CONSTITUTION QUESTIONNAIRE

Instructions: Please print out this questionnaire.  For each category on the left, place the number 3 (most), 2 (moderate) or 1 (least) in each of the element boxes to the right. The earth element is not listed, as it is a stable element and does not get out of balance as often as the other three more volatile elements. 

On the bottom line, add up the two totals for each element to determine your dominant or excess constitutional element. With the help of a skilled herbalist, this can be useful information in deciding which herbs might work best for you. 

This chart needs to be completed twice.  The first time, score according to how you remember yourself in your youth in the healthiest or "normal" stage of your life.  Then, a second time, score according to your present condition.  



body type
thin physique, dry rough skin, pronounced veins, small hands  
medium physique, muscular, moist reddish skin, medium hands  
stocky physique, pale and smooth skin
light, restless
moderate, wakes up then falls back to sleep 
deep, difficult to wake up
scanty, variable 
profuse, hot 
moderate, cold 
light, variable                              
robust, hard to skip meals          
constant but able to skip meals   
poor, variable  
strong, warm  
slow, steady 
weather sensitivity
cold, wind, dryness 
heat, sun  
cold, damp 
common illnesses
arthritis, mental disorders, insomnia, body pain 
fevers, inflammatory diseases, infections 
congestion, mucous, water retention 
mental activity
active, adaptable, creative, enthusiastic
focused, precise, competitive, articulate 
stable, patient affectionate,
down to earth  
energy level overall
highly energetic, frequent fluctuations 
vigorous and determined
stable, sometimes lethargic 
  wind =  
  fire =  
  water =