Kioh Gyoku is a vertical danmaku shooting game with massive emphasis on grazing streaming bullets, where two characters engage in danmaku gameplay within individual and separate play areas (aka. split-screen). Upon meeting certain conditions, players are able to unleash a variety of character-specific attacks upon their opponents in an attempt to whittle down their remaining health points.
In Story Mode, the player will face five opponents, each more capable than the previous. Kioh Gyoku also features a Match Play Mode where the player may face off against AI opponents or compete against other players, as well as watch AI vs. AI matches.
The name 稀翁玉 is named after the Japanese-translated name of a cactus, copiapoa krainziana.
The music of this game includes 10 tracks composed by ZUN. Each theme (apart from the title theme) is designed for one of the player characters specifically, due to the nature of the game. It's the first ever time ZUN used PCM (Pulse-code modulation) that's in a .wav format. The game also included MIDI versions of the music, but according to ZUN, playing the MIDI version on SC-88Pro does not convert it to .wav, so the MIDI cannot be played in-game. It is recommended to keep it on the .wav version.
Later on, ZUN created an arrange of "Lovely Mound of Cherry Blossoms ~ Flower of Japan" (桜花之恋塚 ～ Flower of Japan) and "Enigmatic Doll ~ God Knows" (エニグマティクドール ～ God Knows) and added them to Dolls in Pseudo Paradise, where "Enigmatic Doll ~ God Knows" was renamed to just エニグマティクドール.