Note: This version of the Digestion questionnaire was archived for research purposes 6/28/2022. The last modification other than this note was 6/19/2021. I recommend use of the current version for self-assessment.

What is the Nature of My Digestion?

Ayurveda explains how the qualities of the food we eat bear on the balance of our Doshas, and on the quality of our tissues and consciousness. Yet, it is not enough to eat wholesome foods in proper quantity and combination at appropriate times. If the digestive fire known as Agni is not strong and balanced, we are unable to properly process that food. The result can be that, instead of producing healthy tissues and Ojas (the essence of the tissues which promotes strength, vitality, immunity from disease, and the growth of consciousness), the digestive system produces Ama (toxic products that clog the channels of the body) and, thereby, sows the seeds of disease.

Avoid the danger that has not yet come. Correct problems with digestion without delay. Often this can be accomplished by shifting to a diet that is lighter in quality and quantity while attending to the basic Ayurvedic guidelines. If the problem is severe or longstanding, herbs become an important adjunct to treatment.

This brief questionnaire will characterize the quality of your digestion and highlight any imbalances. I ask all new clients to complete it as an adjunct to their consultation. It supplements the pulse reading and responses to the other questionnaires.

Instructions for Completing the Digestion Questionnaire

  • Respond to every item.
  • Please enter your email. That way you will receive a copy of the report.
  • I welcome your comments and suggestions for improvement.
  • All information entered here will be kept confidential according to my Privacy Policy.
Qualities of Digestion

Choose the response to each of the following items that best describes what has been most generally true over the long term.

My hunger is:

After eating, my digestion is:

My food capacity is:

I find that my body weight is:

My energy level is:

My bowel movements are:

My stool tends to be:

Digestion-Related Symptoms

When responding to the following items, think about what has been most recently true.

Please indicate the degree to which the following statements apply to you Strongly
Disagree		 Disagree Somewhat
Disagree		 Neutral Somewhat
Agree		 Agree Strongly
Agree
I'm troubled by excessive gas 1
 2
 3
 4
 5
 6
 7
I frequently feel bloated after eating 1
 2
 3
 4
 5
 6
 7
I belch or burp too much 1
 2
 3
 4
 5
 6
 7
I'm troubled by constipation 1
 2
 3
 4
 5
 6
 7
I'm troubled by abdominal cramps or other discomforts 1
 2
 3
 4
 5
 6
 7
It's like I am always hungry. I need to eat every few hours. 1
 2
 3
 4
 5
 6
 7
I have trouble with acid indigestion 1
 2
 3
 4
 5
 6
 7
I have trouble with esophageal reflux 1
 2
 3
 4
 5
 6
 7
I frequently experience heartburn after meals 1
 2
 3
 4
 5
 6
 7
I often have diarrhea 1
 2
 3
 4
 5
 6
 7
My digestion is sluggish. More often than not, whatever I eat seems to just sit there for a long time. 1
 2
 3
 4
 5
 6
 7
I feel heavy or sleepy after meals 1
 2
 3
 4
 5
 6
 7
My bowel movements are sticky or passed with mucous 1
 2
 3
 4
 5
 6
 7

Required Supportive Information

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Comments

Do your responses reflect your situation and represent permission to use your de-identified data in aggregate scientific studies? Clients should be able to comfortably answer yes. If not, please call to discuss.

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Digestive Tendencies section adapted with permission © 2009 Maharishi AyurVeda Association of America

Digestive Imbalanaces section © 2020 Marc T. Edwards

Major Revision: November 28, 2020