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In addition to the four main difficulties, there is an extra stage which is a long and difficult stage in which players must play through hordes of enemies, bullets, and bosses. In order to reach the extra stage, one must beat the game on normal difficulty or higher without the use of a continue. The only games that allow players to reach the extra stage by completing the easy difficulty are Perfect Cherry Blossom and Imperishable Night. In terms of difficulty, the extra stage is around the normal or above difficulty levels. In Perfect Cherry Blossom, there is also a phantasm extra stage in which the enemies that were already once difficult in the extra stage have become even more challenging. Although the phantasm stage is aimed for the most experienced players, the difficulty is somewhere in between hard and lunatic. The phantasm stage is accessed by beating the extra stage and capturing at least 60 spells with any of the characters and weapon types combined.

Each Touhou game has four difficulty levels—easy, normal, hard, and lunatic—with each one being harder than the previous one. Regardless of difficulty choice, there are six stages in each game and each one is harder than the previous. Each individual game of the main series after Embodiment of Scarlet Devil has additional items that affect some aspect of gameplay, such as scoring or gaining extra lives/bombs. For example, Perfect Cherry Blossom has "cherry points", which are used mostly in scoring, but can grant temporary invulnerability (known as 'supernatural border'); Imperishable Night has "time points", which are essential to advancing to later stages, and also determine if the player gets to challenge a boss's 'final spell' on normal or higher difficulties; Mountain of Faith has 'faith' points, which help tabulate the score the player receives upon gathering point items and bonuses for clearing spell cards without dying or using a spell card.

The player can use a weapon called a 'spell card', which is similar to a 'bomb' in most other shooting games. While the player has a limited number, using one makes the user temporarily invulnerable and uses a special magical attack that generally clears the screen. Each character has two cards with different names and patterns. The player can use one during a short period after being hit by a bullet (known as the 'border between life and death') to avoid loss of a life, the amount of time the player has available to use the border is usually around 0.3 seconds. Bosses also have spell cards, but with bosses the term applies to a prolonged pattern of movements and shots that lasts until the player depletes the boss' health by a certain amount or the time runs out, not a one-shot attack.

The Touhou series of games started on the Japanese PC-98 series of computers and its first five entries are native to that platform; standard PC users are only capable of playing them through an emulator such as Anex 86. Also, the PC-9801 series of computers was already on the decline when these games were released. Because of this, they are not well known among players. The group making these games was called "Amusement Makers".

The Touhou Project (東方Project, Tōhō Purojekuto?, lit. Eastern Project), also known as Toho Project or Project Shrine Maiden, is a Japanese dōjin game series focused on bullet hell shooters made by the one-man developer Team Shanghai Alice, whose sole member, known as ZUN, is responsible for all the graphics, music, and programming for the most part. The series was inducted into the Guinness World Records in October 2010 for being the "most prolific fan-made shooter series". The Touhou Project began in 1996 with the release of the first game, Highly Responsive to Prayers, developed by the group Amusement Makers for the Japanese NEC PC-9801 series of computers. The next four Touhou games released between August 1997 and December 1998 also were released on the NEC PC-9801. The Touhou Project was inactive for the next three and half years until the first Microsoft Windows Touhou game, The Embodiment of Scarlet Devil, was released in August 2002 solely by ZUN after he split from Amusement Makers and started Team Shanghai Alice. The Touhou Project became a media franchise spanning a steadily increasing number of official games, in addition to commercial fan books, light novels, and manga.

The plots of the Touhou Project revolve around the strange phenomena that occur in the fictional realm of Gensokyo (幻想郷, Gensōkyō?, literally Illusion Village or Fantasy Village) in Japan. Long ago, it was a desolate place haunted by yōkai who preyed on lost wanderers in the area. Soon exorcists were sent into the area to resolve the yōkai problem, and they eventually settled in the area as a check on the yōkai. As human civilization advanced elsewhere, the power of yōkai began to diminish and they chose to seal Gensokyo away from the outside world as a haven for themselves.