Ah DS. Yes she was not healing anyone she stopped fatal injuries from progressing to death and that naturally does not require healing. Really?
Why do you assume that maintaining life in a bisected body would not cost that much energy. Did you miss when I said we have no idea how much it would cost to sustain life in two halves of a bisected body but I am assuming it would be more than was needed to heal a stab wound. Not to mention that she would be doing the same for the other kages as well since I doubt their injuries were any less life threatening, as Madara was trying to kill them all. I so don't want to have to restate points I already made since you are probably going to dismiss them anyway.
Here it is, over explaining again.
Tsunade's mitotic regeneration jutsu requires a megaton of chakra. It is a forbidden technique because it works by forcing the body to rapidly generate new cells as opposed to simply repairing damaged ones. It puts a tremendous strain on the user and drastically shortens their life span. As has been shown many times when Tsunade runs out of chakra she collapses and reverts to her aged appearance. In the very beginning of this battle Naruto asked her if using her technique was not going to cause her to collapse like she did when Pain attacked Konoha. She that unlike then she isn't using her technique on anyone else only on herself and her injuries aren't severe and she still has a lot of chakra saved up. Earlier in this very same battle when she was running low on chakra she had to deflect a few of Madara's fireballs and simply healing her burnt arms required so much power that her technique ran out and she collapsed and had to be saved from Madara by Dan.
Lets move on to summoning. As we know high level summons like Katsuyu, Gamabunta and Manda require a ton of chakra. Jiraiya had to throw Naruto off a cliff just to force his body to use enough of the Kyuubi's chakra to summon anything bigger than a young Gamakichi. The only people who have used such high level summoning at all, much less in battle, were The sannin and their various students, Hanzo, Pain, and Hiruzen(if you count Enma). They are all powerhouses.
Assuming you aren't going to dispute any of that here is my shitty reasoning as you put it. Simple assumptions based on things that were explicitly stated. Tsunades technique requires a ton of chakra to use. The fact that it took Sakura so long just to store enough chakra to use it reinforces that. Summoning Katsuyu also requires a ton of chakra. Katsuyu said that she is using Tsunade's technique and the reason Tsunade's recovery is so slow is because Tsunade has so little power that Katsuyu has to focus on maintaining the summoning. This would not be so much of an issue if Kishi had not spent years establishing how much chakra all these techniques require and spent years establishing that when Tsunade takes on that aged appearance it is because she is completely out of energy. Even without those 2 established facts it would not be a problem but that he made Katsuyu state explicitly that her power depends on Tsunade's byakugo power when Tsunade is in a state where she is unable to use said power. Amazing!
Back to semantics, Katsuyu's words implied that she was indeed attempting to heal Tsunade and not simply maintain life support and the healing was going very slowly because she could not use her full power but as I said it is semantics. I just really find it odd that you would say that when I specifically mentioned how much energy would be required simply to sustain life in Tsunade's state and even inquired as to how long she has been like this. My best guess is that it has been a few hours at least. Time enough for Madara to leave the kages and get to Obito, that battle to happen, Sasuke and company to arrive and Orochimaru get to Tsunade. That said it is hard to believe that Tsunade has the power to maintain the summoning and sustain her own life and that of the other kages in the state she is in. Just prior to this, when she was in obviously much better condition, simply healing some mostly superficial and definitely not life threatening burns cause her technique to run out and she collapsed.
Whatever though and I am going to ignore the implication that the reason for my supposed shitty reasoning is that I am foaming at the mouth to see Tsunade die and will of course be unsatisfied with anything less than her gruesome death. Lol. I guess you saw my simple statement that I want her to die as bait and you of course took it. Her death is not that important by the way, just something that has been hinted at numerous times now and yet never happened. The deaths of the 2 other Sannin were hinted at equally as much and in Orochimaru's case "happened" more than once even. So I just wanted her to but Oro is back now so whatever. I guess Jiraiya should have developed some form of an immortality jutsu like the other two.
My problem is that this is all just bad writing. Tsunade lives, Tsunade dies, whatever. Just explain it properly. Not to mention that this means that the great and powerful Madara, Madara whose very name is dread, could not even manage to kill the 5 kage. Props to him.