Heavily written in pencil. Highlighter used. Index has sticky notes (will remove if not needed). Storage conditions: No pets, non-smoking room. Purchased the 2021 edition used because it allows you to read problems and explanations from over 10 years ago. I was able to check past exam explanations and deepen my understanding. (Since it's not the latest edition, it's for those who want to solve a lot of problems and check the explanations.) "Thoroughly Conquer! National Examination Past Question Collection for Acupuncturists and Moxibustionists, 19th to 28th Editions 2021" Edited by Meiji Toyo Medical College Editorial Committee Price: ¥4200