The gameplay of Rummy Ox was further enhanced as it expanded throughout various regions and incorporated elements from regional card games. While a standard deck of cards is typically used to play the game, someteem patti variations add special rules or wild cards to increase the strategic depth. The term "Rummy Ox" itself is believed to have come from the game's focus on creating sets & melds, much like an ox is renowned for its dependability and strength when carrying loads. Players who value the game's competitive and social elements have found it to be enduringly appealing due in part to its association with strength and strategy.