In Akuji: The Heartless the player takes the role of Akuji, a voodoo-priest. The title of the game is meant to be taken literally as Akuji's wedding day brought a problem with it: his brother kills him and rips out his heart. Now Akuji has to travel through the underworld to get back to the living and take his revenge.

This game is a typical third-person action: the player jumps and fights through the stages. The player can increase his health bar by collecting voodoo dolls which are lying around in the levels. The camera is set in the over-the-shoulder perspective but can be adjusted manually. The levels in the game are mostly horror-themed.