Abstract：Professor ZHANG Xijian identifies the pathogenesis by focusing on two key elements of pulse：pulse qi and pulse properties，guiding the treatment of refractory nephrotic syndrome. He emphasizes that the treatment of this disease is not limited to the lung， spleen， and kidney. Instead， it should involve coordinated regulation of the five zang-organs and reinforcing the healthy qi while calming hyperactivity， based on the principles of strengthening the spleen and boosting qi，expelling pathogens，and removing the turbid. In diagnosis，he combines the four diagnostic methods with pulse diagnosis as the priority and achieving excellent efficacy.