Tsunade

Tsunade (綱手) is one of Konohagakure's legendary Sannin. She eventually gained the title of Konoha's Slug Princess Tsunade (木ノ葉のナメクジ綱手姫). Though celebrated as the world's most powerful kunoichi, and its greatest medical nin Tsunade abandoned the life of the ninja for many years in pursuit of other goals. She is eventually persuaded to return to Konoha, and becomes the Fifth Hokage (五代目火影). Where she uses her strength to crush the village's enemies, and her medical knowledge to keep its villagers safe. Eventually she steps down, and gives Hatake Kakashi the position.

Background
Tsunade was born on the day of August 2nd to two unnamed parents. She is the very first grandchild and granddaughter of Senju Hashirama and Uzumaki Mito. Because Hashirama was the First Hokage of Konohagakure, this means that Tsunade is famously called a "Princess" (姫). Not surprisingly, Hashirama spoiled Tsunade greatly when she was very young because she was his first grandchild. He found her deviance and her adoption of his own gambling habits to be highly amusing; Tsunade also inherited his necklace when he had died. After she graduated from the Ninja Academy, Tsunade was teamed up with Orochimaru and Jiraiya under the leadership of Sarutobi Hiruzen. When Jiraya failed to acquire a bell during the team's first bell test, Tsunade teased him, but this prompted him to criticize her flat chest. Despite this remark, Jiraiya had a certain interest in Tsunade from their very first meeting, which only increased after her breasts developed; when she nearly killed him for spying on her while she bathed at the hot spring, he was forced to be more discrete about his interests.

After losing a gambling deal, Taunade was trying to figure out ways to win back with dice. But she was spotted by Orochimaru who was wearing a mask. Clueless on what is going on, Tsunade smashed the ground with her feet and was surprised to see Jiraiya. She then asked the two what was going on. Soon time later Tsunade's little brother, Nawaki dreamed of someday becoming the Hokage so that he could protect Konoha, their grandfather's legacy. On Nawaki's twelfth birthday, Tsunade kissed his forehead and gave him Hashirama's necklace in the hopes that it would help him achieve his dream. However he died the next day, a casualty of the ongoing Second Shinobi War, thus returning the necklace to her. Tsunade began advocating for the inclusion of medical-nin on all four-man squads in order to avoid future deaths like Nawaki's. Hiruzen agreed with her arguments, but could not dedicate resources to the necessary implementation due to the ongoing war. Kato Dan, on the other hand, shared her views, and as their relationship developed he confided with her about his dreams of becoming the Hokage so that he could bring change to Konoha and protect his loved ones from death. Tsunade kissed his forehead and gave him Hashirama's necklace in the hopes that it would help him achieve his dream.

Although their team under Hiruzen's leadership had disbanded, Tsunade, Orochimaru, and Jiraiya continued fighting together during the Second World War. They rest at a fire and talk about dreams, where Tsunade say she wanted to travel. The group fought enemy ninja for the rest of the night, with Tsunade using her fists. During one such fight in Amegakure, they were the only three to survive an encounter with Hanzō, for which accomplishment Hanzo nicknamed them Konoha's "Legendary Sannin". In the aftermath of the battle, Jiraiya opted not to return to Konoha so that he could train the Ame orphans. Tsunade would go on to make her own independent contributions to the war, frequently counteracting Chiyo of Sunagakure's poisons. Although Tsunade's actions are said to have won the war for Konoha, Tsunade was unable to prevent Dan's death, and her failure to stop his severe blood loss caused her to develop a fear of blood.

With Dan's death, Hashirama's necklace returned to Tsunade once again, convincing some people that the necklace was cursed to kill anyone who wore it other than Tsunade. Tsunade herself became convinced that achieving one's dreams was impossible and that to be the Hokage was a fool's job. She therefore left Konoha, taking Dan's niece, Shizune, who was very young at the time, with her to train her as an apprentice.

In the anime, Tsunade met the Fourth Raikage, A, after he and his followers were ambushed by the ninja of the Nokizaru Group. So they needed her help to remove an Exploding Insects implanted in A, and one of his followers. However, due to her phobia, Tsunade had Shizune carry out the surgery while she oversaw it until a bit of blood splattered on her, and she excused herself from the room.

Personality
Tsunade was very willing to believe in the attainability of dreams when Nawaki and Dan were alive, and that by supporting and encouraging those dreams she might be able to help achieve them. When both died gruesomely shortly after receiving her support, Tsunade lost faith in the idea of dreaming for anything, believing that the mere pursuit would be doomed from the outset. She becomes especially critical of wanting to be Hokage, as both Dan and Nawaki died trying to attain the title and the past Hokage have all died prematurely. As Tsunade argues, pointlessly because they held the position, she concludes that to be the Hokage is a fool's job.

However upon meeting Uzumaki Naruto, who demonstrates two things to her: just because a goal seems impossible does not mean it actually is. Since Naruto is able to master the Rasengan unprecedentedly quickly despite any seeming natural talent. Just because the dreamer dies does not mean the dream itself does, as Nawaki and Dan's desire to become Hokage lives on in Naruto. Because Naruto is so very much an exception to how she thought the world worked, Tsunade puts her faith in dreams once again, a desire so strong that she overcomes her fear of blood. She becomes Hokage herself, partly so that she can live Nawaki and Dan's dream for them, but also so that she can pave the way for Naruto inevitably holding the title. Just as she once did, Tsunade supports all other dreams that she can: when Rock Lee tells her he dreams of being a ninja despite knowing he may die trying, she does not argue his decision, and in the anime, does all that she can to ensure he survives.

As the Hokage, Tsunade is committed to protecting Konoha and its villagers, willing to give her life for her village and allies if necessary. She does this because Nawaki and Dan loved Konoha and so she keeps their dreams alive by doing so, but also because Konoha's continued survival honours all those who gave their lives creating it and keeping it safe. Although her reasons are somewhat different, the outcome is nevertheless consistent with the Will of Fire. Tsunade is similarly optimistic about the next generation of Konoha's ninja, especially Naruto, by being convinced that the village's future will be in good hands because of them. She in fact becomes angry when others lack this same faith in Naruto and his peers, believing it is better to let them try and then fail than to assume their failure is inevitable and thus prevent them from trying. Demonstrations of her own faith include: congratulating Nara Shikamaru for his failed mission because at least none of his teammates died. Along with not labelling Uchiha Sasuke a missing-nin because she trusts that Naruto can someday convince him to return to Konoha.

Despite her many noble qualities, Tsunade is not without her faults. She is blunt and short tempered, prone to striking Naruto for his immaturity or Jiraiya for his pervertness; she is widely feared because of this tendency and her temper. Her own behavior isn't much better than theirs, since she is a alcoholic, sleeps on the job when no one is around, and tries to have other people do her work for her. One of her favorite vices is gambling, which she acquired from her grandfather, Senju Hashirama. Despite how often and how irresponsibly she gambles, Tsunade has notoriously bad luck, causing those who have made huge profits off of her to call her "The Legendary Sucker" (伝説のカモ).

Tsunade is fully aware of how unlucky she is, and whenever she hits a winning streak she takes it as a bad omen and prepares for the worst. She has at times tried using her bad luck to her advantage, betting on outcomes she doesn't want so that her unluckiness will prevent them from happening. Hashirama finds Tsunade's many bad habits highly amusing on a personal level, but when he is told that Tsunade is Hokage he immediately worries about what misfortunes she's brought upon Konoha.

Jiraiya assumed that there was a mutual attraction between him and Tsunade from their first meeting, a statement that only served to annoy and anger her. Despite his many advances over the years, Tsunade never reciprocated his feelings, only loving Dan, even decades after his death. Jiraiya wasn't discouraged by this and claimed that her repeated rejections had not only made him stronger, but they've been excellent material for his Icha Icha series of books. Though he concluded that to be happy wasn't his fate. Tsunade doubted he believed his own words and she commented that he did not need to put on a brave front when he returned from Amegakure. When Jiraiya ended up dying during that same mission, Tsunade privately mourned for the loss of her dear friend and team-mate. Ultimately when trapped in the Infinite Tsukuyomi, her greatest desire was to be with her loved ones, while supporting Dan as he lived out his dream of being the Hokage. Despite this, she chose not to have Dan and Nawaki reincarnated when given the chance as she realized it would go against everything they stood for.

Appearance
Tsunade is a fairly tall, light-skinned woman with brown eyes and straight, blonde hair. Her hair is waist-length with shoulder-length bangs framing both sides of her face. As a child, she tied her hair in twin short pigtails before becoming Hiruzen's student when she then wore her hair in a high ponytail. As an adult, Tsunade usually ties her hair into two loose ponytails. Some time after leaving the village, she obtained a violet rhombus mark on her forehead similar to her grandmother's, which she uses as a chakra gathering point known as the Yin Seal. It will temporarily disappear when unleashing the conserved chakra and reappear after she has accumulated enough chakra. When she releases the Yin Seal, the diamond mark on her forehead opens out into a seal that usually extends to her jaws. When using the Strength of a Hundred Technique, the markings extend themselves around her entire body.

While only in her early fifties, her form is a frail and wrinkled old appearance, more so than her age would suggest. However, she maintains the appearance of her younger self through a unique and constant Transformation Technique. In her youth, the appearance she normally takes, she had a slender frame. Despite being known as flat-chested in her childhood, she now has a rather large bust; 106 centimetres in circumference, according to Jiraiya. Her beauty has been pointed out several times and she's been called the most beautiful kunoichi in the world by several characters.

She often wears a grass-green haori with the kanji for gamble (賭, kake) written in black on the back, inside a red circle. Underneath she wears a grey, kimono-style blouse with no sleeves, held closed by a broad, dark bluish-grey obi that matches her pants. Her blouse is closed quite low, revealing her sizeable cleavage. She wears open-toed sandals with high heels and red polish on both her fingernails and toenails. She also wears a soft light pink lipstick. She also used to wear her grandfather's necklace in clear view on her chest, before giving it to Naruto.

Abilities
Like other students of the Third Hokage, Tsunade is an exceptionally talented shinobi. It wasn't until the Second Shinobi War that their skills became widely known, being dubbed by Hanzo as the Legendary Sannin, the most powerful of their generation. Tsunade's skills are popularly held as the reason for Konoha's victory during that war, and in the years following, she became known as the world's strongest kunoichi. She is selected to be Konoha's Fifth Hokage in Part I, and it is because of her that many villagers are saved from death during Pain's invasion in Part II. When they first meet, Uchiha Madara characterizes Tsunade as weaker than Hashirama, only to later admit from fighting her that she does in fact possess some of her grandfather's natural talent.

Chakra
Tsunade has excellent control over her chakra, a necessary prerequisite to her job as a medical-nin. After the Second Shinobi War, she started gradually storing her chakra into the Strength of a Hundred Seal on her forehead. When the seal is released, Tsunade has access to all the accumulated chakra, totaling a so-named hundred times her usual chakra levels. Although she normally uses this extra chakra to heal injuries or perform her other jutsu, she can also transfer the chakra to others, either to replenish or amplify their own.

Taijutsu
Tsunade teaches her student, Haruno Sakura, how to build up chakra in her fists and release it on contact with a target, causing severe damage. Tsunade presumably uses this ability herself, but it isn't always clear when since she is naturally very strong, enough to lift Gamabunta's sword. Her physical accomplishments, whatever the cause, include: creating a fissure in the ground by striking it with one finger; breaking six of Jiraiya's ribs, both of his arms, and rupturing several of his internal organs, one of two near-death experiences in his life; breaking through Susanoo, an "absolute defense", with only a few punches.

Tsunade believes it is vital for a medical nin to avoid injury, as they cannot perform their duties if anything happens to them. To a certain extent, her unnatural strength helps her in this regard, as opponents may avoid getting near her so that she cannot strike them. At the same time, though, Tsunade is regularly injured in combat, even going so far as to place herself in harm's way in order to protect her allies. This is all because Tsunade deems her Creation Rebirth ability a reasonable exception to the "avoid injury" tenet, as she can receive serious damage and still survive. Even without the Creation Rebirth, Tsunade's ability to endure injury is quite impressive, as she can survive several mortal stabs to the chest and remain able to perform jutsu after being bisected.

Tranformation 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, 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 healed the psychological damage caused by Tsukuyomi, the damage done to Rock Lee's spine, and counteracted the effects of the Three Coloured Pills on Choji, something Choza 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 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.

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.

Nature Transformation
Tsunade's natures include Lightning, Fire, Water, and Earth, as well as Yin and Yang Release.[3] She isn't seen directly using any of these natures in the series, although her Body Pathway Derangement is suggested to use some amount of lightning chakra: she injects her chakra into an opponent, scrambling their body's electric signals so that commands to move their hand instead move their leg, and so on.

In addition to her other skills, the anime shows Tsunade using some amount of space–time ninjutsu,[36] fūinjutsu, and barrier ninjutsu. In the anime, within her own Infinite Tsukuyomi dream, Tsunade could perform the Four Red Yang Formation.

Intelligance
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 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
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. Tsunade is also well-versed in fuinjutsu, capable of developing an S-ran 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, she designed the Four-Corner Sealing Barrier which can be used to seal a tailed beast from scratch.

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 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 can could master the technique within a week with and he would give her all the money he had in his frog wallet if 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, realising 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 (Shizune losing the use of her legs and being knocked out), 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 Uchiha Itachi's Tsukuyomi on Hatake Kakashi and Uchiha Sasuke. 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. In the anime, while Lee is struggling to decide what he should do, Tsunade looks 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 an inspiration to expand on the life-threatening operation and improved Lee's chances of survival from fifty to fifty-eight percent. Lee finally agreed to undergo the procedure and survives.

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 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 Choji, 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 Choza gratefully stated. In the aftermath of Sasuke's betrayal, Haruno Sakura asked to become Tsunade's apprentice, which Tsunade gladly accepted.

Pre-Shippuuden Filler arc
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 Uzumaki 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 Maito Gai, who had entered the village.

Tsunade continued training Sakura in medical ninjutsu, along with keeping up her duties as Hokage. Shortly after Naruto and Jiraiya left, Yamanaka Ino appeared with a similar desire to Sakura for learning medical ninjutsu under Tsunade. Intrigued, Tsunade decided to test Ino, giving her three months to master resuscitation of an octopus to officially become Tsunade's student alongside Sakura. At the same time, she tasked Sakura with memorizing a large shelf of medical books. While keeping quiet about it, she noticed that the strong rivalry between Sakura and Ino helped in pushing the duo into improving. Ultimately, Ino passed her challenged and Tsunade began training Ino as well. Despite this, Tsunade decided to not train Ino beyond basic medical ninjutsu, feeling that it would simply better help her in learning her clan's secret techniques in the future.

Two years after Naruto and Jiraiya left, Tsunade decided to organize the next Chunin Exam early within Konoha, sponsored alongside Suna with their new ties alongside the Suna-nin. While wanting to also to restore Konoha's reputation after the interruption of the last Chunin Exam by Orochimaru's invasion, she also saw this as an opportunity to lure out the Akatsuki. While Gaara, now the Kazekage, agreed with this, he expressed his desire to host the exams personally in Suna. Ultimately, it was agreed to host the first exam within Konoha and the second exam within Suna. While Tsunade sent out an invitation to the other ninja villages, the other Kage all rejected the offer. At the same time, Tsunade sent Hatake Kakashi to Amegakure to deliver the invitation and investigate the rumors of a coup d'état on Hanzo. Later, Tsunade received word that Amegakure would join the exams. While this implied that the village was still its usual state, Tsunade was convinced it was a cover-up.

As word that Kusagakure and Takigakure would also join the exams, Shizune noted that Konoha has yet to apply any genin of their own. This resulted in Tsunade needed to even more paperwork than normal, much to her dismay. Later, when Tsunade heard that Sakura was personally handling an operation for a severely injured man, Tsunade was worried about Sakura and went to watch. Upon arriving, she caught Sakura in time as she overtaxed herself from the procedure, but not without successfully healing the man. As Sakura was resting in Tsunade's hold, the Sannin congratulated Sakura for how far she has come.

When approached by Kankuro, he tells her of the proposal of letting Sunagakure personally take charge of the second round as they are more familiar with their territory. Skeptical at first, she asks for additional reasons, ultimately allowing them the privilege, but not before stating that the jonin of the genin teams will still have to follow up with their team to Sunagakure.

Later, Kakashi return from his mission to report his failure at learning anything useful about Amegakure. He also noted that despite his seamless and stealthy re-entrance to the village, he was almost immediately pursued, forcing Kakashi to retreat out of the village. As Kakashi noted that with how the pursuers only knew of his general location and not that it was actually him, he concluded it was as if a ghost was watching, further troubling Tsunade. Later, Tsunade sent word to Konoha-nin in Sunagakure who were proctoring the exams to be on guard for anyone attempting to kill Gaara with new evidence showing that there were still many against Gaara being Kazekage.

Ultimately, the Chunin Exams were ended early before starting the finals due to controversy happening in the second exam. Instead, it was decided by Gaara that the a report on each participant would be sent to their respective village leader for them to decide if they would be promoted. After reading everything, Tsunade decided to promote all of Team Maito Gai, Team Asuma, and Team Kurenai. Also, upon Gaara's recommendation for his remarkable efforts in saving the Kazekage's life, Tsunade promoted Hyuga Neji to jonin rank.

Naruto Shippuuden (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 Uzumaki Naruto had returned. Tsunade then decided to test Naruto and Sakura's growth as ninjas by pitting them against their former jonin-sensei Hatake Kakashi. After the two succeeded in their challenge and received praise from Kakashi, Tsunade officially made them a unit under their old squad 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 Maito Gai as backup for the mission in response.

Sasuke and Sai arc
After Team Kakashi and Team Maito Gai 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 Danzo 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 Danzo'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 dead ANBU captain about Orochimaru and Sasuke's whereabouts. She called for Kakashi, and put him in charge of Team Kurenai 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 Yamanaka Ino 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 Uchiha Itachi 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 about Naruto and his parents. 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. 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.

Konoha History arc
Choji and Naruto bring lunch to Sakura and Shizune. Then Naruto leaves to assist rebuilding Ichiraku. When Choji says the saying, "Fools never catch a cold", Sakura has a flashback of catching Naruto's cold. When Sakura sees Tsunade at her office, she collapses which Tsunade claims Sakura has an illness known as a chakra virus. It was an illness long ago in another village that would turn chakra into a terrible flu and Naruto recently went to that village for a mission. Tsunade, not wanting to scare the villagers orders Shizune and a team of medical ninja to capture Naruto.

The medical-nin try to capture Naruto, thinking they are after him for overeating ramen but he escapes them every time. The next morning, Naruto finds the village deserted and gets shot at from a distance from one of the medical ninja. Naruto finds the ninja and questions him. The medical ninja tells him that the villagers have evacuated and that Tsunade ordered Naruto's capture with explaining the reason. Shizune and a team of medical ninja arrive and chase after Naruto who tries to locate Tsunade. Naruto finds Tsunade but tries to corner him with a bunch of tall walls. In each sides are Choji, Kiba and Tenten who are also ordered to capture Naruto though the groups of shadow clones they defeat do not contain the real Naruto.

The real Naruto flees to Konoha Hospital, distracting Aburame Shino with one last another shadow clone as he hides in one of the rooms. The room Naruto is in happens to be where Sasuke is still recuperating after their Land of Tea mission. Learning Naruto was the source of ruckus occurring outside, Sasuke kicks Naruto out of his room with medical ninja grabbing him. After getting results from Naruto, Shizune tells Tsunade that he doesn't have the chakra virus but sneezed due to pepper he had in his pocket and Sakura just has an allergic reaction from Naruto's sneeze. After he is released, Naruto demands an apology from Tsunade for her mistake though she covers it up by claiming the entire event as an "emergency drill".

Tsunade assigns Naruto to capture Mr. Ostrich who escaped again into Training Ground Zero. Unlike last time, Mr. Ostrich trained himself into becoming a nindachō. Tsunade has Kotetsu Hagane captain of the team of Naruto, Shino and Lee. Izumo Kamizuki learns of Kotetsu's mission and whines about not being with Kotetsu which annoys Tsunade. Kotetsu has Shino locate Mr. Ostrich with his kikaichū and the team manages to find him who laughs at Naruto. Shino has Naruto to try and distract him while he would surprise him with his bugs. Naruto makes an insult about Mr. Ostrich's father but makes a fool of himself instead. Shino's bugs get eaten by fly traps and the ostrich makes an escape. Lee runs after him but runs into a boxing kangaroo. Mr. Ostrich runs to Naruto and surprises him with his ability to speak. Naruto, Kotetsu and Lee all struggle in fighting against the powerful animals and decide to retreat.

Kotetsu decides for the team to longer hold back against them when suddenly Mr. Ostrich and the kangaroo find them. Mr. Ostrich, who now names himself Condor, is tired of humans domesticating animals and formed a team of ninja animals. Shino tries to sneak his bugs to Condor again but they are eaten yet again by an anteater that is part of Condor's team. The team battles against the animals, who prove to be a handful for them. Kotetsu decides to use his Conch Shell Mace to fight Condor who is knocked down by his powerful kicks. Izumo arrives and yells at Kotetsu to run from Condor's attack. Izumo uses his Water Release: Starch Syrup Capturing Field to trap Condor and Kotetsu manages to strike down Condor. The rest of the team manages to defeat the other animals they were fighting. Izumo arrived to help out Kotetsu but resulted in leaving a stack of Tsunade's paperwork unfinished. Kotetsu decides to make it up by finishing the work for him. The flashback ends and Naruto finds Condor who is surprised to see he escaped yet again and chases after him.

Lee arrives at Tsunade's tent and asks Sakura how she is feeling though Sakura nods her head no. Lee brought a bottle of medicine Guy made for her to get well and has a flashback of when Tsunade told him he could no longer become a ninja. Naruto and Sakura find Yamanaka Ino at the hospital who tells them they have a mission together. They say their hellos to Lee in his room. Lee accidentally drops his youth drink bottle that Gai made for him but catches it and drinks it all, putting Lee is dismay. With the drink, Lee would be able to recover a little faster. Naruto decides to go see Guy and have him make another drink. Guy appoints Naruto to a mission to go to Mount Jofuku to retrieve the Jofuku Flower, a medicinal herb said to cure any illness and the missing ingredient in the medicine he is making. Before setting off, Naruto puts on the green jumpsuit that Guy gave him.

Naruto meets Sakura and Ino at the village gate who were waiting to leave with Naruto to their mission. Naruto tells them of his mission at Mount Jofuku which is also the place of his team's mission. The team takes a break at a small tea soup where the old lady there warns them of Jofuku Forest that has ghosts of dead ninja wandering about. The team head to Jofuku Forest where they find a large sign blocking a path. Naruto decides to go through it with Sakura and Ino following him, having no choice. Naruto finds the Jofuku Flowers but upon pulling them causes some sand appearing that forms into Gaara after the mention of him from Ino. The team are shocked to see "Gaara" and decide to retreat but suddenly the Gaara impostor starts attacking Naruto, having the same abilities as the real Gaara. Ino tries her Mind Body Switch Technique on the impostor but cannot sense a consciousness in it. Naruto destroys the Gaara impostor with the Uzumaki Naruto Combo and a Rasengan. Suddenly they are approached by an old medical ninja from Konoha named Furofuki who is doing research in the forest.

Sakura asks Furofuki who or what was the Gaara impostor and she tells it was a Jofuku Flower, which assumes the form of the nemesis of whoever pulls it. They give Furofuki the letter that they were assigned to do and are given another mission by her to take loads of Jofuku Flowers back to Konoha. With final ingredient made, Guy is able to finish the medicine and makes a bowl full of medicine balls for Lee. Lee is shocked to hear that Sakura and her team did this and decides to recover as soon as possible. While Lee starts devouring the horribly tasting medicine balls, Guy does 1000 push-ups, not wanting Lee the only one to suffer and the flashback ends.

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, Gai and Shikamaru the results of Team Kakashi's observations and sends them out to assist them.

Adventures at Sea arc
At a meeting held by the Hyuga clan regarding the impending war, Hyuga Neji is appointed as the commander of the clan on the frontlines by Hyuga Hiashi which shocked some of the members. Hyuga Hinata later meets with Kurenai where she is told by Shikamaru that he and quite a few of the other members of the Konoha 11 had seen Uzumaki Naruto since he left the village and that Tsunade was looking for her.

Hopeful that Tsunade had in fact requested her to go on a mission so she could see Naruto she goes in search of her only to be disappointed. She along with the other females of the Konoha 11 and Shiho are later invited by Tenten to a girls night out at Yakiniku Q. Somewhat saddened that he wasn't invited, Akimichi Choji comes up with the idea of a guys night out at the same place. The two groups talk about Naruto and the past, reminiscing about the first Chunin Exams. The girls are later joined by Shizune and a moderately intoxicated Tsunade. Tsunade attempts to apologise for how she dismissed Hinata earlier but Hinata tells her it was fine as she knew what she had to do. The next day during her training with Neji she tells him that she bore no ill will towards him for her father's decision and that he was the right person to lead them in the war.

Confining the Jinchuriki arc
While Tsunade remained in a comatose state, Shimura Danzo was chosen to replace her as the Candidate Sixth Hokage. However, he was killed by the now-international criminal Uchiha Sasuke after the Kage Summit and the village prepared to make Hatake Kakashi 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 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 Gaara 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.

Fourth Shinobi 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 jinchuriki 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 Onoki 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 — Onoki then went on to explain that the war was no longer just about protecting him. After being completely healed, Onoki 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 Obito. 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 Onoki 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.

Onoki 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.

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.

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 and Shizune no longer had enough chakra to use medical ninjutsu and directed Sakura who still had barely enough to help.

Despite the Allied Forces' efforts, they are unable to stop Madara from casting the Infinite Tsukuyomi, trapping the world in a dream. Tsunade dreams of a Konoha where Dan is Hokage, including that Nawaki and Jiraiya are still alive, and where Orochimaru never defected from the village. In the anime, while waiting to join Dan for a Kage Summit, she reads a novel written by Jiraiya titled Jiraiya Shinobi Handbook: The Tale of Naruto the Hero, despite her telling him she had no interest in it earlier. In the novel, Konoha went through much less upheaval; the Fourth Hokage and his wife survived the Kyuubi's attack on Konoha, and the Uchiha Clan Massacre never happened. Naruto and Sasuke eventually release the Infinite Tsukuyomi, freeing Tsunade and the rest of the world and thus ending the Fourth Shinobi War. While back in the village, Tsunade attends Neji's funeral. Then she gives the Hokage hat to Kakashi. While Kakashi is unsure about paperwork, Tsunade says that since she mange so would he.

Blank Period
Two months later in Konohagakure, Tsunade had already given Naruto a new arm, since he lost his during the war. After that she hears Naruto point out that Kakashi's face has already been added to the Hokage Monument, so for Tsunade to continue to be in charge confuses everyone. Naruto also argues that Tsunade is too old to continue being Hokage and unfit for the responsibilities, unaware that Tsunade is behind him.

After Tsunade angrily knocks Naruto unconscious, she too asks about Kakashi's plans. Kakashi feels unqualified since he no longer has his Sharingan and therefore can't properly use the Lightning Cutter anymore. He asks for her to wait until his current mission is complete before demanding his decision. Kakashi is to oversee security for the maiden voyage of the Tobishachimaru, as most of Konoha's other forces are on guard duty for the Blood Prison in the wake of the death of Mui, its previous warden, several years earlier. Tsunade wishes Kakashi luck and reminds him that the Tobishachimaru's existence is currently supposed to be a secret from the other Five Great Shinobi Countries.

Later, she learns that Guy want to the Land of Waves without her permission to aid Kakashi on his mission. In Konoha, Guy reports to Tsunade and pretends his innocence. Before she can get started punishing him, she is forced to take a call from the Third Tsuchikage. The Tsuchikage informs her that the "secret" Tobishachimaru is visible from several countries, including his own Iwagakure. Although he and the other Kage have actually known about it for some time, they've trusted Konoha to keep its own affairs. However, the Tsuchikage shares reports that there is a large amount of blue fire powder, a powerful explosive that reacts to water, on board. He wants to trust that Konoha will handle it, but he warns that he will not hesitate to destroy the ship if it seems like it will threaten Iwagakure; the other Kage will do the same for their own villages. Tsunade tells him it is bound for the Blood Prison in Kusagakure. The Tsuchikage ends the call stating his hopes that that is true, or else Konoha will be held responsible for anything that happens.

Tsunade immediately calls Rahyo, tells him the Tsuchikage's threat, and asks him to stop the Tobishachimaru. Rahyō refuses. Down in Konoha, villagers can now see the Tobishachimaru as it flies above them towards its destination. Tsunade decides that the ship must be destroyed before another village is forced to intervene. She has Ino tell Kakashi to do what he can but also warn him of her decision. She sends all available Konoha ninja — except for Naruto — to the Blood Prison with the standing order to destroy the ship if it is about to cross the border into Iwagakure.

After learning Kahyo's motives, Tsunade went to the location of the Blood Prison. When Kahyo emerges, Tsunade orders she be taken into custody because the Armament Alliance's stunt has destroyed Konoha's credibility and caused the Land of Waves to abandon their plans for airborne transportation. Before she can have Kahyo thrown into jail, Kakashi appears and asks to be allowed to decide her punishment.

Because of how many passengers died because of the Armament Alliance, Kahyo should be sentenced to death. However, Kakashi is willing to reduce her sentence to life-imprisonment if she will agree to be the new warden of the Blood Prison, dedicating the rest of her life to keeping those imprisoned there within its walls. He explains to Tsunade how the Chains of Ice work, and how they make Kahyo uniquely qualified to replace Mui, the previous warden. Shikamaru approves of this, believing it will be in all the villages' best interests. Tsunade agrees on the condition that it be Kakashi's first act as Hokage. Kahyo vows to accept this assignment if that is what Kakashi asks of her, so he officially takes on the title of Sixth Hokage.

Two years after the war ended, Sakura meets with Tsunade before she leaves for Suna. Tsunade tries to encourage Sakura to take it easy, as the clinic's growing success means that there are other people able and willing to do some of the work. Sakura takes the opportunity to ask how to make men take notice. When Tsunade can't offer her any specific advice, Sakura asks that Tsunade bet against her love life, hoping for Tsunade's bad luck to play in her favor.

Later, Sakura has drinks with Tsunade to try and figure out how the Sasuke impostor is able to reproduce Sasuke's chakra without his knowledge. Sakura theorizes that samples of Sasuke's skin and hair that naturally fall off have been gathered in amounts large enough to extract a chakra signature from. Tsunade deems her idea plausible.

Many years later in Konoha, Tsunade receives an invitation to Naruto and Hinata's wedding. In the anime, she gets angry when Shizune tells her the reason why Kakashi gave everyone a mission to get gifts. She learns that everyone who isn't at Naruto will be on a mission. Therefore she tells Kakashi that as the Hokage he will have to change the wedding treat, so everyone can attend the wedding. On the day of the wedding, guests start arriving at the ceremony to be held under the Hokage Monument. Tsunade is seen occasionally offering Yamato advice on how to keep the wedding going smoothly, since he is doing the most work.

Epilogue
On the day that Naruto became Hokage, Tsunade visited Jiraiya's grave by toasting a cup of sake. Years later, Tsunade attends an ex-Kage meeting with the other former Kage at the Tsuchikage residence, where the Tsuchikage now resides due to his advanced age.

Naruto movie 1
Tsunade was seen in a flashback by Naruto.

Naruto movie 3
Tsunade's voice is heard off screen during the opening of the movie. She sends Naruto, Sakura and Rock Lee on a B rank mission to protect Michiru and his son Hikaru.

Naruto Shippuuden movie 1
Tsunade sent out many advance teams to stall the stone army. Naruto Uzumaki, Sakura Haruno, Neji Hyūga and Rock Lee were sent to guard Shion, and deliver her to the shrine where Mōryō's body was sealed.

Naruto Shippuuden movie 3
Tsunade was reported by Kakashi about the mission, while worrying that the next ninja targeted will be him. Tsunade seems to not care so much, telling Kakashi to relax. At the hospital, Kakashi gives Naruto his bells, which they used for their first drill together, and tells him to fix them because he crushed them. Tsunade sent Konoha ANBU to Mount Shumisen to search the area for tracks of the missing kekkei genkai ninja. Tsunade is awaiting Gaara at a secret meeting place to discuss what shall be done. However, on the way there Gaara and his Sunagakure shinobi are attacked by a hawk, which traps them in an avalanche.

Naruto Shippuuden movie 5
Tsunade states that Naruto is wanted for attempting to assassinate the leader of Kumogakure, the Raikage, and killing jōnin from Kirigakure and Iwagakure to Team Kakashi placed him under arrest and taken to Hōzukijō, a criminal containment facility, also known as the "Blood Prison", in Kusagakure. She and all his friends have gathered there. Tsunade reveals that it was Naruto's mission to destroy the box and that no one believed that Naruto really committed any of the crimes. After the battle she captures the escaped criminals, and returns to Konoha.

Naruto Shippuuden movie 6
The alternate world's Tsunade, like the Tsunade that Naruto and Sakura know, is the Fifth Hokage. However, in compared to her other self, the alternate Tsunade wears glasses and is flat-chested. During her time in Konoha, the alternate Sakura nearly gets herself killed when pointing out Tsunade's busty appearance. When Naruto and Sakura returnfrom the genjutsu world, Naruto and Sakura tell Tsunade and Kakashi of what transpired and sets out more guard patrol since Tobi was easily able to enter further in the village than they imagined. Shizune also brings up the topic of the letters of recommendation from the beginning of the movie, to which Tsunade replies that she has no intention of promoting any of Naruto's friends to jonin.

Naruto Shippuuden movie 7
Two years after the Fourth Shinobi War, Tsunade assisted hundreds of Konoha citizens in evacuating to an underground shelter to protect them from falling meteors. Afterwards, she attended Naruto and Hinata's wedding and congratulated them.

Boruto movie
She is seen during the end credits alongside Shizune.

Boruto Naruto Next Generations Manga
She also came to know Naruto's children well, especially terrifying Boruto with her temper.

In the anime, when two chūnin-level gate guards were attacked by unknown assailants, the village was put on lockdown. Tsunade soon after returned from her trip to meet with Naruto about the events. She then join him when Ino probe one of the guard's his mind for answers, learning that Mitsuki had left willingly with the attackers. When Tsunade asked who this boy is, Naruto revealed that Mitsuki was in fact Orochimaru's son. Tsunade was furious that Naruto would permit an offspring of the man who killed the Third Hokage live in Konohagakure, let alone keep it a secret from her. Naruto rationalised this on the grounds that Orochimaru's conduct as changed from before and that his aid in investigating the Ōtsutsuki. Despite this, noting the unpredictable nature of Orochimaru, the meeting ended with deeming the Oto-born boy as a threat.

As the council and the Hokage continued to talk about how best to deal with this, Kakashi voiced his overall approval of Naruto actions, noting that Naruto would never do anything he through would bring danger to the village and that the elders wouldn't even consider letting the boy in the village had they known the full story to begin with.

As Tsunade continued to keep word about Mitsuki quite and the council from taking drastic actions, questions continue to build up on Mitsuki as Naruto and Shikamaru still felt the situation didn't make sense for Mitsuki to betray them. They began wondering if the enemy's goal was Mitsuki himself because of his unique background. They then received word that one of the guards was recovering and would soon awake to give them answers.

When Shikadai contacted his father via phone, he revealed that Iwagakure was taken over as part of a plan by Ōnoki. Knowing that they couldn't act hastily, Kakashi and Tsunade were sent to meet with the other Great Villages to get their support on engaging this personal matter.

Video Games
Tsunade is a playable character in the following video games:
 * Jump Ultimate Stars
 * Naruto Clash of Ninja Revolution
 * Naruto Clash of Ninja Revolution 2
 * Naruto Gekito Ninja Taisen! 3
 * Naruto Gekito Ninja Taisen! 4
 * Naruto Ninja Council 3
 * Naruto Ninja Destiny
 * Naruto Path of the Ninja 2
 * Naruto RPG 2 Chidori vs Rasengan
 * Naruto Shinobi Collection
 * Naruto Shinobi Collection Shippu Ranbu
 * Naruto Shippuuden Clash of Ninja Revolution 3
 * Naruto Shippuuden Gekito Ninja Taisen! EX 2
 * Naruto Shippuuden Gekito Ninja Taisen! EX 3
 * Naruto Shippuuden Gekito Ninja Taisen! Special
 * Naruto Shippuuden Ninja Council 4
 * Naruto Shippuuden Ninja Destiny 2
 * Naruto Shippuuden Ninja Destiny 3
 * Naruto Shippuuden Ultimate Ninja 4
 * Naruto Shippuuden Ultimate Ninja 5
 * Naruto Shippuuden Ultimate Ninja Blazing
 * Naruto Shippuuden Ultimate Ninja Heroes 3
 * Naruto Shippuuden Ultimate Ninja Storm 2
 * Naruto Shippuuden Ultimate Ninja Storm 3
 * Naruto Shippuuden Ultimate Ninja Storm 4
 * Naruto Shippuuden Ultimate Ninja Storm Generations
 * Naruto Shippuuden Ultimate Ninja Storm Revolution
 * Naruto The Broken Bond
 * Naruto to Boruto Shinobi Striker
 * Naruto Ultimate Ninja 2
 * Naruto Ultimate Ninja 3
 * Naruto Ultimate Ninja Heroes
 * Naruto Ultimate Ninja Heroes 2 The Phantom Fortress
 * Naruto Ultimate Ninja Online
 * Naruto Ultimate Ninja Storm
 * Naruto X Boruto Ninja Voltage

Quotes

 * You'll become a fine young man and a great Hokage too
 * Are you watching Nawaki, Dan? Be at peace my beloved your dream is still alive in him.

Senju Hashirama
Tsunade had nothing but respect for her grandfather, and got many of his habits during her childhood. Once her grandfather died, she had kept his necklace as a memoir.

Uzumaki Naruto
Naruto's relationship with Tsunade began when he aided Jiraiya in looking for her as an ideal successor to their mentor Hiruzen. Upon finding her, Uzumaki Naruto challenged Tsunade after she said only fools would want to become Hokage, accepting her wager of mastering the Rasengan within a week. Despite her reluctance to become Hokage and lack of faith, Tsunade was loyal to her village and attempted to kill her former team-mate Orochimaru before Kabuto used her haemophobia to his advantage. When Naruto defeated Kabuto with a fully mastered Rasengan, Tsunade overcame her phobia to aid him and accepted the position of Fifth Hokage. As a sign of thanks for restoring her faith in their village, Tsunade entrusted Naruto with her grandfather's necklace.

Overall, the two have a very strong relationship based on mutual love and respect, one that could almost be called familial, as Naruto is the only person to refer to Tsunade as "grandma", and likewise he is the only one Tsunade has ever allowed to refer to her in such a manner. Tsunade aided Naruto in not only keeping the Konoha Council from restricting his movement, but also supporting his search for Sasuke and keeping him out of Konoha's Bingo Book. During the Fourth Shinobi War, Tsunade is the only Kage who argued in favor of Naruto being allowed to fight with them. Though outvoted, the other Kage eventually agree with her resolve. Watching Naruto head off into battle, Tsunade looked on with an expression of nostalgia, sadness, and pride on her face. A few years later she attended his and Hinata's wedding to congratulate them.

Haruno Sakura
Tsunade first met Haruno Sakura when she came to Konoha to be the fifth Hokage. Tsunade saw Sakura again at the hospital after Naruto lost his battle against Sasuke to stop him from leaving Konoha. Sakura requested to be her apprentice and Tsunade saw Sakura's strong determination to catch up with Naruto and Sasuke in strength and to help Naruto save Sasuke. Over the next three years, Tsunade taught Sakura medical ninjutsu and how to enfuse her chakra through her fists, giving her superhuman strength. Sakura credits Tsunade for passing her contempt at losing onto her and helping her gain more self-confidence. While respectful of Tsunade, Sakura is fearful of her teacher's temper and says she almost came close to being killed several times during their training.

Although displaying pride for her student, Tsunade actually worries about Sakura, due to the girl's desire to protect Naruto from the Akatsuki and her personal goal to save Sasuke from darkness. Tsunade still tries to support Sakura's choices, except when she announced they would be fighting the Akatsuki and Sasuke (who had briefly been one) to protect Naruto and the rest of the world, in spite of Sakura's feelings for him. She trusts Sakura enough to put her in charge of looking after the shinobi who suffer physical and mental damage during the war.

Throughout the war, Tsunade and Sakura work together on healing all the injured after Sakura awakens her 100 Healings Seal. After the war ends, Tsunade supports Sakura and Ino's clinic for mentally damaged children and seeks out ways to fund the clinic. Their friendship deepens to the point where Tsunade supports Sakura's marriage to Sasuke.

Uchiha Sasuke
Tsunade met Sasuke when she was brought to the hospital to heal him after he was injured from fighting Itachi. Although she became the Fifth Hokage and healed him, Sasuke thought less of her and showed her disrespect due to him falling deeper into darkness out of jealousy for Naruto. After Sasuke abandoned Konoha and became a criminal, Tsunade declined to pursue him as a missing-nin out of respect for Naruto and Sakura. However, while she was unconscious from Pain's attack on the village, Danzo decided to take her place as Hokage and his first act was to order Sasuke to be executed.

Afterwards, Sasuke attacked the Kage Summit and created an international incident, leading Tsunade and the others to decide that she cannot afford to continue protecting him and, due to him briefly siding with the Akatsuki, they will have to fight him during the war. During the war, however, when Sasuke ended up helping them to end it, Tsunade and the others were willing to let their issues with him slide because they had a war to worry about and needed his help. While she was under the Infinite Tsukuyomi, Sasuke was willing to kill her and the rest of the Kage in order to start a revolution and force the nations into a peaceful union. However, Naruto forces him to change his mind after their final battle.

Despite her hard feelings for him, Tsunade later comes to accept Sasuke as a Konoha shinobi, to the point where she supports his marriage to Sakura.

Hatake Kakashi
Tsunade has nothing but great respect for Kakashi, who equally respects her as the Fifth Hokage. The two have a strong bond to where the crack jokes with one another and are trustful of the other. Tsunade's trust for Kakashi is proven when she passes the title of Hokage to Kakashi after her retirement.

Knownable Relatives

 * Senju Hashirama (Grandfather/dead)
 * Uzumaki Mito (Grandmother/dead)
 * Senju Tobirama (Granduncle/dead)
 * Nawaki (Little Brother/dead)
 * Kato Dan (Boyfriend/dead)
 * Shizune (Stundent)
 * Haruno Sakura (Medical Student/True Counterpart)
 * Uzumaki Naruto (#1 Rival)
 * Jiraiya (Teammate/dead)
 * Orochimaru (Teammate)

Trivia
According to the databook(s): There is one key difference between her character in the actual timeline and in her own Infinite Tsukuyomi dream: Tsunade has many similarities with her medical student, Haruno Sakura. Tsunade has many similarities with Uotani Arisa from Fruits Basket. Tsunade has many similarities with Masaki Kurosaki from Bleach. Tsunade has many similarities with Rangiku Matsumoto from 'Bleach. Tsunade has many similarities with Hanajima Saki from Fruits Basket.
 * "Tsunade" (綱手) means "mooring rope", which is not dissimilar to her brother's name, Nawaki, which means "rope tree". A similar word "tsundere" (ツンデレ), could also be a play on Tsunade's personality.
 * Tsunade and the other Sannin are named after the characters in the Japanese folktale Jiraiya Goketsu Monogatari. The Tsunade of that story excels in slug magic.
 * Tsunade shares the same blood type with Naruto, including her former team-mates, Jiraiya and Orochimaru.
 * Tsunade was the first female Hokage, as well as the first female Kage, that appeared in the series.
 * Tsunade is first mentioned by Tenten when Might Guy questions Rock Lee, Neji, and Tenten about their goals as genin. Tenten says that she wants to become a great kunoichi and follow the footsteps of the legendary Tsunade. Tsunade is also seen in a flashback by The Third Hokage.
 * Tsunade found Naruto very similar to her late younger brother Nawaki; by looking at him both in appearance and personality. In fact, the three are all descended from the Uzumaki clan.
 * Tsunade is the only Hokage to live long enough to see two generations of successors take office.
 * Her birthday is August 2, & her bloodtype is B.
 * Tsunade's hobby is gambling.
 * Tsunade wishes to fight Uzumaki Naruto.
 * Tsunade's favorite foods are chicken breast & sake. While her least favorite food is liver sashimi.
 * Tsunade has completed 1,256 official missions in total: 40 D-rank, 236 C-rank, 467 B-rank, 418 A-rank, 95 S-rank.
 * Tsunade's favorite phrase is "One grab, a thousand gold" (一攫千金), referring to getting rich without much effort.
 * Studio Pierrot's Settei sheets of Tsunade show that she was 145 cm when she was part of Hiruzen's genin team, and that her high-heeled sandals she wears add 5 cm to her height.
 * While Tsunade's English voice actress is Debi Mae West. Insome video games she is voiced by Mary Elizabeth McGlynn, who is Yuhi Kurenai's voice actress. In Clash of Ninja Revolution 2, McGlynn voices Tsunade throughout the story-line and West voices Tsunade during actual game-play.
 * Tsunade's grandmother, Uzumaki Mito had a similar diamond shape mark on her forehead. It is possible that Tsunade modelled her own seal after this.
 * In the current time line, Tsunade didn't perform the Four Red Yang Formation technique at all with the previous three Hokage. But in her Infinite Tsukuyomi dream, Tsunade could perform this technique with Hiruzen, Minato and Kushina.

Voice Actresses

 * Japanese : Masako Katsuki (Teenager and Adult), Haruchi Nanao (Child)
 * English : Debi Mae West (Teenager and Adult), Mary Elizabeth McGlynn (Child)

all information on Tsunade is from http://naruto.wikia.com/wiki/Tsunade