Puyo Puyo is a falling pieces puzzle, with basic similarities to Tetris. Pairs of puyos (monsters from Compile's RPG series Madō Monogatari) fall down from the top into a cylinder. They can be moved left or right, rotated in either direction and made to drop faster. The goal is to get four puyos of the same color touching each other horizontally or vertically. Doing so removes them from the field. Making groups of larger than four, several at the same time or creating chain reactions nets more points. The game ends once the stacked puyos reach the top of the cylinder.

The game offers an endless single-player mode, a two-player mode (first player to fill their cylinder loses) and a mission mode. Mission mode presents the player with a number of pre-filled playing fields with a preset task, like making a minimum number of puyos disappear in one move, or removing all puyos of a certain color.

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