House Rules, Table Top

Gritty Healing for Dungeons and Dragons 5e

Below you’ll find a set of alternate rules for healing in 5th edition Dungeons and Dragons. These rules are intended to replace the existing rules for healing, healing spells, and other health abilities. Their purpose is to make damage feel more gritty and dangerous, along with making mundane healing skills more useful.

My gaming group and I were not satisfied with how damage did not feel real when there was a healer just a moment away. It softened the risk of an encounter and at the same time, made it feel less heroic.  Additionally, with the way magical healing worked, the non-magical healing skills seemed almost worthless and thus made character concepts build around them seem invalid and less fulfilling to play.

This alternative to the magical healing system puts gritty danger back into combat. It makes being wounded, well, hurt. Adding back in a missing element to an encounter and making the mundane healing skills important again. Using both magical and mundane healing in tandem becomes important, making healers of both types valuable to the party.

That’s enough of my ramblings, onto the rules.

Gritty Healing

Disregard anything relating to Magical Healing in the core Book and Amend it to the following:

There are three types of magical healing:

  1. Magical Triage: Healing spells cast in this fashion do not remove damage, but instead provide Temporary hit points (That can NOT go over the target maximum) This is like magical life support, keeping you going and fending off future injuries. You are still in pain, you are still bleeding. Declare you are casting a healing spell as “Magical Triage” before rolling for HP. These Temporary HP Expire 1 minute after the end of combat
  2. Instant Magical Healing: The healing spells are cast the same, but heal the actual damage, quickly, but not cleanly. Bones will not set, organs will not mend well and mangled limbs will still be mangled. But you will no longer be bleeding to death and they are not at immediate risk of dying. Your scars will be horrible, you will be disfigured. It pretty much just heals any injury, in the bluntest to the point way possible. If under 50% health, healing in this fashion generates a lingering Injury. (See DMG for more information on Lingering Injuries.)
  3. Spellbound Healing: Once combat is over, Spellbound Healing can be used. By combining mundane healing skills with magical healing spells, grievous wounds can be tended to and healed quickly.First, a person with the Medicine skill makes any required healing skill checks to perform first aid and more advanced medical procedures. ( Setting bones, sewing up wounds, surgery to repair internal damage, etc)Next, someone with magical healing ability then casts a healing spell upon them. This will restore a number of HP equal to the amount the spell would normally restore, plus the Medicine proficiency score (Proficiency bonus + Wis Bonus + other modifiers)  of the person who performed mundane healing on the target. Additionally, if the medicine roll was a critical success, double the amount of HP restored.If Instant Magical Healing was used on the target, Spellbound Healing may not be used, without re-injuring the subject (As their wounds are technically healed.) Add +5 to all difficulties forMedicine skill checks made to undo the instant healing.

Other Types of Healing:

Lay on Hands:
Change Lay on Hands to Holy Ward. A Paladin may lay a Holy Ward upon a person, protecting them from damage. They may give a target temporary hit points, from a pool of 5 times their Paladin Level. Temporary Hitpoints last until they are used or until the target completes a long rest. This pool behaves otherwise normally. The other effects of lay on hands remain unchanged. Alternitively, Treat layout hands like magical healing (Triage, Instant, and Spellbound.)

Healing Potions:
Healing Potions work as Instant Magical Healing if used in battle, but can also be used for Spellbound Healing. They can not be used for Magical Triage

Wands of Healing:
Can be used for Magical Triage, Instant Magical Healing and for Spellbound Healing

Second Wind:
The HP provided by Second Wind counts as temporary HP

Additional Rules:

Clerics with the dominion of life: Add Ritual Casting to all standard healing spells

Optional- Health Status Effect:
If you are at:

  • 100% Health: +1 to all Skill checks
  • 50% and Under: Disadvantage on all non-combat rolls (skill checks)
  • 25% and Under: Disadvantage on all rolls and -10 Movement and you can not fly through physical means (Wings no, magical flight yes.)

A note on thematics

The Gritty Healing System is designed to add a level of detail to the injury and healing process. In battle, magical triage is designed to provide a buffer to an injured target. Using magical energy to keep them alive while they are hurt.  They still bleed, their bones are still broken and they are still in pain. Instant Magical Healing quickly closes up wounds and mends bones, in the most expedient way possible. It will ensure the target won’t bleed to death and keep their entrails from falling out, but that’s it. Grievous scars and crippling disfigurement may result. Lastly, Spellbound healing is will accelerate natural healing and behaves much like instant magical healing, except that someone with medical skills has set the bones, repaired internal damage and has sewn up wounds. This allowed the magic to heal and restore the body is a much cleaner way.

The change to the paladin lay on hands ability is to give them a unique effect that keeps the spirit of the ability while making it different and unique. Laying blessings about a target to help bolster them in combat, shielding them from damage. This allows the Paladin to bolster their allies before a combat, as well as during.

House Rules

While these rules add a level of complexity to the system and may slow down combat, they may add a level of grit and danger to your own game. Making the player with a bucket full of Hit Points less likely to treat being hurt as something to just laugh at as long as they still have 1hp left and at the same time allowing healers of all types feel like their skills matter.

Feel free to ask questions in the comments and feedback is always appreciated.

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Photo: Kelsey Elise Daily



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