Tsunade

"Although I am a descendant of the First Hokage, it's true that I don't know how to use Wood Release. And compared to him, who was able to use medical ninjutsu without even making seals, it's true that my own ninjutsu is nothing to brag about. And it's true that I'm a woman...but I'm definitely not a weak woman. What I inherited from my grandfather isn't just simple 'power'. My true strength comes from that which was passed down from the First to each generation afterward. Don't underestimate the Will of Fire!"

- Tsunade Tsunade is one of the main supporting characters of the Naruto series. She is one of the The Legendary Sannin and is the Fifth Hokage of the Hidden Leaf Village and the predecessor of Kakashi Hatake the Sixth Hokage.

In the English version, she is voiced by Debi Mae West (adult) and Megan Hollingshead (child & young adult) in the anime, and Mary Elizabeth McGlynn (video games). In the Japanese version series she is voiced by Masako Katsuki (adult) and Haruhi Terada (child).

Background
Tsunade was born on August 2 in the Hidden Leaf Village. She is the granddaughter of Hashirama Senju (The First Hokage) and Mito Uzumaki, the first Nine-tailed Fox Jinchuuriki, which gave Tsunade the title name Princess because of her grandfather's legacy.

At a very young age, Tsunade was gifted in ninjutsu and having high levels of Chakra. By the time she was 6 years old, she was taken under the leadership of Hiruzen Sarutobi (The Third Hokage) along with Orochimaru and Jiraiya where they were taught of the Art of Jutsus. As the years go by, Tsunade became more stronger and she became involved with Medical Ninjutsu that she wanted to become a Medical Ninja. So she was trained under the arts of medicine and healing so that she can be helpful to and save her comrades.

As a young adult, Tsunade gave her younger brother Nawaki a gift for his 12th Birthday which was their grandfather's amulet as a good luck charm so that it gave Nawaki the strength to fullfill his dream into becoming Hokage. However, Nawaki died shortly on the battlefield much to Tsunade's grief and Orochimaru gave her back the necklace. Around that time, she met Dan Kato and they both worked together to help increased the potential of allowing more Ninjas to study and train in the arts of medical ninjutsu so to increase the survival rates of Ninjas on the battlefield and the two became lovers. Like Nawaki, Dan dreamed of becoming Hokage and build a better world for the sister, which was a dream ever since his younger sister died. Overwhelmed by Dan's determination, Tsunade gave her necklace to Dan so that his dream can be fullfillled. But that dream was at a lost since Dan was severly injuried during the war and Tsunade tried to rebuild to damaged organs, but it was no use as Dan died and Tsunade cried out in grief. After the deaths of her brother and lover, Tsunade decided that the dream of being Hokage was nothing but a foolish gamble. Years later, Tsunade took Dan's niece named Shizune under her wing as a medical student and the two left the village and traveled around the world.

Abilities
As one of the Legendary Sannin and the Fifth Hokage, Tsunade is undoubtedly one of the most powerful ninja that Konoha has ever produced. Greatly admired around the world, Tsunade is reputed to be one of the most powerful kunoichi in ninja history. She is a remarkable combatant and medical-nin and is also hailed as the world's strongest kunoichi, which has lead to many younger kunoichi to look up to her. Jiraiya commented that no one could stand equal to her in terms of combat and medical prowess. Her overall might was even acknowledged by Madara Uchiha, able to defeat one of the legendary Uchiha's wood clone-Susanoo on her own.

Physical Prowess
Tsunade's trademark ability is her immense raw strength, with which she is able to launch her targets several metres with a mere finger flick or create fissures with a single finger jab at the ground. An opponent struck by her attacks could suffer damage ranging from broken bones, ruptured organs, or even death, as Jiraiya learned from his perverted actions in his youth. She was able to obliterate a large portion of Madara Uchiha's wood clone's body with a single punch. She was also capable of cracking the defences of Madara's Susanoo's ribcage with a single punch, bringing it down with a second attack. The strength of her physical attack was acknowledged by Madara Uchiha himself to be stronger than the Fourth Raikage, whose lightning infused attacks are known to be extremely strong. In the anime, when facing the Fourth Raikage in an arm-wrestling match, the latter had to resort a feint to throw her off-balance in conjunction with his high-speed to defeat her, as he was being overpowered.

In battle, Tsunade has displayed great speed, flexibility, and ferocity. She was able to incapacitate Shizune with a quick strike before the latter could react. In her battle with Kabuto Yakushi, she showed enough skills to attack while on the defensive, giving the younger shinobi very little time to react to her attacks. She was also able to use the Body Pathway Derangement technique on him when he thought she was incapacitated, use her feet to counter Orochimaru's sword moments after her hands were bound, and even intercept Manda mid-strike while lifting Gamabunta's sword. Before Mei could react, Tsunade intercepted all five of Madara's flame dragons dissipating them all. Likewise, Tsunade showed herself to be very nimble, able to attack from various angles, even while in mid-air, to effectively pressure her opponents. As a field medical-nin, Tsunade is reputed to be highly skilled in the art of evasion; skills she deems necessary for field medics since their healing abilities would be pointless if they are unable to survive and be the last to die. These are skills and views she instilled in her own disciples.

Her remarkable durability also allowed her to survive the life-risking Heavenly Transfer Technique with only minor injuries in the process. She was also able to recover from a Yasaka Magatama fired at close-range. A further testament to this trait also allowed her to still move after having her muscles torn — something Kabuto noted was an impressive and praise-worthy feat no ordinary person could achieve. While a medical-nin normally tries to avoid direct battle, Tsunade's taijutsu has been considered unsurpassed, which she uses mainly to intimidate her opponents from approaching her in order to carry out her primary duties as a medical-nin. When entering battle directly, she is a force to be reckoned with as seen during her assault on Orochimaru and Kabuto, where she single-handedly demolished the the entire landscape while attacking them.

Life Force and Chakra Control
As a direct descendant of the Senju clan, Tsunade inherited an incredibly strong life force and physical energy, granting her great durability, stamina and chakra reserves. At the same time, as also a direct descendant of the Uzumaki clan, her life force is blessed with immense vitality and endurance, giving her the potential for an exceptionally long lifespan and allowing her to survive most otherwise fatal injuries and in most cases continue battling. She also has a high tolerance for physical pain, as she was able to deliver a heavy kick to Orochimaru after being sliced in her shoulder, and stabbed through her chest. to still land a powerful blow to Orochimaru. Throughout the fight with Orochimaru, she was able to push herself to fight on despite being tired and injured. She was also able to continue fighting with extreme force against Madara's Susanoo army despite being impaled through her abdomen with two Susanoo blades. Even after being bisected, she was still able to survive the ordeal, regain consciousness, summon Katsuyu, and survived long enough to start healing the other Kage, which she completed after she herself was healed by Karin under the orders of Orochimaru.

Due to her heritage, Tsunade was also gifted with immense supplies of chakra. She was able to simultaneously heal a large number of people with the help of Katsuyu over a long period of time, without being fatigued. Even more impressive than her chakra reserves is Tsunade's control. Since at a young age, Tsunade excelled in all forms of chakra manipulation; even able to maintain multiple techniques at once. Her innate talent for it allows her to gather her chakra from any part of her body with such precision and perform any technique to their maximum potential without any wasted chakra or timing. Her signature ability with chakra control is to instinctively amplify her already legendary strength with chakra control to monstrous levels, allowing her to perform feats like causing gigantic craters with a simple punch or kick to the ground, launch Gamabunta's tantō into the air and then guide it down right into Manda's mouth, and she easily shattered Madara Uchiha Susanoo's ribcage, its sword, and later knocking down a complete version of the Susanoo with single punches. This is done by building up and releasing her chakra with precise timing upon impact, making it effortless for her to decimate any target.

The peak of her chakra control, is her ability to form the Strength of a Hundred Seal, which allows her to store massive amounts of chakra on a point on her forehead and the release it; a feat that only Tsunade and her own student have accomplished, further showing the difficulty of it. Upon its release, Tsunade can either use the stored chakra to facilitate the activation of one of her techniques such as the Creation Rebirth and Strength of a Hundred Technique which makes her virtually immortal in battle or simultaneously heal and protect the entire citizens of Konoha from a very powerful attack such as Pain's Shinra Tensei. She is also able to transfer chakra to others as seen when she gave Ōnoki some of her chakra in order to facilitate his large-scale Dust Release: Detachment of the Primitive World Technique.

Transformation Technique
Even though she is in her early fifties, Tsunade's Transformation Technique makes her appear as if she were still in her twenties as Jiraiya noted she was not one to "age gracefully". She readily alters what age she appears in order to avoid her gambling debts. Tsunade's transformation is somewhat different from a normal transformation, as it seems to be permanent, not getting dispelled when she is slashed or injured, and she apparently does not need to exert any effort to stay transformed. She is able to maintain her transformation even while asleep. The transformation dispels when she runs out of chakra from the Strength of a Hundred Seal, reverting her to her natural appearance.

Medical Ninjutsu
Much of Tsunade's fame comes from her being able to perform any procedure flawlessly to cure and heal injuries that others would consider impossible or a lost cause. She can do so through the usage of no more than chakra or basic tools. She quickly healed the psychological damage caused by Tsukuyomi upon her return to Konohagakure, fixed the damage done to Rock Lee's spine, and counteracted the effects of the Three Coloured Pills on Chōji, something Chōza stated would have been impossible if she weren't there. Tsunade has also been noted to be capable of making powerful sleeping potions that are also colourless; so much that she is the only one in the world who could spike a drink without a ninja knowing it was drugged.

With her remarkable knowledge of the human body and converting her chakra into electricity, Tsunade is capable of sending electric waves into the opponent's nervous system by striking the back of the neck. This then scrambles the electric signals within them and disrupts the way their body moves, such as attempting to move the right hand would cause the left leg to move instead, and so on. It is unknown if this is Lightning Release. In a similar manner, Tsunade has also shown the ability to use medical ninjutsu adversely and use it to harm, even kill, instead of heal. She can use a single chakra-infused strike to effortlessly cause internal damage or incapacitate a target as she did the latter to Shizune when she tried to stop Tsunade from meeting with Orochimaru. Tsunade is also able to create a chakra scalpel both for surgery and to inflict internal lacerations and even attack the internal organs.

The most extreme example of her medical prowess is her Creation Rebirth, a technique that makes use of the massive amounts of chakra stored in her Yin Seal: Release to continuously create new cells in her body, healing any wound and even growing back missing organs. It gives her a form of "immortality" in battle that even Orochimaru expressed envy for. However, as cells can only divide and be created a set amount of times, the technique shortens her life-span. Because of the risk associated with the technique, Tsunade only uses Creation Rebirth in extremely desperate situations. This technique is considered as the absolute pinnacle of medical ninjutsu, and Tsunade developed it under the resolution of protecting those dear to her. She also created an extension of the Creation Rebirth known as the Strength of a Hundred Technique, which causes the seal to extend all the way down her body. While this technique is active, any wounds Tsunade receives will heal instantaneously, without the need to make hand seals or even a conscious effort.

She was also able to instantly heal Shikamaru, who was suffering from severe chakra depleting simply by laying her hands on him.

Summoning Technique
Tsunade can summon slugs of varying sizes, although she has only ever been seen summoning Katsuyu. The slugs' primary abilities seem to revolve around spitting acid and splitting into smaller slugs. Tsunade apparently has a mental connection with Katsuyu, as she was able to get reports and send out messages through Katsuyu during the invasion of Pain. Tsunade can transfer her chakra to a large number of slugs over long distances. By having the slugs spread out and attach themselves to wounded individuals, Tsunade is then capable of healing multiple injuries at different locations simultaneously. This technique proved particularly helpful during the Invasion of Pain which helped Tsunade preserve the life of the villagers even after a devastating attack by the enemy forces.

Intelligence
While normally appearing carefree or short-tempered, Tsunade is a capable leader. A keen thinker, Tsunade is also highly observant and analytical, allowing her to see through most deceptions, and is rarely caught off-guard. Most commonly, Tsunade will choose the best ninja available to construct a team after looking over the assigned mission. In the anime, she was able to analyse and replicate the basic mechanics of Kabuto’s regeneration technique to aid in bettering the chances of Rock Lee's life-risking surgery being a success.

Her intelligence is most renowned as the best in the world for her expertise in all areas of medicine. She has been credited with creating the official medical-nin system and the laws that govern them. She can immediately determine what kind of injuries or illness (physical or mental) a person has from a single glance. In addition to this, Tsunade seems to have a vast knowledge of poisons and herbal medicine, as noted by Chiyo who stated that during the Second Great Shinobi War, Tsunade was the only one capable of countering all her poisons perfectly. She also has remarkable knowledge of the human psyche, as she was able to effortlessly undo the damage to Kakashi and Sasuke's minds inflicted by Itachi's Tsukuyomi in a matter of seconds. Tsunade has also proven to be a very capable teacher, having single-handedly trained Sakura and Shizune and passed on much of her knowledge make them become two of Konoha's best medical-nin and field support.

In battle, she has shown great ingenuity, able to quickly pick up on her opponent's fighting style and battle pattern to better avoid damage and plan her attacks around that. These traits are to keep herself alive in battle so she may heal her team-mates; things she drilled into Sakura while training her. Her mental fortitude is also noteworthy, as she overcame her paralysing fear of blood through willpower alone, something every eyewitness found miraculous.

Other Skills
Tsunade is also well-versed in fūinjutsu, capable of developing an S-rank seal that continuously stores up chakra for various reasons including using the high-level techniques such as the Creation Rebirth technique which she also created. In the anime, Tsunade demonstrated noticeable skill in a variety of other areas. When dealing with the Legendary Stupid Brothers, her skill in genjutsu was great enough to bind the immensely strong duo at once. She was also able to use Space–Time Ninjutsu to send one of Katsuyu's divisions to Team Three's location despite the great distance. She is also highly adept in barrier ninjutsu; able to design the Four-Corner Sealing Barrier from scratch, which can be used to seal a tailed beast.

Search for Tsunade Arc
After his failed invasion of Konoha cost him his arms in the aftermath of his fight with Hiruzen, Orochimaru sought out Tsunade to heal his arms. Declining at first while noticing is arms, Kabuto Yakushi complemented Tsunade's talent while saying that she's the only one in the world who can cure Orochimaru or kill him. Inspecting the injury, Tsunade learns that it was inflicted on her former team mate by Hiruzen, whom Orochimaru killed in battle. Shocked upon hearing that revelation, Tsunade attempts to kill Orochimaru before he offers to use Impure World Reincarnation to bring back Dan and Nawaki as payment for her services. Seeing that she was tempted by this offer, Orochimaru left her a week to consider his proposal.

Soon afterwards, Tsunade was approached by Jiraiya, who wanted her to become the next Hokage. After she disrespectfully turns down the offer, an enraged Naruto challenges Tsunade to a fight for her ridiculing of the title. Though she easily beats him in the match, Tsunade shows interest at Naruto's attempt of using the Rasengan and makes a bet with him: she would give him Hashirama's necklace if he could master the technique within a week and he would give her all the money he had on him should he fail. Naruto accepted the bet, and Tsunade kept a careful eye on Naruto's progress throughout the week while contemplating Orochimaru's offer. When the week was up, and Naruto appeared to have failed in mastering the technique, she drugged Jiraiya so he would not meddle and went to meet Orochimaru.

Though it seemed she was able to heal Orochimaru, having him promise not destroy Konoha once his arms were healed, Kabuto exposes Tsunade's actual intent to kill Orochimaru. Her motives known, Tsunade revealed that she knew Orochimaru has no intention of honouring his promise to leave Konoha alone, and that she couldn't bring herself to let him attack the village again even if it meant seeing Nawaki and Dan again. While she had tried to forget this fact over the years, Naruto's determination and desire to be Hokage reminded her of their dreams, and she had decided to do whatever was necessary to protect those dreams.

With that, Tsunade attacked Orochimaru, though Kabuto fought her in his place. However, realizing that he is completely outmatched, Kabuto slits his wrists to use Tsunade's hæmophobia against her before Shizune and Naruto came to her rescue. While he and Shizune were easily defeated, despite Tsunade telling him to run, Naruto was able to overcome his injuries and manages to defeat Kabuto with a perfected Rasengan in his effort to protect her. As Naruto collapsed and in critical condition, Tsunade manages to heal him and giving him Hashirama's necklace in hope he would become a Hokage.

Orochimaru, worrying about what kind of threat Naruto might become when he got older, attempts to kill him, though Tsunade blocks that attack with her body. When inquired as to why she was protecting Naruto, Tsunade replies that Naruto would someday be Hokage, and that she would not allow him to die before that happened. With that, Tsunade accepted the title of Fifth Hokage while overcoming her fear of blood to eliminate Orochimaru. Joining forces with the still drugged Jiraiya, the two attacked Orochimaru. After a battle of summons, Tsunade dealt the finishing blow to Orochimaru. Defeated, Orochimaru escaped, vowing to destroy Konoha once he'd healed himself. Once Naruto recovered, the group returned to Konoha where Tsunade begins her term while secretly believing that Naruto would someday become her successor. Also, like with Nawaki and Dan before Naruto, Tsunade gives him a kiss on the forehead to show her faith in him.

Sasuke Retrieval Arc
Soon after arriving in Konoha to take her place as Hokage, Tsunade healed the mental injuries inflicted by Itachi Uchiha's Tsukuyomi on Kakashi Hatake and Sasuke Uchiha. She also gave a grim prognosis on Rock Lee's condition. She stated that the only procedure that could allow him to return to duty as a ninja was one that she alone was capable of performing, and it only had a fifty percent success chance that could prove to be fatal for Lee. Not wanting to take such a risk, Tsunade advised Lee that it was best that he retire as a ninja and find another profession. However, upon seeing Lee's resolve to become a ninja and the Will of Fire which burned within him, she decided to conduct the surgery.

In the anime, while Lee is struggling to decide what he should do, Tsunade looked into ways to improve his chance of survival. Thinking back to how she had seen Kabuto withstand Naruto's Rasengan, Tsunade used Kabuto's technique as a basis to improve Lee's chances of survival from fifty to fifty-eight percent. Lee finally agreed to undergo the procedure, and survived.

When Sasuke defected from the village so that he could go to Orochimaru, Tsunade was forced to send out a group of genin to try and stop and retrieve him, due to lack of manpower. She also used Konoha's reacquired alliance with Sunagakure to call in a favour for reinforcements, hoping to give the retrieval team some back-up. Despite her efforts, the group ultimately failed, and Tsunade helped in healing their mortal injuries, bringing them back to full health. She was particularly instrumental in the healing of Chōji, mixing the antidote to the side effects of the Three Coloured Pills that she got from the medical encyclopaedia kept by the Naras; a fact Chōza gratefully stated. In the aftermath of Sasuke's betrayal, Sakura Haruno asked to become Tsunade's apprentice, which Tsunade gladly accepted.

Pre-Shippūden Filler Arcs
Tsunade appeared in numerous filler arcs, though she typically did nothing more than sending others out on missions, occasionally trying new ways of deciding who would go on a specific mission. Her goal during the filler arcs was to keep Naruto busy until Jiraiya came back, to prevent him from going after Sasuke himself. When the Legendary Stupid Brothers escape from prison, she convinces them to surrender with a quick display of genjutsu and her strength. In another filler, she summoned Katsuyu to deal with some impersonators of Rock Lee and Might Guy, who had entered the village. Later, as Jiraiya and Naruto left the village to begin their two-year training, Ino Yamanaka approached Tsunade with the request of studying medical ninjutsu under the Sannin, to which she presumably agreed.

Part II
During the next few years while Jiraiya and Naruto were off training, Tsunade continued her duties as Hokage and her tutelage of Sakura as a field medical-nin. Also during this time, the Hokage Monument was altered to include Tsunade's face in chronological order.

Kazekage Rescue Arc
While taking care of reports for genin missions, Tsunade learned that Jiraiya and Naruto had returned. Tsunade then decided to test Naruto's, as well as the now chūnin Sakura's, growth as ninjas by pitting them against their former jōnin-sensei Kakashi. After the two succeeded in their challenge and received praise from Kakashi, Tsunade officially made them a unit under their old name "Team Kakashi".

Later, while deciding on Team Kakashi’s first mission, Tsunade received word from Sunagakure that the Akatsuki had abducted Gaara, now the Fifth Kazekage. Out of respect for the Konoha-Suna alliance, Tsunade sent Team Kakashi to assist. A few days later, Tsunade had a bad premonition when she discovered she won a major sweepstakes and sent Team Guy as backup for the mission in response.

Sasuke and Sai Arc
After Team Kakashi and Team Guy returned from rescuing Gaara, Tsunade was informed that the fallen Akatsuki member Sasori had intended to meet an agent of his working within Orochimaru’s ranks. Seeing the chance to get intelligence on Orochimaru, Tsunade decided to have Team Kakashi capture this spy. Unfortunately, the elders were against letting Naruto go out on dangerous missions as the Akatsuki sought to capture him. Tsunade sternly voiced her belief in Naruto. The elders ultimately yielded under the condition that Tsunade added one of the men of Danzō Shimura, Hiruzen's fierce rival and leader of the ANBU Root division, to Team Kakashi. With Kakashi currently hospitalised, Tsunade also added an ANBU agent codenamed "Yamato", mainly for his ability to utilise the Wood Release and its ability to suppress the tailed beasts, should Naruto get out of control. She also warned Yamato to keep an eye on Danzō's addition to the team, Sai.

After Team Yamato returned, having failed their mission but gained new information on Sasuke, Tsunade surmised that Sasuke’s immense growth may have come from the assistance of Orochimaru’s use of kinjutsu and Kabuto’s medical ninjutsu. Tsunade was also troubled to learn that Danzō, in his self-righteous ideals, was willing to give the enemy top-secret information in an effort to complete the mission as Sai was instructed to give Orochimaru ANBU data should they meet.

Twelve Guardian Ninja Arc
In the anime, word reached Konoha that several villages on the Fire Country’s borders were being attacked. Tsunade sent several teams to investigate. She also sent Team Yamato to investigate several tombs near the Fire Temple being disturbed. When Team Yamato returned, they informed Tsunade that the tombrobbers were apparently after corpses of four former members of the Twelve Guardian Ninja. Team Yamato also brought an unofficial new member to the team from the Fire Temple to replace an injured Sai, a young monk named Sora. Tsunade also received a message explaining Sora’s troubled past and unusual powers that he is not able to control that lead to great damage of the Fire Temple.

Later, Tsunade had the ANBU apprehend Danzō due to his recent and possibly treacherous actions and ninja from the Amegakure with Danzō. Before she could interrogate the man, the elders arrived. They revealed that the Rain ninja was a double-agent working for them. The elders explained the same tombrobbers Team Yamato encountered may also be after Sora. The elders and Danzō came to the conclusion they should confine or eliminate him. Before Tsunade could voice her refusal, Sora was found spying on them. Convinced that Tsunade wanted to eliminate him, Sora became furious at her. Sora then asked Asuma if it was true that Asuma killed his father Kazuma. When Asuma sadly admitted it, Sora’s rage unleashed his hidden powers and was able to escape.

Later while Tsunade was deciding what to do about Sora, the village had a complete power-outage, thanks to the tombrobbers. They arrived in the village and surrounded it in a giant barrier. They voiced their distain for Konoha as they viewed as an imbalance to the Fire Country’s power and sought to destroy the village. As they overwhelmed Konoha’s forces with a zombie resurrection technique due to most of the ninjas being outside the village, Tsunade discussed the situation with Shikamaru. It was determined through Asuma that the tombrobbers intended to destroy the village with the deadly Limelight technique through the four resurrected guardians.

After the tombrobbers were defeated and Sora was purged of his powers, Tsunade forgave Sora for his mistakes and was allowed to leave the village in peace.

Hidan and Kakuzu Arc
Later, when two Akatsuki members entered the Land of Fire — namely Hidan and Kakuzu — Tsunade mobilised the Nijū Shōtai to look for and if possible, capture the Akatsuki duo. While capture never came to be possible, the Akatsuki members were both defeated. Tsunade later performed an autopsy on Kakuzu, and found Naruto's newest technique, Wind Release: Rasenshuriken to be too dangerous for use, based on the damage done to Kakuzu's body and Naruto's arm. She explained that the attack had struck at a cellular level, causing extensive damage to the both of them, and regretfully told Kakashi and Yamato not to allow Naruto to use the technique again.

Three-Tails Arc
In the anime, after finishing her autopsy on Kakuzu, Tsunade received a report from a deceased ANBU captain about Orochimaru and Sasuke's whereabouts. She called for Kakashi, and put him in charge of Team 8 to investigate. Because the mission involved a chance of finding Sasuke, Tsunade tried to keep Naruto from finding out about it. He found out anyway, so Tsunade didn't hesitate to send him as back-up.

Later, Tsunade received news that Team Kakashi had encountered the Three-Tails. Deciding that they needed to capture the beast quickly, as to not let it fall into enemy hands, Tsunade ordered Tenten, Rock Lee, and Ino Yamanaka to aid Team Kakashi in sealing the beast. Before sending them out, Tsunade made a large and special scroll to aid the team in sealing the beast. She also decided to summon and send out Katsuyu for further assistance. When the forces they sent continued to have problems with the sealing, Tsunade called them back to Konoha, and sent some ANBU to replace them. After she heard about the ANBU losing contact with Konoha, and the disappearance of the Three-Tails, Tsunade suspected that Akatsuki were somehow involved.

Itachi Pursuit Arc
Tsunade assigned Team Kakashi and Team Kurenai on a mission to find Itachi Uchiha in the hopes that it would lead them to Sasuke. Jiraiya later comes to inform her that he had found the location of the leader of Akatsuki. Despite her insistence for his location to formulate a surprise attack, Jiraiya instead invites Tsunade for drinks, which she ultimately ends up agreeing to it. While in Shushuya, Jiraiya reveals the details of the Akatsuki's leader and that he was in Amegakure and the difficulty of getting into the village. As Jiraiya declares that he would infiltrate the village on his own, Tsunade objects but Jiraiya reminds her that he is one of the Legendary Sannin and what that meant. After the two reminisce a bit, Tsunade tells Jiraiya to come back alive and if he needed help to send a toad and she'd come in person to back him up. On departing, Jiraiya tells her to remain cautious of Root.

Tsuchigumo Kinjutsu Arc
In the anime, word reaches Konoha that the Tsuchigumo clan's fort protecting a powerful forbidden technique was under attack. With Team Kakashi and Team Kurenai being the closest, Tsunade sent Katsuyu to inform them of their mission to aid the Tsuchigumo clan, in accordance with the peace treaty the Third Hokage made with them. Tsunade later receives word from the teams that they and the clan have considered destroying the technique to end the possible danger it can cause.

Invasion of Pain Arc
When word reaches Konoha of Jiraiya's death, Tsunade makes the village's top priority to analyse the clues Jiraiya gave them to uncover Pain's identity. While the likes of Shizune, Ibiki, and Shikamaru are hard at work, Tsunade allows herself an opportunity to cry for her old friend, remembering all the the memories they had share in their youth. Naruto, just as badly affected by Jiraiya's death as Tsunade, went away to train, both of them knowing that he was Pain's next target.

When the invasion of Pain began, Tsunade tried to send word for Naruto to return home. She was stopped by the Konoha Council, who feared his capture by the Akatsuki. However, Tsunade insisted that they must have faith in Naruto, along with the rest of the next generation, and so they relented. Tsunade began issuing orders for the village's defence, placing extra protection around those still working on Pain's secret. She summoned Katsuyu, and had her divide and seek out every villager so that she could protect and heal them remotely.

While sitting in the middle of a seal guarded by ANBU, transferring her chakra to Katsuyu, she was found by Pain's Deva Path, whom she recognised as one of the orphans Jiraiya had trained in the past. Tsunade refused to tell it where Naruto was, proclaiming that Akatsuki was just a terrorist group and that Konoha would not give in to their demands. Despite this Pain discovered Naruto's location through other means, the Deva Path resolved to make Tsunade see what Akatsuki's true goals were, by witnessing peace.

When the Deva Path jumped into their air, Tsunade and her ANBU followed only for the village to be destroyed. In the few moments between when the destruction began and ended, Tsunade poured all her chakra into Katsuyu in order to keep the villagers safe. In the aftermath, she confronted Pain, who attempted to kill her with his Asura Path. It was stopped by Naruto, who informed Tsunade that he would personally deal with Pain. Leaving a clone of Katsuyu with Naruto, Gamakichi carries Tsunade to Sakura. Having used up almost all of her chakra, Tsunade's elderly form resurfaced, she then falls into a coma and does not see Naruto's victory over Pain.

Chikara Arc
Tsunade tasked Team Kakashi with the mission to investigate the massacre of the Tonika Village. She noted that she wished that she could send more persons along with them, but currently they were elsewhere investigating a grave robbery and the theft of Hidan's Triple-Bladed Scythe from the Nara clan's forest. She later showed Kakashi Hatake, Might Guy and Shikamaru Nara the results of Team Kakashi's observations and sends them out to assist them.

Confining the Jinchūriki Arc
While Tsunade remained in a comatose state, Danzō Shimura was chosen to replace her as the Candidate Sixth Hokage. However, he was killed by the now-international criminal Sasuke Uchiha after the Kage Summit and the village prepared to make Kakashi Hatake the new Hokage, but Tsunade woke up before the appointment could be finalised. Tsunade learned of everything that happened while she was in her coma; the start of the Fourth Shinobi World War, the Shinobi Alliance, and the "identity" of Tobi. After replenishing her chakra levels, she convened a war council to prepare the village for the impending war. In the anime after the war council, she calls a private meeting in her temporary office as they discuss the impending war.

Three days later, Tsunade goes to Kumogakure to meet with the other heads of the Alliance. She is warmly greeted by the Fifth Mizukage while the Third Tsuchikage suggests she retire so that she can finish recuperating. When they get down to business, Tsunade learns that the other Kage have decided to send Naruto and Killer B into hiding to keep them safe from Akatsuki. Tsunade argues against this, believing that the jinchūriki will be valuable assets in the coming war. The other Kage insist that it's for the best and the Fifth Kazekage reminds her that she must also take others' views into consideration. She eventually agrees with their decision, albeit reluctantly. Later, she helps organise the joint armies, placing particular interest in the Logistical Support and Medical Division and the Intelligence Division. In the anime after the meeting with the other heads of the Alliance she requests the Fourth Raikage that B teaches Naruto to achieve the control over the Nine-Tails.

Shinobi World War Arc
Later, Tsunade remained at headquarters with the Raikage and the Tsuchikage, providing input when needed. When the First Division engaged several reincarnated ninja, Tsunade was disturbed by the possibility that Dan may be amongst their numbers. She is later surprised by news that enemies on the battlefield contained the Nine-Tails' chakra.

When more news reached headquarters of Naruto and B's escape from their confinement, the Raikage asked Tsunade to help him deal with them. She summoned Katsuyu and leaves a clone at headquarters, taking another Katsuyu with her so that they could keep up-to-date on any urgent matters at headquarters. When they intercepted Naruto and B, Tsunade was amazed by Naruto's subjugation of the beast. Naruto appealed to Tsunade to let him and B pass, but she informed him that she could no longer act independently, and must do what was best for the Alliance. Naruto tries to escape but was stopped by the enraged Raikage, who voiced his willingness to kill Naruto and B if they would not submit. Upon hearing this however, a shocked Tsunade, told him that she would not allow him to do any such thing.

Turning to oppose the Raikage instead, she remembered Naruto's words, that he would not die until he became the Hokage, and argued that even if Naruto being killed delayed the enemy's plan, that it was unlikely that another jinchūriki would have the same success as Naruto had with controlling the Nine-Tails, and going against A's instructions, she would allow them to enter the battlefield. When despite this it seemed as though A would not be swayed, Tsunade was intent on fighting him, but, as it turned out, A was testing Naruto one final time and then agreed to let him and B continue on to the battlefield when the young man proved himself.

Upon returning to headquarters, Tsunade reviewed the data from the Logistical Support and Medical Division autopsy and was disconcerted by what Madara Uchiha and Orochimaru had done with her grandfather's DNA, and concluded that harvesting the cells was probably what had allowed Madara to live for so long. When A asked if there were any hints on how to defeat Madara, Tsunade replied saying that Madara may in fact be the true definition of the word "immortal". She then told Shikaku to inform Naruto and B about the White Zetsu Army clone's transformation ability.

Having heard a report from Inoichi about the progress that the Alliance was making on the battlefield after Naruto's release, Shikaku commented that they were gaining the upper hand. At this, Tsunade smiled at A triumphantly. They are subsequently told, however, that a new chakra had been sensed in the region of the Fourth Division. This was confirmed to be the real Madara Uchiha which sent those at headquarters into confusion. Mabui inquired about the reason behind the masked man assuming the name "Madara", to which Tsunade responded that, even more than a name, Madara was an ideal which struck fear into people from just the simple idea of him. A sudden tremor was felt, and after hearing the report from Inoichi that a meteorite had been dropped on the Fourth Division, and hearing Ao report that the lives of several shinobi had been lost, Tsunade decided to head out to the front-lines of the battlefield personally.

Adamant about her decision, she told Mabui to prepare her Heavenly Transfer Technique to transport her there. Mabui protests however, saying that her technique was not intended for use on living organisms. She comments that the Third Raikage was the only one able to withstand her technique because of his special body. Shikaku also tried to dissuade Tsunade, telling her that it was a huge gamble regardless, and reminded her that she wasn't so lucky when it came to gambling so they should have the Hokage Guard Platoon use the Flying Thunder God Technique to transport her instead.

Though she admits that she is bad at betting money, she argued that it was a different matter when it came to her life, citing that as the reason why she’s still alive also claiming that they should use the Flying Thunder God Technique to transport Mei, since they needed a way to deal with Madara's Fire Release techniques, and that she would simply use her Strength of a Hundred Seal to heal any damages. Despite Mabui's insistence, A told her to prepare the technique for two, as he would be accompanying Tsunade.

Mabui eventually conceded to the order, and used her technique to send them to the battlefield. Upon their arrival, Tsunade attacked Madara immediately with a kick sending him flying while A attacked Mū simultaneously. Sustaining some minor injuries in transit, she released the seal on her forehead and used her Creation Rebirth technique to heal herself. Standing up alongside all the other Kage, she faces Madara prepared to fight.

As the battle with Madara began, Tsunade stated that first she would heal Ōnoki and Gaara's injuries, and asked Mei and A to hold off Madara while she did so. As she was healing them, Naruto questioned her on why she hadn't collapsed after using Creation Rebirth when she arrived. Tsunade responded, telling him that this instance is different compared to the scale she had to use it on during Pain's invasion, as this time she was only healing her own injuries which were nowhere near as bad as the injuries she healed during Pain's invasion. Naruto asked to be healed despite being a clone, so he could join the battle as well, but Tsunade told him that there was no need for that — Ōnoki then went on to explain that the war was no longer just about protecting him. After being completely healed, Ōnoki and Gaara join the battle just in time to protect everyone from Madara's attack. As Madara is downed by the Kage's combined assault, Naruto turned to Tsunade, but was told by Ōnoki that this battle is no longer Naruto's to fight. Tsunade told Naruto that they could only win if they defeat both Madaras — stating that while they protected him from the reincarnated Madara on this side, he needed to protect them from Tobi. With that, Tsunade and the rest of the Kage give Naruto a message, telling him simply to "win" as the clone dispersed.

As the battle continued, Tsunade took up a supplementary role and hung behind the main battle to heal the other Kage whenever they got injured. As Madara used the Wood Release: Advent of a World of Flowering Trees technique, Tsunade was visibly shocked to see him use her grandfather's technique before calling out to Gaara, who suspended them above the attack. She then told the other Kage to ensure they didn't inhale any of the pollen, but the Kage however were ambushed and knocked back to the forest floor by Madara's Susanoo. Inhaling the pollen, they fell unconscious until Ōnoki managed to destroy the trees and part of Madara. Tsunade later stared in shock as she sees the face formed from her grandfather's DNA jutting out of Madara's now-exposed chest.

As Madara regenerated he asks Tsunade if she was a descendant of the man on his chest. After this was confirmed, he declared that she would be the first to die. As Mei states that attacking the medical-nin in a team was a common tactic that they'd never allow, Madara tells them that it was not because she was a medical-nin, but because she was a Senju descendant whom he has deemed to be weak in comparison to her grandfather, who could also use medical ninjutsu. After Madara recounted Hashirama's skill with medical ninjutsu, stating that Tsunade's paled in comparison, Tsunade stated that even though she was a descendant of Hashirama who could not use Wood Release, and admits that her medical ninjutsu paled in comparison to her grandfather's — whose techniques did not require hand seals — she stated that Madara was wrong in thinking that she was weak. She then went on to declare that more so than the abilities she did not inherit from her grandfather, she inherited his Will of Fire, which Madara should not take so lightly.

As she denounced Madara's claims, she told him of the four rules she created for her students and medical-nin alike stating that she was the only one who was allowed to break these because of rule number four: only those that had mastered the Creation Rebirth technique were allowed to break the other three rules and engage directly in battle. With this she completely released her Strength of a Hundred Seal, activated the Strength of a Hundred Technique, and confronted Madara — cracking his Susanoo's ribcage with a single punch. As Madara counter-attacked with the Fire Release: Great Fire Destruction technique, Mei intercepted this and countered with the Water Release: Water Formation Pillar technique and then sent Madara flying into the air with the Water Release: Water Dragon Bullet Technique. With this, A, Ōnoki and Tsunade prepared a twofold attack which sends Madara plummeting into the ground. Barely giving him time to relent, Tsunade chided him again about inheriting the Will of Fire as opposed to something physical wondering whether or not he was even listening.

Attacking once again, Tsunade was able to land a blow to Madara directly which destroyed his entire right side. Seemingly incapacitated enough, Gaara bound and sealed him. As Tsunade congratulates the other Kage, her face widened in shock as one of Madara's Susanoo Swords emerge from the ground and impaled her. As Madara emerges from a root, he revealed that what they had sealed was nothing but a mere wood clone and that when Hashirama used it during their battles, he was the only one that was able to distinguish the clone with the use of his dōjutsu.

Just as Madara sets his sights on the other Kage — believing her to be dead — Tsunade broke the sword lodged in her abdomen and, in one fluid motion, swung it at him, but Madara managed to block it by using his Susanoo's ribcage. Tsunade was then sent flying back when Madara attacks her with his Yasaka Magatama technique — crashing into a wall. She emerged seemingly unaffected by his attack as her wound heals. Madara praised her for this, and compared her technique to Hashirama's, though she admitted that she had just intended to create an opening for an attack, but Madara was also able to nullify Ōnoki's sneak attack.

Jeering Madara, Tsunade stated that it was true that he was able to outwit them with his wood clone, but, that at the same time it could be said that they had cornered him into using the clone. This causes Madara to use the Multiple Wood Release Clone Technique, sending five clones to fight each of the Kage. With this he asks them whether or not they'd prefer the clones use Susanoo, much to the Kage's collective shock.

As the battle raged on, Tsunade sent one of the Susanoo-clad clones plummeting into the ground. After A berated her increasingly reckless actions Tsunade reminded him that she had already stated she would bet her life and removed the two broken Susanoo blades from her abdomen. This however, caused her some pain and she coughed up blood. Spurred on to stand and fight by Ōnoki once more, the five Kage regroup and launch a new strategy with Tsunade transferring some of her chakra to Ōnoki in order to facilitate his large-scale Dust Release: Detachment of the Primitive World Technique which results in them taking out all twenty-five clones in one shot. After a follow-up combo attack from A, Mei, and Gaara, Madara acknowledges that they are indeed worthy of their Kage titles, and manifests his complete Susanoo. After Susanoo is completed, Tsunade along with the other Kage stared in shock at the humongous construct. Now realising the difference in power between the Kage and Madara, Tsunade wondered whether her grandfather really fought and defeated someone like that before being knocked down by a swing of Madara Susanoo's sword. As they regained their footing, she and the other Kage stood to face Madara once more. As Madara prepared to deliver another devastating blow with his sword, Tsunade formed a seal, seemingly prepared to counter the attack. However, Madara's attack is halted as he was then enveloped by a light of sorts and it appeared as though he was about to be released, she wonders who could possibly have stopped the Impure World Reincarnation since the Alliance was still in the process of searching for Kabuto.

Ōnoki cautioned his fellow Kage as Madara made a last desperate attempt to attack them, using the Fire Release: Dragon Flame Release Song Technique. Intercepting the attack, Tsunade dissipated the flame dragons with her bare hands. Her arms are burned in the process, and though Strength of a Hundred Technique was able to repair the damage, the technique wore off shortly afterwards and her Strength of a Hundred Seal disappeared as her chakra reserves depleted. As she began to lose consciousness while still in mid-air, Madara prepared to impale her with his Susanoo's sword once again, but Tsunade miraculously dodged the blow. As she wondered what it was that saved her, she heard a voice inside her subconscious where she saw Dan standing before her. He commented that she hadn't changed since he was alive, still taking risks in combat, but then thanked her for achieving what he didn't by becoming Hokage and apologises for bringing so much pain into her life with his death. He stated that he would be waiting for her on the other side, but insisted that she not come too soon, as she was his dream itself. He left her with a kiss on her forehead, reminiscent of the one she gave him decades before, grateful that he was able to protect her, even if it meant being used in the Impure World Reincarnation. Before departing, he gave her the remainder of his chakra and as the Strength of a Hundred Seal reformed, Madara commented that she has regained her vitality and wondered how that could be, to which she simply replied saying she had met an old friend. With Madara having broken the Impure World Reincarnation technique's contract with the summoner, however, the Kage now faced an opponent with limitless chakra, and an immortal, uncontrolled body.

Ten-Tails Revival Arc
Despite the Kage's attempts to stop Madara, they ultimately failed and were left heavily wounded, with Tsunade bisected. Despite her condition, Tsunade was able to muster enough energy to summon Katsuyu. Distressed by its master's condition, the slug immediately stated that it would put her back together. Tsunade instead asked Katsuyu to first bring the heavily injured Kage to her, stating that she would save them first before healing herself. Later, she was approached by a revived Orochimaru, who remarks about her current state. He was joined by Karin and Suigetsu Hōzuki. Orochimaru ordered Suigetsu to aid Katsuyu in re-attaching Tsunade's bisected body. Meanwhile, Karin allowed Tsunade to bite down on her arm in order to heal her wounds. After she'd recovered, Tsunade thanked Orochimaru and reluctantly admitted that he seemed to have changed since being sealed by Itachi, though she also noted that had he changed earlier, Jiraiya might have still been alive.

Just before they parted ways, Tsunade was shocked to find out that Katsuyu's other half was already on the battlefield, and she could in fact update them on the situation there. Tsunade fully healed her fellow Kage, and the group prepared to head back to the battlefield as soon as possible. Atop Gaara's sand, the Kage make their way to the battlefield. Upon seeing the enormous tree ahead of them, Tsunade inquired to Katsuyu about the current situation. While making their way there, Tsunade and the others are startled when a telepathic link was opened and she heard the voice of her grandfather who warmly greeted her. Through this method, she listened on as her grandfather explained the situation and what Madara's intentions were. Later, As Naruto's anger at the loss of his comrades he had fought so hard to protect grew, his emotions and memories were conveyed to everyone within the telepathic link. Tsunade sympathised with Naruto over the loss of Jiraiya and later viewed her grandfather's memories of the first ever Summit of the five Kage before arriving on the battlefield as Hashirama declared his wishes for the future of the world.

Noting that they needed to disperse across the battlefield immediately to keep the morale going, Tsunade's first act was to head over to where a chakra-depleted Shikamaru was and expedite his healing before commending Sakura for a job well done. Heading over to her grandfather, she apologised to him for the state of things, she then told him that he himself had no need to apologise either as it was not only the ills of the past that got carried into this generation, but good things such as his indomitable Will of Fire. With this, she called out to her troops to prepare to fight.

As the troops around her charged forward, she and Sakura remained behind. Releasing their Strength of a Hundred Seals, Tsunade noted that with two of them able to use the seal they would be able to summon one tenth of Katsuyu's main body from the Shikkotsu Forest. As the slug appeared on the battlefield and began to deconstruct, Tsuande noted that they could use Katsuyu's body in this form to create a recovery area where the shinobi could heal themselves and continue fighting.

Return of Madara Arc
The Alliance is successful in defeating Obito, but as they charged forward to finish the Uchiha, Tsunade stopped them after seeing Minato and Kakashi with him. They soon realise that the war was not yet won after Madara Uchiha is revived. Their battlefield is soon assaulted by Guruguru and a miniature Sage Art: Wood Release: True Several Thousand Hands statue. As Tsunade wondered who was using the technique, Gaara arrived with Naruto in tow pleading with Tsunade and her students to help him, however, Tsunade noted that she not Shizune no longer hand enough chakra to use medical ninjutsu and directed Sakura who still had barely enough to help.