Vikruti Questionnaire Please circle which answer fits you best in the present moment. VATA
PITTA
Constipation Gas/Flatulence Bloating Variable appetite Shifting pain Tearing pain Moving pain Vague pain Dry skin Cracked skin Rough skin Thin skin Discolored skin Patchy skin Insomnia Need night light Restless sleep Difficulty falling asleep Asthma type allergy symptoms Constipation due to allergies Constriction due to allergies Difficulty sweating Muscle Twitching Muscle Cramping Muscle Weakness Muscle Numbness Muscle Tingling Painful joints Popping joints Cracking joints Stiffness in joints Loose joints Cold extremities (hands, feet) Variable body weight Can’t gain weight Dry cough Ringing ears
Loose stools Burning stomach pain Still hungry after eating Nausea Vomiting Acid stomach Indigestion Heart-burn Excess hunger Sharp hunger Burning pain Sharp pain Hot pain Migraine headaches Hives Rash Acne Tender skin Warm/hot to touch Redness of skin boils Interrupted sleep Must have complete darkness to sleep Needs to read/TV to sleep Rash due to allergies Itching eyes Hives Hay fever Skin Irritation due to allergies Inflammation due to allergies Excess sweating Muscles Easily Bruised Muscles Tenderness to touch Muscle Soreness Excess heat in Muscles Inflamed joints Hot / feverish joints Burning hands / feet Excessively high metabolism Spontaneous bleeding Hyper-sensitive to smells Hair loss Excess thirst
KAPHA Sleepy after eating Low energy after meals Excess mucous Emotional eating Dull-no appetite Dull pain Stable pain Throbbing pain Excess oily skin Thick skin Edema Pallor Cold/clammy skin Excess sleep Daytime napping Heavy sleeper Runny nose due to allergies Watery eyes due to allergies Congestion due to allergies Food allergies Respiratory allergies Cold/clammy sweat Muscle Edema Muscle Tumors Muscle Cysts Muscle Growths Swelling in joints Cold clammy hands Increasing weight Over weight Cold Cough Congestion Excess urination Frequent urination Fibrocystic Depression Greed
Copyright 2015 © - all rights reserved. Bhak0 Ayurveda – Maria Garre | www.mariagarre.com
VATA
PITTA
Ringing ears Light-headed Dryness: external/internal Hemorrhoids: external / nonbleeding Inability to concentrate Forgetful Worry Fear Anxiety Loneliness Nervousness Grief Depression Restlessness Repetitive thinking Spacey
Hemorrhoids: internal / bleeding Anger Rage Resentful Judgmental Critical Envious Sharp tongued Depression Vengeful Intolerant
KAPHA Attachment Mental lethargy Resistant to change Laziness Unforgiving Stubborn
Copyright 2015 © - all rights reserved. Bhak0 Ayurveda – Maria Garre | www.mariagarre.com