The game takes place in 'The Eastern Country', which ZUN mentions in the text file included with the game to be a 'strange, strange world where the shrine maiden lives'. Rather than the classic arcade game's paddle, however, you control Reimu, and the ball is allowed to touch the bottom of the screen. The gameplay is similar to Arkanoid, which clearly differs from games later in the series. Each route features unique stages, bosses, and endings. There are two selectable paths in Highly Responsive to Prayers after the fifth stage: the Hell path and the Makai path. Getting hit by a projectile or the Yin-Yang Orb causes the player to lose a life. To complete a stage, the player must clear all cards or defeat the boss. The game consists of twenty stages of increasing difficulty, with a boss fight occurring every five stages. There is no guarantee that any given card will be hit, and will often fail to damage a boss. As a last resort, Reimu can use a bomb to hit all cards on the screen.

Only the Yin-Yang Orb can damage enemies throwing ofuda at enemies has no effect. Enemies attempt to hinder the player's progress by firing at them, but shots can be cancelled with ofuda or deflected by swinging Reimu's gohei.

Reimu can manipulate the Yin-Yang Orb by hitting it with her gohei, slide-tackling it, or firing shots at it. Highly Responsive to Prayers introduces the Shrine Maiden Reimu Hakurei, who attempts to persuade a bouncing Yin-Yang Orb to hit various on-screen targets, 'cards' and ' bosses' alike.

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