The Super Real Mahjong PIV is a game that challenges players to compete in mahjong tournaments against three female opponents. The game's story follows the player character, a member of a mahjong club, as they navigate through various matches and try to outdo their opponents. With each round won, the player's opponents will gradually lose their clothing, adding an extra layer of competition to the game.
The gameplay in Super Real Mahjong PIV is focused on winning mahjong rounds, which are the core component of the game. Players must strategically lay tiles to win the round, with the goal of being the first player to get rid of all their tiles. The game features a unique "puzzle mode" in its Super Famicom (SNES) version, where players can uncover parts of a puzzle as they progress through the rounds.