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.
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wind |
fire |
water |
|
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
|
|
sleep
|
light, restless
|
moderate, wakes up then falls back to sleep |
deep, difficult to wake up |
|
sweat |
scanty, variable |
profuse, hot |
moderate, cold |
|
appetite
|
light, variable |
robust, hard to skip meals |
constant but able to skip meals |
|
circulation |
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
|
|
totals |
wind = |
fire = |
water = |
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