NBCE Acupuncture (Acup) Actual Practice Exam
& Board Certification Prep: Complete Questions
with Verified Answers
SECTION 1: TCM Foundations & Diagnosis (Questions 1-15)
Q1: A 42-year-old male presents with burning epigastric pain, irritability, bitter taste, red
tongue edges with yellow coating, and a wiry, rapid pulse. He reports stress aggravates
the pain. This presentation is MOST characteristic of:
A) Liver Qi Stagnation invading the Stomach
B) Stomach Yin Deficiency
C) Spleen Qi Deficiency with Dampness
D) Cold stagnation in the Middle Jiao
Correct Answer: A
RATIONALE:
● Diagnostic Reasoning: The wiry pulse indicates Liver involvement; the rapid
pulse, red tongue edges (Liver area), and bitter taste indicate Heat/Fire. The
epigastric pain aggravated by stress (Liver emotion) indicates the Liver
overacting on the Stomach (Wood overacting on Earth), causing rebellious Qi and
heat. This is "Liver Qi Stagnation transforming to Fire" invading the Stomach.
● TCM Theory: The Liver's function of ensuring smooth Qi flow affects the
Stomach's descending function. When Liver Qi stagnates, it attacks the Stomach,
causing pain, reflux, and heat signs.
● Biomedical Correlation: Corresponds to stress-induced gastritis, GERD, or peptic
ulcer disease exacerbated by sympathetic nervous system activation.
, ● NBCE Focus: Differentiating between pure Stomach patterns and
Liver-Overacting-on-Stomach patterns is a high-yield topic. The presence of
emotional aggravation and wiry pulse distinguishes Liver involvement.
Q2: A patient presents with chronic cough, weak voice, spontaneous sweating that is
worse with exertion, pale tongue, and an empty (Xu) pulse. This pattern represents:
A) Lung Yin Deficiency
B) Lung Qi Deficiency
C) Wind-Cold invading the Lung
D) Phlegm-Heat obstructing the Lung
Correct Answer: B
RATIONALE:
● Diagnostic Reasoning: The empty/floating pulse with pale tongue indicates
deficiency. Spontaneous sweating (Wei Qi failing to secure the exterior) and weak
voice are classic signs of Lung Qi deficiency. There are no heat signs (red tongue,
night sweats) to suggest Yin deficiency, nor exterior signs (aversion to cold,
floating pulse with fever) for Wind-Cold.
● TCM Theory: The Lung governs Qi and respiration, controls the voice, and
governs the exterior (Wei Qi). Qi deficiency leads to failure of these functions.
● Biomedical Correlation: Corresponds to chronic bronchitis, COPD, or post-viral
fatigue with reduced pulmonary function.
● NBCE Focus: Differentiating Lung Qi vs. Lung Yin deficiency is essential; Qi
deficiency presents with cold/weak signs while Yin deficiency presents with
empty heat (night sweats, malar flush, heat in 5 palms).
Q3: In the Five Element (Wu Xing) model, which sequence describes the "Overacting"
(Cheng) cycle where the Liver is pathologically over-controlling another organ?
A) Liver (Wood) overacting on Spleen (Earth)
B) Liver (Wood) overacting on Lung (Metal)
C) Heart (Fire) overacting on Kidney (Water)
,D) Spleen (Earth) overacting on Kidney (Water)
Correct Answer: A
RATIONALE:
● Diagnostic Reasoning: The normal controlling sequence (Ke cycle) is Wood
controls Earth (Liver stores blood, Spleen governs transformation). In pathology,
when Liver Qi stagnates or has excess Yang, it "overacts" (bulldozes) the Spleen,
causing digestive symptoms (diarrhea with stress, hypochondriac pain with poor
appetite).
● TCM Theory: The five elements maintain balance through generation (Sheng) and
control (Ke). Pathological over-control (Cheng) or counter-insult (Wu) creates
disease patterns.
● Biomedical Correlation: Correlates with the gut-brain axis dysfunction, IBS, or
stress-induced malabsorption.
● NBCE Focus: The Wood-Earth relationship (Liver-Spleen/Stomach) is the most
clinically tested Five Element relationship, representing the psycho-emotional
impact on digestion.
Q4: A patient has severe, fixed, stabbing joint pain that is worse with cold and better
with warmth. The tongue is pale with white coating, pulse is tight. This is classified as:
A) Wind Bi (Moving pain)
B) Cold Bi (Painful obstruction)
C) Damp Bi (Fixed heavy pain)
D) Heat Bi (Red, swollen, hot pain)
Correct Answer: B
RATIONALE:
● Diagnostic Reasoning: The description "severe pain," "fixed location," and "better
with warmth" are the hallmark characteristics of Cold Bi. Wind Bi moves
locations; Damp Bi is heavy and swollen but not necessarily severe sharp pain;
Heat Bi presents with redness, warmth, and burning.
, ● TCM Theory: Cold is Yin; it congeals, contracts, and obstructs the flow of Qi and
Blood in the channels, causing severe pain. Cold is the dominant pathogen.
● Biomedical Correlation: Corresponds to arthritis aggravated by cold weather,
vasospastic conditions, or Raynaud's phenomenon affecting joints.
● NBCE Focus: Distinguishing the "Three Bi" (Wind, Cold, Damp) patterns based on
pain quality and thermal preferences is fundamental for treatment planning
(moxa for Cold, draining for Damp, etc.).
Q5: According to the Eight Principles (Ba Gang), a patient with fever, aversion to cold,
headache, floating pulse, and thin white tongue coating is exhibiting:
A) Exterior Cold Pattern
B) Interior Heat Pattern
C) Exterior Wind-Heat Pattern
D) Interior Deficiency Pattern
Correct Answer: A
RATIONALE:
● Diagnostic Reasoning: Aversion to cold (not fever only), floating pulse (pulse at
the exterior/skin level), and headache indicate pathogens at the exterior level.
Thin white coating indicates Cold (or Wind) rather than Heat (which would be
yellow). This is an exterior cold invasion (Wind-Cold).
● TCM Theory: The Eight Principles categorize location (Exterior/Interior), nature
(Cold/Hot), excess/deficiency (Shi/Xu), and Yin/Yang. Exterior patterns affect the
skin, muscles, and Lung Wei Qi.
● Biomedical Correlation: Acute viral upper respiratory infection or early stage
influenza.
● NBCE Focus: Correct identification of Exterior vs. Interior determines treatment
strategy—Exterior patterns require "releasing the exterior" (sweating/diaphoresis)
while Interior patterns require draining, tonifying, or clearing.
Q6: A patient presents with palpitations, insomnia, dream-disturbed sleep, poor memory,
pale lips and nails, and a thin pulse. The tongue is pale and thin. This indicates:
A) Heart Blood Deficiency
& Board Certification Prep: Complete Questions
with Verified Answers
SECTION 1: TCM Foundations & Diagnosis (Questions 1-15)
Q1: A 42-year-old male presents with burning epigastric pain, irritability, bitter taste, red
tongue edges with yellow coating, and a wiry, rapid pulse. He reports stress aggravates
the pain. This presentation is MOST characteristic of:
A) Liver Qi Stagnation invading the Stomach
B) Stomach Yin Deficiency
C) Spleen Qi Deficiency with Dampness
D) Cold stagnation in the Middle Jiao
Correct Answer: A
RATIONALE:
● Diagnostic Reasoning: The wiry pulse indicates Liver involvement; the rapid
pulse, red tongue edges (Liver area), and bitter taste indicate Heat/Fire. The
epigastric pain aggravated by stress (Liver emotion) indicates the Liver
overacting on the Stomach (Wood overacting on Earth), causing rebellious Qi and
heat. This is "Liver Qi Stagnation transforming to Fire" invading the Stomach.
● TCM Theory: The Liver's function of ensuring smooth Qi flow affects the
Stomach's descending function. When Liver Qi stagnates, it attacks the Stomach,
causing pain, reflux, and heat signs.
● Biomedical Correlation: Corresponds to stress-induced gastritis, GERD, or peptic
ulcer disease exacerbated by sympathetic nervous system activation.
, ● NBCE Focus: Differentiating between pure Stomach patterns and
Liver-Overacting-on-Stomach patterns is a high-yield topic. The presence of
emotional aggravation and wiry pulse distinguishes Liver involvement.
Q2: A patient presents with chronic cough, weak voice, spontaneous sweating that is
worse with exertion, pale tongue, and an empty (Xu) pulse. This pattern represents:
A) Lung Yin Deficiency
B) Lung Qi Deficiency
C) Wind-Cold invading the Lung
D) Phlegm-Heat obstructing the Lung
Correct Answer: B
RATIONALE:
● Diagnostic Reasoning: The empty/floating pulse with pale tongue indicates
deficiency. Spontaneous sweating (Wei Qi failing to secure the exterior) and weak
voice are classic signs of Lung Qi deficiency. There are no heat signs (red tongue,
night sweats) to suggest Yin deficiency, nor exterior signs (aversion to cold,
floating pulse with fever) for Wind-Cold.
● TCM Theory: The Lung governs Qi and respiration, controls the voice, and
governs the exterior (Wei Qi). Qi deficiency leads to failure of these functions.
● Biomedical Correlation: Corresponds to chronic bronchitis, COPD, or post-viral
fatigue with reduced pulmonary function.
● NBCE Focus: Differentiating Lung Qi vs. Lung Yin deficiency is essential; Qi
deficiency presents with cold/weak signs while Yin deficiency presents with
empty heat (night sweats, malar flush, heat in 5 palms).
Q3: In the Five Element (Wu Xing) model, which sequence describes the "Overacting"
(Cheng) cycle where the Liver is pathologically over-controlling another organ?
A) Liver (Wood) overacting on Spleen (Earth)
B) Liver (Wood) overacting on Lung (Metal)
C) Heart (Fire) overacting on Kidney (Water)
,D) Spleen (Earth) overacting on Kidney (Water)
Correct Answer: A
RATIONALE:
● Diagnostic Reasoning: The normal controlling sequence (Ke cycle) is Wood
controls Earth (Liver stores blood, Spleen governs transformation). In pathology,
when Liver Qi stagnates or has excess Yang, it "overacts" (bulldozes) the Spleen,
causing digestive symptoms (diarrhea with stress, hypochondriac pain with poor
appetite).
● TCM Theory: The five elements maintain balance through generation (Sheng) and
control (Ke). Pathological over-control (Cheng) or counter-insult (Wu) creates
disease patterns.
● Biomedical Correlation: Correlates with the gut-brain axis dysfunction, IBS, or
stress-induced malabsorption.
● NBCE Focus: The Wood-Earth relationship (Liver-Spleen/Stomach) is the most
clinically tested Five Element relationship, representing the psycho-emotional
impact on digestion.
Q4: A patient has severe, fixed, stabbing joint pain that is worse with cold and better
with warmth. The tongue is pale with white coating, pulse is tight. This is classified as:
A) Wind Bi (Moving pain)
B) Cold Bi (Painful obstruction)
C) Damp Bi (Fixed heavy pain)
D) Heat Bi (Red, swollen, hot pain)
Correct Answer: B
RATIONALE:
● Diagnostic Reasoning: The description "severe pain," "fixed location," and "better
with warmth" are the hallmark characteristics of Cold Bi. Wind Bi moves
locations; Damp Bi is heavy and swollen but not necessarily severe sharp pain;
Heat Bi presents with redness, warmth, and burning.
, ● TCM Theory: Cold is Yin; it congeals, contracts, and obstructs the flow of Qi and
Blood in the channels, causing severe pain. Cold is the dominant pathogen.
● Biomedical Correlation: Corresponds to arthritis aggravated by cold weather,
vasospastic conditions, or Raynaud's phenomenon affecting joints.
● NBCE Focus: Distinguishing the "Three Bi" (Wind, Cold, Damp) patterns based on
pain quality and thermal preferences is fundamental for treatment planning
(moxa for Cold, draining for Damp, etc.).
Q5: According to the Eight Principles (Ba Gang), a patient with fever, aversion to cold,
headache, floating pulse, and thin white tongue coating is exhibiting:
A) Exterior Cold Pattern
B) Interior Heat Pattern
C) Exterior Wind-Heat Pattern
D) Interior Deficiency Pattern
Correct Answer: A
RATIONALE:
● Diagnostic Reasoning: Aversion to cold (not fever only), floating pulse (pulse at
the exterior/skin level), and headache indicate pathogens at the exterior level.
Thin white coating indicates Cold (or Wind) rather than Heat (which would be
yellow). This is an exterior cold invasion (Wind-Cold).
● TCM Theory: The Eight Principles categorize location (Exterior/Interior), nature
(Cold/Hot), excess/deficiency (Shi/Xu), and Yin/Yang. Exterior patterns affect the
skin, muscles, and Lung Wei Qi.
● Biomedical Correlation: Acute viral upper respiratory infection or early stage
influenza.
● NBCE Focus: Correct identification of Exterior vs. Interior determines treatment
strategy—Exterior patterns require "releasing the exterior" (sweating/diaphoresis)
while Interior patterns require draining, tonifying, or clearing.
Q6: A patient presents with palpitations, insomnia, dream-disturbed sleep, poor memory,
pale lips and nails, and a thin pulse. The tongue is pale and thin. This indicates:
A) Heart Blood Deficiency
