One of the things that I don’t like about the Hit Point system in D&D is that you’re exactly as fit when you’re at 1 HP as you are at your MAX HP (or even more if you’ve got some Temporary HP loaded on top of your MAX). Part of the reason for that is that the history of D&D is that of war gaming, and war gaming didn’t come with rules to degrade the performance of units. Another reason is that the abstract nature of combat means that “loss of Hit Points” doesn’t actually equate to “being wounded.” “Hits” in the game don’t actually indicate hits with a weapon that cause wounds. Instead, there’s a vague notion of HP representing a character’s “ability to resist getting killed” through a number of means including dodging blows, deflecting good strikes, and/or parrying attacks.
Also note that I’m fully aware that attempts at realism in combat are stupid and useless and bad and they destroy the game with needless detail given that the game was designed with the idea that combat and wounding and dying are handled in an abstract manner for ease of play… I get that.
So, what we’re going to implement in our game is the abstract notion that losing Hit Points drains some of a character’s… vitality… getting that vitality back is not an instantaneous process, and while a character is not in “tip-top shape,” their ability to function is impaired.
With that preamble, here are the house rules on Healing, Hurting, and Working While Wounded:
If you are above 1/2 Max HP when you take a long rest, you are fully recovered by that rest.
If you are between 1/4 and 1/2 Max HP, you will recover 1 Hit Die + 3 HP after a long rest, and you will be at -1 on all skill rolls for any activity that requires something I’m going to call “Good, Positive, Healthy Energy.” We’ll figure out what those things are in game. You will also have two levels of Exhaustion.
If you’re between 1 HP and 1/4 Max HP (but didn’t go to 0), you’ll recover 1 Hit Die worth of HP after a long rest, and you’ll be at -1 on those skill rolls. You’ll also have three levels of Exhaustion.
If you go to 0 HP on a day, regardless of healing you may receive, you will recover 0 HP on your first long rest (btw, this is already built into 5th Edition rules… if you take a long rest at 0 HP you don’t recover any HP, but you get a chance to lose the condition which prevents you from recovering them). You will also be at -2 on any skill or attack you try in addition to having five levels of Exhaustion This is the penalty for near death experiences… Please try to avoid them.
Healing magics are going to be very scarce in our game, and will never be for sale. Be very wary of anyone peddling healing draughts.
What all this is going to do for us is that it’ll slow the game down. You will get into a big fight, and you’ll take a few of days to recuperate. I like not being in a hurry, and it bothers me that the game mechanics make it so that going fast fast fast is important.
As a “benefit” to balance out this harm I’m causing, my monsters will suffer these penalties to their combat abilities as they take damage… so orcs fight worse as they take damage, wizards won’t sling spells with rapidity and power as they tire, and dragons don’t recover their breath weapons as quickly when they’re being worn down by brave knights…
As a further clarification, our PCs will not have their fighting abilities degraded during a fight the way my monsters will. The PCs are heroes. If they go into a fight “healthy,” they will stay that way regardless of their Hit Point totals as the fight progresses. Whatever condition the PCs enter into a combat is how they’ll be affected throughout the combat. Only my monsters will be degraded during a combat. There’s an exception, of course. If a PC drops to zero Hit Points, and then finds a way to recover without being stuck in a coma for an hour (see Dropping to 0HP), that PC will suffer the effects of their “having dropped to 0HP” condition… the rule as intended is that, having dropped to 0HP, they did, in fact, leave the fight, and in coming back, they’ve entered a new one.