Which of the two decoctions, Limonia acidissima or Brahmiyadi, is more effective in improving clinical outcomes and modulating immunological markers in patients with Vitiligo (Svitra)

1. Study setting Gampaha Wickramarachchi Ayurveda Teaching Hospital, Yakkala, Sri Lanka.

2. Randomization a. Method of randomization into study arms Simple randomization using a chit-based (lottery) method. b. Unit of randomization Individual patient. c. Method of sequence generation Random allocation sequence was generated using a chit-based (lottery) method. d. Method of allocation concealment Allocation was concealed using identical, opaque, folded chits containing group assignments, which were thoroughly mixed and drawn blindly at the time of participant enrollment.

3. Intervention Arm 1: Limonia acidissima Decoction • Type: Herbal/Traditional Medicine • Formulation: Freshly prepared decoction of Limonia acidissima • Dose: 120 mL • Route: Oral • Frequency: Twice daily before meals • Duration: 90 days • Preparation: Standard Kashaya method (1 part plant material boiled in 8 parts water and reduced to 1 part)

4. Control Arm 2: Brahmiyadi Decoction (Active Comparator) • Type: Herbal/Traditional Medicine • Formulation: Polyherbal Brahmiyadi decoction • Dose: 120 mL • Route: Oral • Frequency: Twice daily before meals • Duration: 90 days

Brahmiyadi decoction is not a formally established standard therapy; however, it is a routinely used clinical preparation in the management of vitiligo (?vitra) at the study setting and is used in this study as an active comparator.Both study arms receive active herbal interventions. This study is designed as a comparative evaluation between two routinely used decoctions, with no placebo or untreated control group.

1. All participants in both groups will receive standard supportive care, including: • Ayurvedic dietary and lifestyle advice • No concurrent systemic or topical anti-vitiligo medications will be permitted during the study period

2. Blinding This is an open-label study. • Participants: Not blinded • Healthcare providers: Not blinded • Data collectors: Not blinded • Outcome assessors: Not blinded • Data analysts: Not blinded

• Patients aged 18–65 years • Male and female patients • Clinically diagnosed cases of vitiligo presenting with white depigmented patches • Duration of disease ? 1 year

• Vitiligo patches that are confluent (combined).
• Patches located near the natural orifices, or on the fingers (distal ends of the upper and lower extremities).
• Patches involving more than one-third of the total body surface area.
• Vitiligo patches resulting from injury or burns.
• Vitiligo associated with exposure to phenolic or other chemical compounds.
• Patches caused by prolonged pressure from clothing or other wearing apparel.
• History of cardiovascular diseases (e.g., myocardial infarction or ischemic heart disease).
• Major systemic illnesses, including acute or chronic renal failure.
• Untreated thyroid disorders.
• Current alcohol dependence, occasional alcohol consumption, or use of narcotic drugs.
• Other dermatological disorders, including hypersensitivity skin conditions.
• Pregnant or lactating women.
• Patients currently using any internal or external medication for vitiligo during the study period.