NAME

Date

Scoring

Cry from self-pity

Moved to tears by music

Relieved by crying

Cry premenstrually

5
5
5
5

Like sympathy

Dislike sympathy

10

Sympathetic

11

Lack sympathy
(especially toward own family)

12

Tend to sigh frequently

13

tend to brood or sulk

14

irritable
(at the least thing)

LYC

5
5

LACH

Cry when thanked

Cry from anxiety

IGN

3
5

GRAPH

CALC

Cry readily
(for no obvious cause)

Score Card
ARS

The Constitutional
Questionnaire

L
1

ARG

Sr.#

V.S S
5
3

5
5
5

3
3

1
1

1
1

5
3
5

3
3
3
3
3
3
3
3

1
1

1
5
3

1
1

5
3

1
1

1
1

1
3

5
3

3
5

15

irritable premenstrually

16

Easily angered

3
5

5
17

dictatorial
(especially at home)

18

Angry when contradicted

19

Prone to contradict

20

Impulsive

21

Changeable and inconsistent

22

Jealous

23

Suspicious

24

Critical

25

Fastidious

26

Concerned with
precision/accuracy

27

Conscientious
about trivial matters

1
1

3
5

3
5

1
3

3
1

5
3

3
5
3
1
3
5

1
3

1
3

5
3

1
3

29

Egotistical

Vain

5
28

1
1

5
3

1
1

5
3

30

Ambitious

31

Tend to theorize

32

Pessimistic

33

Tend to worry
about everything

35

3
5

3
5

1
3

1
1

37

Anxious with
a hurried feeling

anxious and cautious

1
1

39

yielding/passive

40

lack confidence

41

fearful of others' opinions

42

Avoid undertaking
new things for fear
of failure

1
5

Timid about public

speaking (but capable)

3
5

1
1

1
1

3
5

3
5

3
5
3
1
5

43

1
1

anxious and indecisive

5
38

5
36

Anxious in company

anxious when anything

is expected of you

5
34

1
5

43

Timid about public

speaking (but capable)

44

Apprehensive
(e.g., before
a performance)

45

Inhibited

46

Impressionable

47

Think rapidly

48

Think slowly

1
1

5
3
5

1
5

3
5

3
5

1
3

1
3

5
49

50

Talkative and frequently

change subject

Tend to procrastinate

1
1

1
5

5
51

restless while at work

52

Anxious on waking
in the morning

53

anxious about
own health

5
3

1
1

3
5

1
3

suppress grief following

bereavement

55

affectionate

56

Feel better mentally

after vigorous exercise

57

dislike being touched

3
5

1
1

1
1

3
5

3
5
3

5
54

58

clairvoyant

59

low sex drive (female)

60

low sex drive (male)

61

Like warm foods

and drinks

62

dislike warm foods

63

Like raw foods

64

lose appetite
during menstruation

65

mixtures of foods
disagree

66

eat to bursting point

67

Fruit disagrees

3
5

5
3
5

like eggs
(especially
soft-boiled eggs)

70

dislike eggs

71

Beans/peas disagree

72

Like starchy foods

73

Like bread and butter

5
3

3
5

3
5

3
5

3
5

3
5

1
3

3
5

dislike fruit

69

5
68

1
1

5
3
5

1
5
3

1
3

3
5

3
5

73

Like bread and butter

74

Like rich, fatty foods

75

Rich, fatty foods

cause digestive upset

76

Like ice cream

3
5

3
5

3
5

3
5

77

Like peanut butter

78

Like cheese

79

Like olive oil

80

Dislike pork

81

like sweet foods

82

Dislike sweet foods

83

Like sweet foods

but they disagree

1
1

5
3
5

Pastries disagree

86

Like salty foods

87

Dislike salty foods

88

Like oysters

5
3

1
3

1
3

3
1

3
1

1
3

like sweet foods but

not upset by them

85

5
84

3
5

1
1

1
1

3
5

1
3

3
5

88

Like oysters

89

Dislike fish

3
5

5
90

Shellfish disagree

91

Like lemons

92

Like pickles

5
3

1
1

3
5

1
1

3
5

93

94

Dislike tomatoes

Like spicy foods

5
3
5

95

96

Garlic disagrees

Onions disagree

1
1

Like milk

98

Milk disagrees

99

Reluctant to take
breast milk in infancy

1
1

3
5

3
5

100

3
5

97

3 1

hot drinks disagree

3
1

101

iced drinks
disagree

1
3

5
3

5
102

like carbonated
drinks

103

like alcohol

104

Beer disagrees

105

Little thirst

106

Like coffee

107

Dislike coffee

108

Coffee disagrees

109

Heights

110

Enclosed spaces

3
1
1

5
3
5
5

3
1

3
5

3
5

3
5

3
5

1
3

1
1

1
1

5
114

115

Thunderstorms

Water

Mice

5
3

Crowds/public places

Snakes

113

1
112

5
111

1
1

5
3

1
1

116

Sharp pointed objects

(e.g., hypodermic
needles)

117

ghosts

118

Darkness

119

Burglars

120

being alone

121

Being late

122

Being hurt
emotionally

123

Being poisoned
(by bad food or
pollution)

124

Illness

125

insanity

126

Cancer

127

death

128

for the health

of your family

129

Failure in business

130

Poverty

3
5
3
5

5
1

3
5

3
5
3
1
3
5

5
3

3
5
3
1
1

3
5

5
3

3
3
1
1

3
5

3
5

3
5

1
3

5
3

131

Loss of self-control

132

Physical/mental exertion
(due to lack of stamina)

1
3

1
3

5
133

Warm and made

worse by heat

134

ailments are worse

in stuffy rooms

135

Feet are hot in bed

(stick them out
bedclothes)

136

Chilly but made

worse by heat

137

Chilly and better

with heat

138

Feet are
and smelly

139

Ailments are worse

after sweating

140

Head is sweaty
in bed

141

Ailments are worse

from
standing

142

ailments are worse

in cold, wet weather

143

ailments are worse

in cold, dry weather

144

ailments are worse

in windy weather

3
1
1

Feel better from sea air

1
1

3
5

3
5

3
5

3
5

3
5

1
1

3
5
3
5

3
5

1
3

3
5
3
5

145

145

Feel better from sea air

146

Feel worse from

sea air

147

Love to watch
thunderstorms

148

Suffer a headache
before thunderstorms

149

Sensitive to smells

150

Sensitive to the
smell of tobacco

151

Eyes are sensitive

to sunlight

152

Sensitive to the
slightest noise

153

Suffer a headache or
feel faint
missing a meal

154

Feel better
when fasting

155

Feel better after

a short nap

156

ailments are relieved

. by onset
of menstruation

157

ailments seem
worse
between 4-8 a.m./p.m.

158

ailments seem
worse between
4-6 a.m./P.m.

159

ailments seem
worse between
1-2 a.m.

1
1

3
5

3
5

1
3

3
5

3
5

3
5

3
5
3
1
1

3
5

1
3

3
5 3 1

5
3
5
3

5 3 1
5

160

ailments seem
worse between
2-5 a.m.

161

ailments are worse

in the spring

162

ailments are worse

around full moon

163

ailments are worse in the morning

and evening

1
3

1
3

1
3

3
1

3
5

164

ailments are worse

from sunset to sunrise

165

Avoid lying on
the left side
the body in bed

166

Avoid lying on
the right side of
the body in bed

167

Prone to leftsided complaints

168

Prone to right
-sided complaints
TOTAL

1
1

3
1
3
5
3
5
3

155 282 166 168 151 156 360

Score Card

1
5
3
1
5

3
5
3
1

3
5

5
3
1

5
3

SUI F

SEP

SIL

PULS

PHOS

NV

NM

MERC

5
3

3
1

5
3

3
1

5
3

3
1

3
5
3

1
1

1
1

5
3

3
1

5
3

5
3
1
1

5
3

3
5
3
1
5
3

1
5

3
5

3
5
3
1

3
5

3
5
3
1
1

5
3

3
5
3

3
5

3
5

3
5

1
1

3
5

5
3

1
3

3
5
3
1
5

3
1

3
1

5
3

5
3
5
3
1

5
3

5
3
5

3
5
3
1
5

5
3
1
1

3
5
3

5
3
1
5

3
5

3
5
3
1

3
1

3
1

5
3
1
1

5
3

5
3

5
3

3
1

3
5

3
1

5
3

5
3

3
5
3
1
1

3
1

3
1

5
3

3
5

3
1

5
3

3
5

3
5
3

3
5

3
5
3
5

3
5

3
5

5
3

3
1

5
3
1

5
3

3
1

3
5
3

5
3
1
1

85 186 214 331 339 190 152 221