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Technically there is Akaza who doesn't do that and Hantengu's main body. There is also the fact that her just using an ordinary biwa is a perfectly valid possibility as well based on what we know since her being a demon doesn't mean that she cannot make use of any objects that aren't made from her flesh.We can probably just presume the biwa is made from her flesh since every other upper moon does that, why wouldn't Nakime do that?