinospora Cordifolia in Postadolescence Acne: A Randomized Double-Blind Placebo-Controlled Trial"],"prefix":"10.1177","author":[{"given":"Achala","family":"Liyanage","sequence":"first","affiliation":[{"name":"Specialist Dermatologist, Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuwan","family":"Darshana","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadeeka","family":"Chandraratne","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7450-5672","authenticated-orcid":false,"given":"Jennifer","family":"Perera","sequence":"additional","affiliation":[{"name":"Emeritus Professor, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/jid.2013.446"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/9781444300086"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2007.06.045"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.13743"},{"issue":"4","key":"e_1_3_3_6_2","first-page":"577","article-title":"Prevalence of facial acne in adults","volume":"41","author":"Goulden V","year":"1999","unstructured":"Goulden V, , Stables GI, , Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol., 1999; 41(4):577\u2013580.","journal-title":"J Am Acad Dermatol."},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.4103\/2229-5178.202273"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/2011945"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jep.2021.114570"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/molecules29071642"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e26125"},{"key":"e_1_3_3_12_2","first-page":"160","volume-title":"Indian Herbal Pharmacopoeia.","author":"Indian Drug Manufacturers\u2019 Association, Regional Research Laboratory","year":"1998","unstructured":"Indian Drug Manufacturers\u2019 Association, Regional Research Laboratory. Indian Herbal Pharmacopoeia. Vol. 1. Mumbai: IDMA\/RRL, 1998, pp.160\u2013162."},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/1476-511X-9-141"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2023.1153101"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.4103\/0378-6323"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.25588.1"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090374"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n1800"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X713873"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(15)00527-7"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.2147\/CCID.S416267"},{"issue":"2","key":"e_1_3_3_22_2","first-page":"36","article-title":"Ayurveda: A historical perspective and principles of the traditional healthcare system in India","volume":"7","author":"Mishra L","year":"2001","unstructured":"Mishra L, , Singh BB, , Dagenais S. Ayurveda: A historical perspective and principles of the traditional healthcare system in India. Altern Ther Health Med., 2001; 7(2):36\u201342.","journal-title":"Altern Ther Health Med."},{"key":"e_1_3_3_23_2","first-page":"578","volume-title":"commentator. Bhavaprakasa of Bhavamisra (Original Text Along with Commentary and Translation) (Madhyama and Uttara Khanda","author":"Sitaram B","year":"2010","unstructured":"Sitaram B. commentator. Bhavaprakasa of Bhavamisra (Original Text Along with Commentary and Translation) (Madhyama and Uttara Khanda). Vol. 2. Chaukhambha Orientalia: Varanasi; 2010, p. 578."},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/0378-8741(95)01309-1"},{"key":"e_1_3_3_25_2","first-page":"238","volume-title":"Ayurveda Pharmacopoeia","author":"Department of Ayurveda","year":"1985","unstructured":"Department of Ayurveda. Ayurveda Pharmacopoeia. Vol. 1 (Part 3). Department of Ayurveda of Sri Lanka: Colombo; 1985, pp. 238\u2013237,305."},{"key":"e_1_3_3_26_2","volume-title":"Bhavaprakasa of Bhavamisra (Original Text Along with Commentary and Translation) (Including Nighantu Portion)","author":"Sitaram B","year":"2010","unstructured":"Sitaram B. Commentator. Bhavaprakasa of Bhavamisra (Original Text Along with Commentary and Translation) (Including Nighantu Portion). Chaukhambha Orientalia: Varanasi; 2010, pp. 135, 229\u2013230."},{"key":"e_1_3_3_27_2","first-page":"145","volume-title":"Ayurveda Pharmacopoeia","author":"Department of Ayurveda","year":"1979","unstructured":"Department of Ayurveda. Ayurveda Pharmacopoeia. Vol 1, Department of Ayurveda of Sri Lanka: Colombo; 1979, p. 145."},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.3390\/pharmaceutics16121531"},{"key":"e_1_3_3_29_2","unstructured":"World Health Organization. Operational guidance: Information needed to support clinical trials of herbal products. Available from: https:\/\/www.who.int\/publications\/i\/item\/TDR-GEN-Guidance-05.1 [Last accessed: 28December 2025]."},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c332"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/009286150804200603"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajoms.2017.08.009"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.09.078"},{"key":"e_1_3_3_34_2","unstructured":"U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER). Acne Vulgaris: Establishing Effectiveness of Drugs Intended for Treatment Guidance for Industry. Available from: https:\/\/www.fda.gov\/regulatory-information\/search-fda-guidance-documents\/acne-vulgaris-establishing-effectiveness-drugs-intended-treatment [Last accessed: 28December 2025]."},{"key":"e_1_3_3_35_2","unstructured":"Cardiff University. Cardiff Acne Disability Index [Internet]. Available from: https:\/\/www.cardiff.ac.uk\/medicine\/resources\/quality-of-life-questionnaires\/cardiff-acne-disability-index [Last accessed: 28December 2025]."},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.2147\/PROM.S451537"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1201\/b10783"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7130.542"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-3083.2005.01344.x"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1002\/fsn3.1553"},{"issue":"2","key":"e_1_3_3_41_2","first-page":"28","article-title":"Anti-inflammatory and analgesic activities of the water extract from the fruit of Phyllanthus emblica Linn","volume":"3","author":"Jaijoy K","year":"2010","unstructured":"Jaijoy K, , Soonthornchareonnon N, , Panthong A, et al. Anti-inflammatory and analgesic activities of the water extract from the fruit of Phyllanthus emblica Linn. Int. J. Appl. Res. Nat. Prod, 2010; 3(2):28\u201335.","journal-title":"Int. J. Appl. Res. Nat. Prod"},{"key":"e_1_3_3_42_2","first-page":"46","article-title":"Tinospora cordifolia: A novel antimicrobial agent","author":"Somalwar S","year":"2022","unstructured":"Somalwar S, , Somalwar AR. Tinospora cordifolia: A novel antimicrobial agent. Int. J. Res. Biosci. Agri, 2022;II(X):46\u201351.","journal-title":"Int. J. Res. Biosci. Agri"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2023.1276383"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1159\/000211087"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-475X.2008.00446.x"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jep.2008.05.039"},{"issue":"7","key":"e_1_3_3_47_2","first-page":"3832","article-title":"A randomized single-blind placebo-controlled clinical study to evaluate the efficacy of amalaki (Emblica officinalis) extract capsules on acne vulgaris along with its antioxidant property","volume":"12","author":"Patel G","year":"2021","unstructured":"Patel G, , Sorake R, , Pai N. A randomized single-blind placebo-controlled clinical study to evaluate the efficacy of amalaki (Emblica officinalis) extract capsules on acne vulgaris along with its antioxidant property. Int J Pharm Sci Rev Res, 2021; 12(7):3832\u20133838.","journal-title":"Int J Pharm Sci Rev Res"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/46.12.2027"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1080\/09546634.2021.1967269"}],"container-title":["Journal of Integrative and Complementary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/27683605261469317","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/27683605261469317","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/27683605261469317","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:44:35Z","timestamp":1789044275000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/27683605261469317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":48,"alternative-id":["10.1177\/27683605261469317"],"URL":"https:\/\/doi.org\/10.1177\/27683605261469317","relation":{},"ISSN":["2768-3605","2768-3613"],"issn-type":[{"value":"2768-3605","type":"print"},{"value":"2768-3613","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"27683605261469317"}}