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Born in 1641 as the eldest son of the third shogun Tokugawa Iemitsu, Ietsuna became the fourth shogun in 1651 at the age of ten. Because of his youth, great elders and senior councillors such as Sakai Tadakiyo held real power. The Keian Incident (the Yui Shōsetsu Uprising) shortly after his accession revealed the gravity of the rōnin problem, and policies such as relaxing the prohibition on adoptions on the verge of death were adopted as relief measures. The Ietsuna era is regarded as a transition from military rule to civil rule: domain confiscations decreased and the bakuhan system stabilised. Regulations for the sankin-kōtai system and revisions to the Laws for Military Houses were also carried out. He died in 1680 without an heir, aged 40. Known for his gentle nature, he was also called the "Uemon Shogun." His reign was an important period that laid the groundwork for the Edo Shogunate's era of stability.

Gentle and mild-natured, he was affectionately called the "Uemon Shogun." Because he became shogun as a child, real political authority was delegated to his aides, but throughout his reign he contributed to social stabilisation. He was characteristically conservative, prioritising the maintenance of social stability over the active promotion of policy, and helped advance the transition from military to civil rule.

As the shogun of the era that advanced the policy shift of the Edo Shogunate from military rule to civil rule, he presided over reforms aimed at stabilising the bakuhan system, including a review of rōnin policy after the Keian Incident and the establishment of the sankin-kōtai system. His moderate reign served as a bridge to the succeeding era of Tsunayoshi.