Photo Credit: FreeImages.com/ Alexandre Jaeger Vendruscolo, color modification by Mike

When I first started gaming, one of the hot topics of conversation was always Clerical Healing and how to stop Clerics being nothing more than “holy drip bottles”. Over the next 30-odd years, not much changed. At the heart of the problem are the “Cure” spells.

Over the years, there have been many proposed cures for the problem. But all of them come with baggage attached, ripple effects that can be more profound than the change to healing itself. The most commonly proposed solution is to make the “cure” spells more inconvenient and slower to cast and replace them with healing potions that anyone can use and administer.

This immediately presents the problem that healing becomes even more accessible than it was before. Clerics might not have had many limits on the number of healing spells they could cast, but they still weren’t an unlimited fountain of health. Those restrictions went away with this change, and the impact was usually more profound than GMs expected. And so it was with every other proposed cure for the problem; in every case, there was some complication that the GM needed to take into account.

In mid-2012, I wrote up a series of articles [links at the end of this article] outlining three alternatives to the normal damage-handling and recovery systems and the impact that the changes would have on the game. There are at least two more to describe, of which this is the first. It’s also the most obvious, the one that people tend to think of when first considering the subject – and that ubiquity is the reason I didn’t write about it at the time. Since then, a few people have pointed out that just because the idea is one that commonly occurs to DMs, that doesn’t mean that everyone grasps all the implications equally, and since I have a knack for in-depth analysis of such things, I should do this one as well. GMs, ready your best fiendish Hackles…

There is the popular impression of Healing Potions that they do their work instantly. Certainly having them do so is a boon to bookkeeping. Early healing potion descriptions didn’t actually specify, they just said “Heals #d8 HP” – at least that’s what my memory tells me. So: what if it were to take longer? What if you were guaranteed the healing promised, but it was going to take a week? Or a day? Or just an hour? And only if you didn’t get yourself killed in the meantime? What would that do to the dynamic of the game, be it D&D or Pathfinder?

Context: Why does HP go up by a dice plus bonus, each level?

Before we can get into that, there are some nuts and bolts of the game system that should be understood (which were also the subject of much debate back in the day, so your understanding might well be different to mine). The most important piece of housekeeping is understanding exactly what hit points represent, and why they go up when a character gains a level. After all, if a character only ever had their starting hit points (CON changes notwithstanding), you rarely need more than one or two “Cure” spells to restore full health.

If it was merely a matter of physical capacity, the differences would be relatively small – once adulthood is achieved, and ignoring infirmity, there are not many physical changes to take into account. You might, perhaps, earn +1 HP per level, or something. This might be increased a little if you had a high CON, but the changes would be minimal. Instead, going from 1st to 2nd level, your HP (on average) double (100% increase); from 2nd to 3rd, it increases by 50%; 3rd to 4th, there is a 33 1/3% gain, and so on. The variability that comes with the die rolls masks the regularity of the progression, but don’t fundamentally change it.

All the explanations that I have seen describe the hit point increase as an aggregate representation of four different contributing factors: Physical Capacity, Mental Capacity, Legendary Capacity, and (most important of all), Combat Capacity.

Physical Capacity

Characters should get a little tougher as they become accustomed to the hardships of the adventuring life. Part of the increase represents this increased resilience. In a purely Simulationist approach, this contribution to HP would be tracked separately, would also be a function of CON, and would certainly not occur at every character level; that none of this happens (except possibly adjustment for CON) indicates that this is a compromised reality for the sake of gameplay.

Mental Capacity

I have seen it suggested that the reason Physical Capacity increases do not phase out with increasing levels is because they are replaced by another form of enhanced combat expertise – Mental Capacity, the ability to keep better track of multiple combatants at the same time. Logically, this would also increase with time and with expertise (which is what gaining a level represents), but initial gains would be relatively small; only when the character achieved his physical peak would he be able to stay in a fight long enough to begin improving this aspect of his prowess. As a result, the combination of the two would be enough to make overall improvements more-or-less linear with character levels, and certainly not worth tracking the minor variations that might take place.

Legendary Capacity

It was quite a number of years before I heard this argument, but it immediately made sense to me. As characters advance in levels, it proposes, they become more famous, more legendary. In a realistic world, this would be a matter of reputation alone, but in a fantasy game where the perils become more and more epic, an increase in capability to “live up” to these demands should take place – and, in part, this is simulated through an increased capacity for combat damage.

Combat Capacity

By far the most common explanation, however, is simply that characters get better at combat with training and experience, and (in part) this is reflected in a reduction in the relative damage done by weapons, i.e. the damage done by a single typical blow as a percentage of total capacity for receiving such blows.

This could have been represented by an improvement in Armour Class, or by a penalty to attacker’s “to hit” values, or even by varying the damage done (low-level characters only doing a percentage of a larger potential damage total) but none of these offer the granularity or simplicity of a substantial change in Hit Point Capacity. From the point of view of game mechanics, a hit point change is the better solution.

Alternative 1: Bonus Only

That doesn’t make it the only approach, though, and I have seen several in my time. One of the most common is simply to cut out the increase in the number of Hit Dice that occurs when a level is gained. Instead, the character simply receives whatever bonus HP they are awarded as a result of their CON bonus.

I have also seen some very vitriolic rebuttals of the proposal, most of them couched in terms of “fighter vs wizard game balance”.

As I have remarked before, that’s the problem with House Rules: one necessitates another, and then another, and so on. In this case, the damage that magical spells can inflict is predicated on the existing HP progression, and needs to be altered if Wizards – above, say, 3rd level – are not going to be the most powerful characters in the game. If anything, goes the argument, there needs to be a change in the other direction in most editions of the game!

If you are willing to put in the hard work required, AND can convince your players to accept the change, by all means implement this change and all the ancillary changes that are needed in consequence – but don’t call it D&D / pathfinder any more, because (in several of its fundamental parameters and assumptions), it isn’t.

Alternative 2: dice to max

“…if anything, there needs to be a change in the other direction.” That usually gets House-Rule-minded GMs thinking, and it isn’t long thereafter that this simple change suggests itself to them. “Spellcasters get smaller hit dice than your up-front-and-brutal types, so if I do away with the variability and simply state that all the dice results are maximized, every time, all the time, it makes those combat characters just that little bit more effective, ironing out the inequities of the game system at least a little bit.

Everyone that I know of who has actually tried this has subsequently reported that the change over-compensates. That leads to consideration of various ways to cut back on the effect – perhaps it only kicks in at a certain level, or the ability has to be bought for X levels of advancement with a Feat, or they use average die results as a minimum gain, or whatever.

Once again, if you’re prepared to put in the hard work, and can sell your players on the proposition, good luck to you. There will certainly be more effort than you are expecting.

The Cleric Question

Having laid the groundwork, there’s a meta-philosophical question to answer: Are clerical healing spells as effective as potions?

In most forms of D&D, there are potions that are as effective as low level clerical healing, but for more serious wounds, the higher-level cleric is the better choice. Some GMs even reinforce this on the assumption that it makes clerics more indispensably part of the game by restricting the number of Healing Potions to X-per-day.

You often gain insights into difficult problems by turning them on their heads, and this is one occasion when that’s definitely the case. Rephrase the question: Should Clerical Healing Spells be as effective as Potions?

If yes, then you need to add potion forms of the other “Cure” spells to the list of magic items available, and start thinking about availability, manufacture, and treasure occurrence. But, if “no”, there are a couple of alternatives…

Clerical Healing less effective than potions

This is a cure for the problem of Clerics being nothing more than a source of healing, there’s no mistake about that! By making cure potions more effective than clerical spells, potions become the first resort. Immediately, though, there will be an effect: as soon as combat is over, everyone will be chugging from flasks. At the start of any combat, you will be able to assume that the PCs are at or near full health. For beginning players and kids, this “soft option” might be the ideal solution.

On the other hand, are beginners and kids more likely than more experienced players, or less, to complain that “all I ever get to do is cast Healing spells?” Or will any chance to act, to get involved in the storyline, and make a difference to it, be a positive? Will the effect of this change be “I never get to do anything any more!”, or worse still, “Nothing I do matters so just tell me what happens”?

‘Lying around recovering is boring’ – I’m sure that was the thinking of the designers when they first began introducing healing spells and potions. ‘Dying from a trivial encounter on the way to the adventure is both frustrating and boring’ would not have been far removed from the top of their minds, either. From virtually the moment that they did, however, games were locked into a standard configuration: trivial encounters to ‘soak up’ excess spells and healing potions and consume other vital resources on the way to the adventure became an integral part of the game, and an essential element of dungeon design, and the game began to devolve into an exercise in bookkeeping: gold for healing potions, consume potions, gain gold, repeat indefinitely.

Heck, I’ve even seen people quaff a healing potion before going into combat in the hopes that if they got wounded immediately it would still help!

Going into combat knowing you’re not at your best increases the drama and heroism considerably, and that gets lost if healing through potions becomes ubiquitous.

Clerical Healing more effective than potions

There are many arguments for taking things in the other direction, then. But that puts us squarely back on the path to the “Holy Drip Bottle”. And there are several questions about exactly how to increase the effectiveness of clerical healing relative to healing potions. Ultimately, these seem to come down to either limiting healing potions in some way, or boosting the effectiveness of Clerical Healing – while still retaining limits on what can be done.

One of the most effective techniques that I’ve seen is for characters to build up a tolerance to healing potions if over-used. Essentially, players keep track of the number of times they have been healed in the course of an in-game day’s play. Each one after the first imposes a -1 on the benefits received from a healing potion, to a minimum of zero healing. Clerical healing doesn’t count towards this limit. Moreover, this limit doesn’t reset to zero at the end of the day, but only improves by 1.

So the first healing potion of the day is at full strength, but the second is at -1 to the amount of healing done, and the second is at -2, and the third is at -3, and so on, placing ever-greater reliance on the party cleric. What’s more, if your penalty reaches -2 or worse, it won’t go away overnight, only diminish. Whatever the total penalty reaches is also a count of the number of days rest and recuperation the character needs to overcome the penalty.

The tables to the left show the effect this has. “I’ve lost 100 hit points, and a healing potion heals an average of 4.5 hit points plus one for caster level for 5.5, so I take 18 of them.” Not anymore, Binky!

In fact, you very quickly reach the point where taking another potion does minimal or even no healing, and only delays the interval until healing potions are returned to full effectiveness.

Now, I’m not actually recommending this approach, I present it here merely as food for thought.

The Paladin Issue

The second issue of metagame philosophy that deserves consideration is the healing ability of Paladins, the “Laying On Of Hands”. I’ve never been completely happy with this; it seems to serve no function other than to turn the Paladin into a second-rate cleric; there needs to be something about this ability that distinguishes it from both healing by clerics and by potions.

One option that I’ve explored now and then is for the Laying On Of Hands to cure things Clerical Healing and Potions can’t. This notion introduces the concept of Taint, which simply states that wound from certain weapons and/or enemies are “Tainted with Evil” and cannot be healed except by a Paladin’s Gift – and even then, it is quite difficult.

I freely admit that the concept is lifted directly from the Lord Of The Rings, where it was an effect of Nazgul Morgol-blades. Every 6 hours that a tainted wound remains untreated, it increases in severity by 1d6; this can be halved by a skilled healer applying an appropriate compress, and the 6 hour interval can be increased to a day by bed rest in a suitably blessed location. Clerical and Potion healing can do nothing for such wounds other than hide them and present the superficial appearance of healing. And that’s a problem, because nasty things happen should the Taint ever exceed the total hit points of the character – his soul’s purity is consumed and he will become a Taint-wraith, a fell spirit with loyalty to no-one and nothing, whose very touch inflicts Taint upon others.

When the Paladin reaches out his hands to cure the afflicted, he is engaging in spiritual combat with the Taint itself. The Paladin and the Taint make opposed die rolls; the Paladin adds his total remaining capacity for laying-on-of-hands healing AND his character level in Paladin AND his Wisdom bonus, the Taint adds the total damage that it has afflicted so far.

If the Paladin succeeds, the taint is held at bay for a day, and for every point by which he succeeds, one point of Tainted damage is healed, up to the maximum of his Healing ability – so it will become progressively easier to heal the Tainted wound. Nor can a succession of Paladins lay on hands; healing done by others counts as having already being done by the next Paladin to attempt it. Finally, battling Taint is spiritually exhausting; for every point of damage healed by the laying on of hands, the Paladin himself suffers 1d6 shock damage, and for every 6 points healed or part thereof, he also takes a point of Taint which he can only expunge after 2 hours of prayer and meditation per point of secondary Taint inflicted.

That quickly means that it becomes a choice between ridding oneself of the secondary taint or continuing to heal the character afflicted with the Tainted wound. If the Paladin is too generous with his efforts on behalf of others, he can succumb himself.

Again, this is not necessarily something that I am recommending, unless it fits your campaign; for example, it’s entirely too grim for my Fumanor campaign, though it was going to be part of my Shards Of Divinity campaign eventually; the players were lucky in that they never encountered a foe with Taint as an ability, because they had made enemies of the Paladin Orders!

The Skill Significance?

Finally, one consequence of the ubiquity of supernatural healing (via Clerics, potions, and Paladins) is that healing skills and medical knowledge are devalued within the game system, to the point where they are represented by a single skill that is often ignored, and whose benefits do not reflect the effort involved in becoming proficient. In reality, herbalism and surgery (including bone-setting) and medicine should be separate skills, and each should offer tangible benefits with expertise. But there’s no need for that, because healing is so ubiquitously available.

Picture a character discovering a rare tome on medicine in a treasure hoard, one with cures to previously-lethal illnesses. If this were to happen in any real-life situation, it would be cause for great celebration and rejoicing; healer who had studied the work would be very greatly in demand, and – in general – it would be a Big Deal. Now place the same reward in your typical D&D treasure haul, and the players will feel like they’ve been gypped, so devalued is medical knowledge in a D&D / Pathfinder game environment.

One desirable consequence of any changes to the healing subsystem would be a reversal of this situation, even if it were only partial. Any improvement would be a positive benefit.

Healing as an acceleration of time

With those issues all tucked away in the back of our minds, let’s look at what it actually means if one or more forms of magical healing are reinterpreted as an acceleration of time for the purposes of recovery from sickness and injury rather than an instantaneous “healing” of illness and injury.

What won’t heal naturally

The first impact should be immediately obvious but will have major repercussions, which I’ll be spending most of the remainder of this article discussing. Any healing that falls into the “accelerated time” category can’t heal anything that would not heal of it’s own accord, given an appropriate period of rest. If broken bones are misaligned, they will heal crooked. If wounds are not closed properly, they will leave a scar. If surgical intervention or medical treatment are required, the character may not heal at all. Worst-case scenario: death may be accelerated instead.

Healing Skills

That puts a premium on correct examination and diagnosis, as well as providing appropriate medical intervention prior to the healing. Recovery periods may be shortened, perhaps dramatically, but “healing” or “cure wounds” are actually misnomers. Having a character who has invested heavily in medical expertise is suddenly essential – so much so that the broadening into the three distinct skills mentioned (herbalism, surgery (including bone-setting), and medicine, is more than amply justified. The state of the medical art would need to be very carefully defined by the GM in all three categories to prevent characters bringing modern knowledge into play.

This sort of healing won’t prevent a character losing a limb if it is infected; it will speed the recovery after an appropriate amputation.

Better spells = greater acceleration

It can be argued, under this paradigm, that higher orders of healing spell represent a greater acceleration of the healing process, and that this is what is being simulated by the greater HP recovery. This simply means that the time for the healing effect to run its course remains fixed across all levels of spell, or perhaps is a function of caster level.

Let’s say, for example, that the time for the spell effect to run its course is 12 divided by the caster level in hours, and that Cure Light Wounds grants 1 extra day’s recovery in that time, Cure Moderate Wounds grants 2 extra days in that time, Cure Serious Wounds grants 4 extra days, and Cure Critical Wounds grants 8 extra days of recovery. Heal grants as many days as are needed in a one-hour time frame.

Or perhaps it’s one day’s worth per die of healing, and only the duration over which this healing takes place changes. Four options present themselves: a minute, 10 minutes, an hour, or a day. That means that a 3d8 Cure Light Wounds (caster level 3) gives 3 day’s worth of recuperation in a minute, in 10 minutes, in an hour, or in a day (respectively).

But it’s simplest to compare apples with apples – you can normally regain 1 HP with a night’s rest. So every point of healing rolled is one day’s recovery. The same time options present themselves – a minute, 10 minutes, an hour, a day. If you are getting 50 HP of recovery from the spell, that’s 50 days of recuperation in that interval.

If you are getting 60 days healing in one minute, let’s say, that means that every second that passes is one day of rest. If it’s 60 days worth in ten minutes, that’s a day’s worth every 10 seconds. If it’s 60 days worth in an hour, that’s an accelerated rate of one day per minute. And if it’s in a day, that’s simply a 60-fold increase in healing rate.

No matter how you work this, you end up with the same general principle: the higher the spell, the faster the acceleration of time. Whether that’s because some spells are capped, (Cure Light Wounds is capped at 5d8+Caster Level, for example) or because you have explicitly defined a specific healing rate, the result is the same – only the numbers vary.

But, and it’s a big but, those numbers matter, as you’ll see.

Potential re-injury

Anyone who’s ever injured themselves knows that you have to be careful while recovering or you can re-injure yourself, or even do fresh damage. The shorter the operational duration of the spell effect, the less likely this is to happen. When healing is instantaneous, it’s impossible; one instant you’re injured and the next, you’re healed.

That has a profound impact when you think about healing in the field. You’ve beaten the monster, and chugged a healing potion, or had the Cleric pray over your wounds, or whatever; if you only have to wait a minute, that’s not too severe. If ten minutes, you would want to post a sentry or two – restricting the number of characters who can be healed simultaneously. If an hour, you definitely need to post sentries, and there’s a fair-to-high chance that something will come looking for carrion (or real estate) unless you’ve completely cleared the entire Dungeon at least once in that period of time. If you’re going to be laid up for a day, or for 12 hours, or whatever, at the very least you would need to establish a fortified position before commencing the healing.

If you’re one of the front-line fighters and are getting healed when the party comes under attack, do you grab a weapon and try to help out (running the risk of re-injury) or do you leave the party at low ammo in dealing with the situation?

The entire dynamic of the game is affected. And the tension level definitely goes up a notch or two.

The Danger Of Infection

Some infections can be fought off, given rest. Others are far more serious. Medicine can help somewhat. Dungeons are rarely the cleanest of environments; Gangrene and Tetanus would pose serious threats. The longer the duration over which the recovery is spread, the more likely it is that you will be affected by a serious infection.

It might be that by increasing the natural healing rate in this way that the body can actually dedicate more of its resources to fighting off infection. so immediate healing might still offer a benefit. Or it might be that diverting those resources makes the body more vulnerable. Again, “mundane” medical preparations taken prior to the healing and inactivity in as clean and wholesome an environment as you can manage becomes absolutely essential.

When and How to heal become serious decisions of risk vs benefit.

Clerics or Potions or Both?

By now, it should be clear that if Clerical healing works this way and healing potions don’t, then Healing Potions are the way to go. If the opposite, then Clerical Healing becomes preferred. If both work this way, then neither would be preferred over the other. Healing spells are still seriously beneficial, but those benefits now come with price tags. There are many more variations possible: perhaps both are subject to this rules tweak, but Healing Potions are slower, and hence less effective. Other aspects of the risk/reward balance can be tweaked to make swallowing a potion neither better nor worse, but still different, to healing magic.

Laying Of Hands

What of the Laying On Of Hands by a Paladin? Perhaps this represents “old style” healing – purging the body of infections and toxins, aligning bones, etc. Rather than supplanting any of the other healing mechanisms, this now supplements them – even without introducing Taint.

Triage

If you can’t heal everybody at once of everything that’s potentially wrong with them – and that’s what this set of House Rules achieves, by implication if not explicit statement – then Triage becomes important. Who is most seriously wounded? Who can be helped? For whom is a potion the better answer, and who requires the personal attention of a Cleric?

Injuries and wounds become more than simply a loss of Hit Points.

The Advantage Of Regeneration

What’s the difference between healing that’s available on demand and Regeneration? Well, since Regeneration is capable of regrowing lost limbs, the implication is that it can heal things that – under this paradigm – Healing can’t. Trolls and appropriate magic items become a LOT more dangerous and valuable, respectively, and the surgical removal of a damaged limb becomes a viable treatment.

But this also brings up the potential for combination therapy – does this sort of healing also increase the effect of regeneration? Why not? It’s hardly game-unbalancing. Or perhaps this poses a new risk, akin to a combination of medications that are dangerous or even deadly. “Contraindicated” is the usual term of the medical community.

Heal vs Wish

One annoyance has been that Heal, from memory a sixth level spell, does it all. That’s always seemed too powerful to me. By explicitly placing it as “the ultimate Cure Wounds spell” and subject to the same restrictions and effects as we have been discussing here, it is no longer perfection in a single spell. It would still have a benefit yield appropriate to a 6th level (or whatever) spell, but for perfect healing, you need to unlimber the ultimate weapon against injury: a Wish.

Nutritional Needs and Pain

If people go more than about a week without food, they die. If they go more than about 3 days without water, they die. If they don’t inhale enough clean air, they either pass out, or die, depending on how deprived of oxygen they are. Are these needs increased proportionately to the acceleration of time? Or even part-way?

Picture it: you swallow a healing potion, and for the next hour you’re perpetually gasping for breath, choking down food as fast as you can get it into your mouth, and drinking like a fish – plus dealing with the resulting waste products. Nor have we suggested that the process is painless; you might be getting a week’s worth of pain in only a few minutes, making it agonizingly painful. Combat is out of the question! Even walking would be difficult, if not impossible. You’re at least partially incapacitated.

Or perhaps these are not accelerated, and the magic is drawing its power from some other source. That means that you can avoid starvation and death from dehydration or from lack of air by quaffing a healing potion. You might even be able to avoid drowning long enough to get back onto dry land and have your lungs cleared. Sneak attacks and infiltration might become possible that would require scuba gear in the real world.

Clearly, either option brings consequences – you get to decide which set of consequences you want to exploit in your campaign. And of course, it might be quite a while before your PCs figure out the latter one…

The world is more dangerous

Anything that makes injury and damage more significant increases the danger level that the game world poses. This doesn’t alter magical healing much, but the implications are profound, and represent a significant impact on those danger levels. You’re taking away one of the major safety blankets.

Arguably, you achieve a more “realistic” and “gritty” game. It’s less sanitized, less comic-book. If those traits match what you are trying to achieve in your campaign, this is an alternative worth considering; if it conflicts with the style that you want to adopt, don’t do it, but make that a conscious choice.

Going Further

It’s possible to go even further. This option is compatible with every other variant on offer in this series, and substantially enhances some of them, and is in turn enhanced by them. Wound Severity, and having some wounds that can only be healed by certain levels of Cure/Healing spell, for example, have an obvious impact on this rules variation, because those mandated minimum spells have consequential impacts through the accelerated healing process that they create within this concept.

Be careful not to go too far. Remember that if RPGs were completely realistic, you would never be able to defeat a Dragon and many people would not be capable of wielding a tool, never mind a weapon. You want the PCs to remain larger-than-life and heroic in their capabilities; don’t take away too much of their capacity to be exceptional.

Used appropriately, in its’ rightful place, this option can enhance a game. Used incorrectly, it can kill one. Have fun….

And now for something completely different – I’ve just been interviewed by Matt over at DiceGeeks, you can read the interview at this link! Stop by and learn something new about what I’ve been up to and what I expect to be doing in the future :)

Meanwhile, I have one more of the “All Wounds Are Not Alike” series but I won’t be presenting it for a little while – it promises to be a little on the involved and lengthy side…