Though it resembles Hannya in more ways than one, Black Okame has plenty of differences and is overall tougher than its predecessor. While it inflicts less damage than Hannya, it has more than double the health with only one knockback, attacks almost twice as frequently, and possesses long-ranged Omni Strike attacks with a 100% chance of knockback and freeze immunity. It has only one weakness: as a Red and Black hybrid enemy, there are a wide range of units which might be effective against it, assuming they're sturdy, immune to knockback, outrange it, or is a rusher unit.
An Okame or Otafuku is a mask used in Kyōgen theater to represent a positive female and good luck-bringer being; the distaff counterpart to Hyottoko.
Black Okame can be seen as a foil to Hannya. Where Hannya's mask is a symbol of bitterness and jealousy, Okame's represents felicity and blessings.
As a symbol of innocent maidenhood, Black Okame represents the virtue of chastity amongst the Tier 2 Advent Bosses.
The word Gaō in Black Okame's Japanese name, Okame Gaō (阿亀我王), doesn't mean anything on its own and is just a pun on kao (顔), meaning "face", though it can rarely also be a person's name. It consists of the kanji for "ego" or "self-assertion" (我) and "king" (王).
Hannya's Japanese description mentions that she consumes the souls of those who cannot gain enlightenment, with the term used, jōbutsu (成仏) specifically referring to attaining Buddhahood. This theme of Buddhism is continued with several of Black Okame's stage names:
Courts of Torment's Japanese name is Narakumon (奈落門), which literally translates to "Hell Gate" or "Gates of Hell". However, the term used for Hell is naraku, which refers to a Naraka, the Buddhist equivalent of Hell.
A "pure land" is a concept in Mayahayan Buddhism, its many traditions and teachings falling into the branch of Amidism/Pure Land Buddhism. Reaching the Pure Land is the final goal of Amidism and is tantamount to attaining enlightenment.
The opposite of the Pure Land is the land of the living, also called the Impure Land, which appears in Heaven and Hell's Japanese name.