Tsunade focuses a large amount of chakra into her fist and punches the opponent, sending them at least one kilometre (1000 metres) away.
Trivia
- In Naruto Shippūden: Ultimate Ninja Heroes 3, Sakura can also perform this move.
- Jiraiya once mentioned that he came close to dying after Tsunade punched him like this. He ended up breaking both his arms, six ribs, and ruptured several internal organs.