The cards are shuffled, and then dealt to the table in seven face-down piles of seven cards per pile. Or '2nd highest' hand whereas the five-card hand is 'high' or 'big.' The two-card hand is also physically placed in front of the five-card hand, leading to the respective terms 'front' (or 'top') hand and 'back' (or 'bottom') hand. The five-card hand's rank must exceed that of the two-card hand, and it is for this reason that the two-card hand is often called the 'small', 'minor', 'low' The object of pai gow poker is to create a five-card poker hand and a two-card poker hand from seven cards that beat both of the bank's hands. Each player attempts to defeat the banker (who may be the casino dealer, one of the other players at the table, or a player acting in tandem with the dealer as co-bankers). It is played on a table set for six players, plus the dealer.

The game is played with a standard 52-card deck, plus a single joker. The game of pai gow poker was created in 1985 in the United States by Sam Torosian, owner of the Bell Card Club.

Pai gow poker (also called double-hand poker) is a version of pai gow that is played with playing cards, instead of traditional pai gow's Chinese dominoes.

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