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For each section, go through numbers 1-10 asking yourself if you have been experiencing this symptom TOO MUCH in the last thirty days. After each section, give yourself a score 0- 10. You will end up with a vata score, a pitta score, and a kapha score.

 

 

  1. I have been feeling nervous, fearful, panicky, anxious, or frantic.

  2. I have twitches, tics, tremors or spasms in my body. I fidget a lot.

  3. My skin is dry and easily chapped.

  4. I have been suffering from dry hard stools constipation, gas or bloating or I have been having loose stools due to emotional upset.

  5. I feel I am underweight.

  6. Lately I have a stronger dislike for the wind and cold than usual.

  7. I have difficulty tolerating loud noise.

  8. My sleep has been light, restless, interrupted, or disturbed.

  9. I feel scattered, spacey, and have difficulty concentrating or have poor memory.

  10. I am prone to overthinking and worrying.

 

Vata Score____________________

 

 


 

  1. I have a red, inflamed, or burning rash, acne, cold sores or fever blisters.

  2. There is acute inflammation in my body or joints.

  3. I have acid reflux, heartburn, acid indigestion or a gastric or peptic ulcer or a tight burning feeling in my stomach or digestive tract.

  4. I feel nauseated or uncomfortable if I miss a meal.

  5. I have been having loose stools that are not due to emotional upset.

  6. I have been feeling uncomfortably warm or hot.

  7. I have been feeling frustrated, irritable or angry.

  8. I can easily be judgemental, impatient, critical or intolerant of others.

  9. My eyes have been red, bloodshot, inflamed, or sensitive to light.

  10. I expect perfection of myself or of others.

 

Pitta Score ______________________

 

 


 

  1. I have excess mucus in my body or nasal or lung congestion.

  2. I have a thick, white coat on my tongue

  3. My bowel movements are slow, sticky, sluggish, or feel incomplete.

  4. I am overweight.

  5. It is difficult for me to wake up in the mornings, even if I sleep deeply for 8-10 hours, and I feel lethargic throughout the day.

  6. I have been feeling slow, foggy, dull, lethargic, or heavy.

  7. In the mornings I have to cough up a lot of mucus.

  8. I have a deep wet cough that produces a lot of mucus.

  9. I feel complacent, stubborn, and resistant to any change, or my close friends and family tell me that I am very slow to change or make a decision.

  10. I am prone to excessive emotional eating especially of sweet, heavy foods.

 

Kapha Score ______________________

Vikriti Questionnaire

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