Once Rick has reappeared, push the joystick up to make him grab the first Spear that is mounted on the wall, and throw it into the stomach of the Green Deadman who's walking towards you to kill him; you must then repeat the process once you've grabbed the second Spear for another Green Deadman, then jump over the hole in the ground once you have grabbed the third Spear and throw it into the stomach of the Red Deadman who is leaping towards you from the front to kill him. (If Rick is unfortunate enough to fall down the hole, he will be forced to relinquish that third Spear if he is holding it and play an extra section of the stage - which is filled with piles of rotting meat and Body Eaters). Once you have done so, push the joystick up to make Rick grab the fourth Spear that's mounted on the wall, then turn back to the left and throw it into the stomach of another Red Deadman who is leaping towards you from behind to kill him; you must then repeat the process once you've grabbed that fifth Spear for a third Red Deadman who is leaping towards you from the front, then turn back to the left, and punch a fourth Red Deadman who is leaping towards you from behind to kill him. Once you've turned back to the right and jumped over another hole in the ground that leads to the extra section of the stage filled with piles of rotting meat and Body Eaters, a Nobu will come slithering towards you - and you must crouch down and kick it twice to kill it, before it has a chance to spit projectile vomit at you. You'll then come to a fifth Red Deadman writhing around on the floor, who will get up and start leaping towards you from the front; once you have punched him to kill him, a sixth Red Deadman will open the door in the background and start approaching you from behind. Once you have punched him to kill him you will have to jump over two Kaiten Ken, that are rotating in a clockwise direction; once you have done this, two Babito will come flying towards you. Once you have punched both of these to kill them, you will have to jump over two more Kaiten Ken that are rotating in a clockwise direction - and Rick will then proceed to the second section of the stage through that doorway on the right side of the screen. This section of the stage also features three "evil clones" of him, and whenever you kill a "leaping" Red Deadman (regardless of whether it is with a Spear or a punch), they are worth 300 points as opposed to just 100.
The second section of the stage is a mirror hall, and you will notice that Rick's image gets reflected in the background as he walks to the right; once he is fully reflected in the fourth mirror, a Mirror Rick will burst out of the background (the song you are hearing from that Yamaha YM-2151 will also change at this point). He has exactly the same attacks as Rick - and once you have punched him three times to kill him, you must continue walking to the right until Rick is fully reflected in the tenth mirror. A second Mirror Rick will then burst out of the background, and try to attack you; once you've punched him three times to kill him, you must continue walking to the right until Rick is fully reflected in the fourteenth mirror. A third (and final) Mirror Rick will then burst out of the background and try to attack you - and once you have punched him three times to kill him, Rick will automatically continue walking to the right and proceed to the boss room through the door on the right side of the screen. This boss room features the main reason why the title was confined to Japan.
The boss room is a chapel, lit only by the candles upon the pillars in the background; as Rick is walking to the right, the main reason why the game was confined to Japan will appear in front of him: Evil Cross, which is circled by six Nightmares. It initially makes sure to stay ahead of Rick and occasionally let one of the Nightmares fly off on its own and attack him, but one hit will kill them - and about halfway through the boss room, you should crouch down in order to pick up the Axe before continuing to the right. Once you have made it to the very end of the boss room Evil Cross will fly from one side of the screen to the other in an imaginary arc above Rick; it takes six hits to kill, and once you have killed it, Rick will drop the Axe and walk to the chapel altar on the right as an organ-like song is heard from that Yamaha YM-2151 (but if you are using MAME to play this game, which you almost certainly will be unless you are a native inhabitant of that "Land of the Rising Sun", you may not hear it properly depending on which version you are using). A dramatic jingle will then be heard from the Yamaha YM-2151 as a scream is heard from the DAC - and the screen will then fade out to proceed to the fifth stage.