So I've seen some rules referencing that whenever a creature drops to 0 HP it is either knocked unconscious (and starts making death saving throws, unless it's already stable) or it dies outright.

However, trolls have the Regeneration feature that will let them regain hit points and which suggests that they never "die outright" unless the conditions are met that prevent its regeneration (typically fire or acid damage). Normally, from what I understand, a troll gets knocked out when it drops to 0 HP, but unless its Regeneration is stalled, it just regains hit points at the start of its next turn and can get right back up and keep fighting.

The Spirit Troll (Mordenkainen's Tome of Foes, p. 244) has a Regeneration ability that is nullified if the troll takes psychic or force damage since the start of its last turn. However, it also has immunity to the Unconscious condition.

Does the troll ever get knocked out from dropping to 0 hit points? Or can it act normally?

In my specific example, I ran a game where a Spirit Troll attempted to attack the group's fighter (Battle Master archetype), who Riposted the first attack when the troll missed and dropped the creature to 0 HP. As far as I could tell by RAW, the troll was still allowed to make the rest of its attacks on its turn.

I know it's ultimately up to DM discretion, but the whole thing sparked a discussion with my players (because I was honest with them and admitted to them that the troll was at 0 HP and told them I didn't know exactly how it should be ruled), and we ended up letting the troll make its attacks because the players really weren't struggling with the encounter that much anyway.

  • \$\begingroup\$ Here's the general rule on monsters and death at 0 HP, for convenience. Creatures that regenerate are usually described as an exception, given their ability to heal. Also, you may want to ask your followup question as a separate question, since it seems distinct from this one (though related). \$\endgroup\$
    – V2Blast
    Commented Sep 23, 2018 at 7:37
  • \$\begingroup\$ ...I've edited out the secondary question now. Also: Welcome to RPG.SE! Take the tour if you haven't already. This is an excellent question! \$\endgroup\$
    – V2Blast
    Commented Sep 24, 2018 at 0:50

4 Answers 4


The Spirit Troll cannot be knocked Unconscious by any means

As you have said, the Spirit Troll is immune to the Unconscious condition. The rule for falling to 0 hp says:

If damage reduces you to 0 Hit Points and fails to kill you, you fall Unconscious (see Conditions ).

But the Spirit Troll is immune to the Unconscious condition, so simply reducing it to 0 hp has no effect on it.


On the start of the troll's turn, it has n HP.

It attacks and misses.

As a reaction, the fighter ripostes and does n damage.

It's still the troll's turn, it's at 0 HP.

The DMG says, "Most DMs have a monster die the instant it drops to 0 hit points, rather than having it fall unconscious and make death saving throws"; however, if the DM wants to stay true to the spirit troll's stats, then the spirit troll can't die.

What to do?

One solution is that the spirit troll finishes its turn fighting at 0 hp. I don't like this one because the spirit troll doesn't have a feature that says it fights at 0 HP.

Another solution is that the spirit troll "dies", during its turn, as would be expected with another monster. The DM can choose to have it do a death saving throw or not as the DM wishes, per the monster death rules. Of course, it's not alive anyway. It has "a nonphysical form" with "a body as insubstantial as shadow". So when it hits 0 HP, it's insubstantial form insubstantially falls to the floor with insubstantial guts falling out or whatever. THEN, at the beginning of its next turn, assuming it did not take psychic or force damage during the turn it "died", it regenerates, regains hit points, and comes back to "life". Per its stats, it only actually "dies" - disappears, discorporates, disperses - "if it starts its turn with 0 hit points and doesn’t regenerate".


By RAW, specific wording of the Regeneration ability beats general.

I would rule it as the Spirit Troll is still standing (and presumably willing) to fight at 0 HP. Do note that the Spirit Troll cannot be knocked prone as well (immunity to Prone condition), therefore it does not fall prone due to the Unconscious condition (again, due to immunity to Unconscious condition).

So unless the party is able to stop the regeneration ability of the troll, the troll is able to fight on at 0 HP (and at the start of it's next turn, regenerate 10 HP!), which can be very dangerous if your players do not have the means to stop the troll from regenerating.


An Alternate Ruling

I feel that the other answers have adequately addressed the question from a strict rules as written standpoint, however, I would like to offer a different take on the situation which may be helpful were your players having a much more difficult time with the encounter.

The rules for death and dying state (emphasis mine):

If damage reduces you to 0 hit points and fails to kill you, you fall unconscious. This unconsciousness ends if you regain any hit points.

Under the Unconscious condition itself, in addition to other effects, the target is also subject to the Incapacitated condition and the Prone condition.

I think it is reasonable to infer that the manner by which conditions were written into the rules was with consideration for brevity where possible. There's no need to say in the rules for falling to 0 hit points that you fall unconscious, and you're incapacitated, and you are prone because all of that is included within the general rules for the unconscious condition.

For this reason, it's reasonable for a DM to assume that upon a creature reaching 0 hit points, they are not just subjected to the Unconscious effect, you are also subjected to the Incapacitated effect, which specifically says:

An incapacitated creature can't take actions or reactions.

Because the spirit troll isn't immune to the Incapacitated condition, and because that condition bars taking actions, it can't continue to attack.

  • 2
    \$\begingroup\$ Why would any of the effects of the Unconscious condition apply when the spirit troll is immune to that condition? Just because some of those effects happen to be other conditions doesn't make them special, does it? \$\endgroup\$ Commented Nov 10, 2023 at 16:02
  • \$\begingroup\$ @RyanC.Thompson being immune to Unconscious doesn't by default make you immune to being Incapacitated; it makes you immune to being Incapacitated by solely being rendered Unconscious. So a sleep spell, whose sole effect is deliver the Unconscious condition, is not going to work. But reducing a creature to 0 hit points, could reasonably be inferred to not just render a creature Unconscious but also all the other conditions as well; it's just not spelled out because it usually doesn't matter. As I stated from the outset, this is strictly an alternative way to interpret the rules. \$\endgroup\$ Commented Nov 10, 2023 at 17:13
  • \$\begingroup\$ So you're arguing that "fall unconscious"/"knocks you unconscious" is not necessarily equivalent to "you are subjected to the Unconscious condition", and could instead be ruled by the DM as being directly subjected to the Unconscious, Incapacitated, and Prone conditions? \$\endgroup\$ Commented Nov 11, 2023 at 0:27
  • \$\begingroup\$ @RyanC.Thompson correct. \$\endgroup\$ Commented Nov 13, 2023 at 15:06

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