In the original game, the player controls a professional wrestling tag-team, two identical wrestlers with black hair, orange trunks and brown boots named Sunny and Terry (Jocko and Spike in the U.S. version) who must defeat a couple of masked wrestlers known as the Heel Team (Mad Maulers in the U.S. version): one of them a skinny wrestler with an orange mask and boots and white trunks, the other a fat wrestler in a black mask and tights with white boots. The player's team must continually beat the Heel Team in order to win trophies and maintain gameplay. After the tenth match, the player's team is designated the world champions and must keep playing in order to maintain their title. In the event of the Heel Team winning or tying a match, the game is over.
The player is provided with a joystick and two buttons: a "select" button and an "action/pin" button. The player uses the joystick to move Sunny or Terry around the ring, where they must make contact with the member of the Heel Team (in the first match, the skinny wrestler from the Heel Team starts, then the fat one in the second, and it continues that way from there on in, as does with the player's wrestlers). Upon making contact with the opposing wrestler, the two wrestlers will immediately grapple. The player then releases the opposing wrestler by pulling away, then grappling again, waiting for the "Action" command to flash onscreen. Due to being one of the earliest professional wrestling video games, Tag Team Wrestling has a limited number of wrestling moves and characters. Moves and counters are performed through the use of a real-time, menu-based action-reaction fighting module. After engaging in a grapple with the "Action" command flashing, players quickly scroll through a menu and choose a maneuver to perform.