The Keepsake is a necklace belonging to Ekei Ankokuji, it can be obtained after defeating him as a boss, depending on the player's freindship with him. If you have ignored Ekei or given him bad gifts throughout the game you may have to fight him.
Unlike the other necklaces collected throughout the game, Ekei's Keepsake is more of a healing item rather than an armor item, restoring a large amount of health similar to that of a Perfect Medicine.
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