Players do "Jan-ken" (rock, paper, scissors) to determine who goes first. All players, except the one whose turn it is, lay down one of their menko on the ground.
The first player tries to flip one of the menko over by throwing his own menko at it. If a menko on the ground is flipped over, the thrower keeps it and the loser is out of the game. If no menko flips, the next player gets a turn. Rules vary. In one variation, a circle about one meter in diameter is drawn on the ground. Menko knocked out of the circle are taken. In another variation, players take turns, and whoever flips over a menko first gets to keep all of them on the ground.
Some menko have extra details on them, such as images that represent Rock, Paper, or Scissors. "Gu-choki-pa” (AKA Rock, Paper, Scissors) marks on the back of the menko are played as the classic game of RPS. Players would take out one of their menko to compare with their opponent's simultaneously following a given signal. If they won, they win the opposing menko.
Another extra is "Fighting Numbers". Playing with "Fighting Numbers" is largely the same as Gu-Choki-Pa; trying to outnumber your opponent's menko on certain digits. For example, one player might have a Fighting Number of 58786 on his particular menko and the other might have 96587 on his. If they were dueling with the last digit, then the player with the 7 as his last digit would win and again get the other boy’s menko. There were many more ways to play with Fighting Numbers, but this is just one example.