I've introduced a homebrew Lingering Injury system to my D&D 5e campaign. The system is relatively simple but does require the addition of some spells to heal from the injuries.

This question is about the balance of the new homebrew injury healing spells rather than the system itself (which I will be refining through playtesting). However I have included an overview of the system to provide context for the spells.

Lingering Injuries System

When a character is reduced to 0 hitpoints they must make a Constitution saving throw. DC is equal to 10 or half the damage taken whichever is greater. On a fail, they suffer a Lingering Injury and must roll on the table below to determine the injury.

First roll a d20 to determine the severity of injury.

d20 Result Injury Table
1 Roll on Critical Injury Table and subtract 20 from the result
2-6 Roll on Critical Injury Table
7-13 Roll on Moderate Injury Table
14-19 Roll on Minor Injury Table
20 Roll on Minor Injury Table and add 20 to the result

Players then roll on one of three d100 tables to determine the exact injury. The severity of the effects are as follows:

Minor Injury

Low impact effects that can all be recovered on a long rest.

  • Examples: Status effects, conditions, disadvantage on skills checks, minor penalty to speed, etc.
  • Worst Case: One point of exhaustion

Moderate Injury

Similar level of impact as Minor Injuries, but not guaranteed to heal on a long rest.

  • Examples: Conditions, disadvantage on skills checks, disadvantage on attack rolls and saving throws, larger penalty to speed.
  • Worst Case: Disadvantage on all rolls until healed.

Major Injury

Serious effects that will majorly limit characters unless quickly resolved.

  • Examples: Loss of limbs, Reduced ability scores, Permanent Conditions, Reduced Max Hitpoints
  • Worst Case: Death

The Spells

To balance this system I am added the following spells as a means to heal these injuries. My focus is on if these spells are of the appropriate level and cost compared to the severity of the injuries and other similar spells (e.g. Restoration).

Heal Minor Injury

1st Level Abjuration

Casting Time: 1 action

Range: Touch

Target: Creature you touch

Components: V S

Duration: Instantaneous

Classes: Bard, Cleric, Druid, Paladin, Ranger

You touch a creature and cure them of a minor injury afflicting them. The injury can be any effect from the Minor Injury Table.

Heal Moderate Injury

3rd Level Abjuration

Casting Time: 1 action

Range: Touch

Target: Creature you touch

Components: V S M (A piece of cloth to serve as a bandage)

Duration: Instantaneous

Classes: Cleric, Druid, Paladin, Ranger

You touch a creature and cure them of a moderate injury afflicting them. The injury can be any effect from the moderate or minor Injury tables.

Heal Major Injury

5th Level Abjuration

Casting Time: 1 action

Range: Touch

Target: Creature you touch

Components: V S M (A piece of cloth to serve as a bandage, Diamond Dust worth at least 50gp which the spell consumes)

Duration: Instantaneous

Classes: Cleric, Paladin, Ranger

You touch a creature and cure them of a major injury afflicting them. The injury can be any effect from the major, moderate or minor Injury tables. This spell cannot restore a creature to life, but it can heal the injuries of a recently deceased creature.

The goal is for these spells to be accessible but not trivialise the injury system. I also don't want to entirely replace the existing healing and restoration spells.

I understand there is an opportunity cost to taking these spells due to the limited number of prepared/known spells for the various casters. However I am willing to modify rules if that becomes an issue.

Are these spells of the appropriate level and cost compared to the severity of the injuries and other similar spells?

Note: I am not looking for a critique of the system or whether you feel these spells are a good addition to the game or not. I just want to know if they are appropriate leveled. I'm using this system in a survival/exploration game with a number of homebrew rules.

  • 8
    \$\begingroup\$ You would need to list all the possible injuries in order to evaluate the spells. Permanent blindness or deafness can be cured with a 2nd level spell (Lesser Restoration), but reattaching an ear is a 7th level spell (Regeneration). \$\endgroup\$
    – StarHawk
    Feb 3, 2022 at 14:25
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    \$\begingroup\$ You've left a couple comments asking people to focus on the balance of the spells only, but I don't think you're going to get a useful answer that way. The spells are part of a larger whole, and without that context, it's impossible to say anything of value about the spells. Non-Human Person's answer, (and your response to it) in particular, shows how much context we're lacking. That lack of context means we can't give good answers. \$\endgroup\$
    – Tal
    Feb 3, 2022 at 14:31
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    \$\begingroup\$ To clarify, is the intent of these spells to solely be used to remove effects caused by 'Injuries' as you've defined them with your homebrew system? Or is it to remove specific effects, many of which are caused by injuries? For example, a character could suffer from Exhaustion, but the source of said exhaustion could be many. \$\endgroup\$ Feb 3, 2022 at 16:14
  • 3
    \$\begingroup\$ I put in a vote to close the question as we really need more details. Along with all the questions brought up by @PatrickArtner, you ask, "Are these spells of the appropriate level and cost compared to the severity of the injuries and other similar spells?" But each injury would need to be evaluated. "Loss of limb" would be Regenerate which is 7th level, but death can be solved by 3rd level Revivify if done quick. What if death is not by "injury" but by lack of hp? Would Heal Major still work? \$\endgroup\$
    – MivaScott
    Feb 3, 2022 at 19:12
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    \$\begingroup\$ Not an answer because you are only asking about balance: but 3 spells that do the same thing is against the spirit of 5e simplification. You should have 1 spell that can be upcast. Or better yet just add it to existing spells like cure wounds. \$\endgroup\$
    – SeriousBri
    Feb 3, 2022 at 19:56

4 Answers 4


I'm not sure this system achieves your goals. I'll cut right to the chase; the balance of this system hinges entirely on how often players go down. This system effectively adds a spell slot tax to players going down. If players rarely go down (as is the norm in my experience) the system won't affect the game at all. If they go down a lot, then the costs quickly snowball - now the party that is already losing fights has even less resources.

The second issue is that until the end of tier 2 you have essentially no choice but to live with major/critical injuries. This potentially means the party has to leave the dungeon and retreat whenever someone goes down. To me this is a huge issue in t1/2 play. In t3 play the system will either fade to irrelevancy or remain crippling. In mid t3 resurrection may completely replace major heal injury.

Comparing to other resurrection and healing spells, I don't see any problem with the levels or functionality of the spells. But the game impact this system will have is extremely concerning.

To meet your design goals I suggest a redesign forcing players to interact with the system rather than treat it as a tax.

  • 1
    \$\begingroup\$ I'm not exactly sure what kind of redesign you are suggesting. However there is more to the system than what is included in the question. I have extended the medicine skill as well as provided means to heal as long as the can successfully return to specific safe havens. This is for a particular style of campaign and will be adjusted as we play to suit what I'm looking for. This question however is mainly focusing on the spells themselves, which your answer barely touches on. If you can extend that part and support it it would be more useful. \$\endgroup\$
    – linksassin
    Feb 3, 2022 at 12:51
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    \$\begingroup\$ @linksassin: Part of evaluating a spell is knowing how hard it would be to do the thing without magic. e.g. a spell that digs a hole in the ground. It does it quickly, but is it the only thing in the game that can dig holes? No, there are shovels in D&D, so the relevant comparison for the spells power is against what a party can do with shovels and time, rather than compared to not having earth moved at all. \$\endgroup\$ Feb 3, 2022 at 19:32
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    \$\begingroup\$ I wish to come out in support of the Tier 1 problem here (at the least). We were in a game with DMG lingering injuries and it was hella penal to the PCs at levels 1, 2, and 3. Can't speak to Tier 2 as the game died due to the RL Scheduling monster giving it a critical hit. \$\endgroup\$ Feb 3, 2022 at 20:04
  • \$\begingroup\$ @linksassin To reiterate; the balance of the spells is fine wrt existing spells. Sometimes the question you ask isn't answered directly and instead you get a frame challenge. I strongly encourage you to reconsider this system as it has fundamental flaws that I don't think have been considered or addressed. I understand you want to handwave this with "the style will be adjusted to suit what I'm looking for" but I'm not so sure. I urge you to consider my expert opinion and the consensus of this expert community that this system has serious issues. \$\endgroup\$
    – user73918
    Feb 4, 2022 at 4:03

As others have mentioned, there is a problem with using spells

I forget where I read it, but early on in my DnD playing there was an article about changing rules. The argument went something like this:

DM: I've got this cool new concept. Instead of air, the world is nothing but carbon dioxide.
Player: But then how will we breathe?
DM: You'll all have special respirators.
Player: What about NPCs? And monsters? How will they breathe?
DM: All the people will have one. And the monsters have adapted.
Player: But what if mine breaks? Seems pretty easy considering all the fighting we do.
DM: They can't be broken. They just always work.
Player: If everyone has a respirator, that never fails, and we can always breathe normally, tell me again why we are getting rid of air?

So if you're going to modify the rules so that there is no "spell tax", why do you even need spells in the first place?

And as Non-human person pointed out due to some crappy rolls, a 1st level character could end up with a "Major Injury" by their first combat. It would really suck as a Fighter that in my first encounter that I could lose an arm and therefore lose access to shields and two-handed weapons. I'd just scrap that character and make a new one. Unless that's the campaign you're players signed up for...

Instead of spells...

Just use the Medicine skill (it could use some love anyways) and attach a cost of supplies/components (uses of a Healer Kit, create some unique healing remedies for your campaign1) and DC appropriate to the level of the injury.

Also keep in mind that these spells do not cure any hit points.

Hit points represent a combination of physical and mental durability, the will to live, and luck.

So injuries are already factored into healing spells. But now the party may have to cast two different spells to heal the character. This makes it seem like a chore, not a heroic quest.

As a suggestion, you might add a short/long rest requirement to the injury healing process; the injury is attended to, but the character still needs a period of rest for it to fully heal. This would give the character a chance to use hit dice to heal during short rests. Or state that the character cannot use hit dice on a short rest until some other requirement is met.

For the injury level...

I would alter it based on tier of play. Only allow injuries that the players are equipped to handle. Or just outside of what they can currently handle but maybe through quest or NPC get resolved.

1 Which could end up being quests on to themselves. To heal the infection the character must drink water from a certain lake.

And strictly speaking about the spells themselves

If we remove all context of the system and implementation, you have a problem in spell caster lists.

Two of the classes that can cast the spell are only half-casters

Heal Major Injury allows a number of classes to cast so it is not a big deal, and Heal Moderate Injury has a smaller but not impossible list. But the Heal Major Injury spell only allows Clerics, Paladins, and Rangers. Which means two out of three of the only classes that can cast the spell cannot do so until 17th level.

For perspective, at that point a Bard or Druid could have cast Regenerate, Resurrection, and/or True Resurrection and Wizards can cast Wish.

So without access to a Cleric, a character could have a debilitating injury for a huge portion of their life.


These feel like Heal Taxes

The issue here is that this seems to force the party to have a character that can cast these spells. Even the minor conditions could be debilitating. Most parties don't really need healers since failing multiple death saving throws is rare, and parties without revivify prioritize getting downed players up.

These spells are fine, but they become additional taxes that a cleric (or equivalent) must take and keep prepared. So you both narrow the character choices your players can make and also narrow the choices the designated healers can make in their spell selection.

  • \$\begingroup\$ I mentioned in the question I'm aware of the cost to take these spells. I'm prepared to house rule additional slots or prepared spells if required. I'm really just looking for a review of the balance of the spells themselves. \$\endgroup\$
    – linksassin
    Feb 3, 2022 at 13:52

It is impossible to balance these spells in the traditional manner

Many people have commented on how much of a tax this is etc, and I agree with them all, but your main point of reference with these spells should be the resurrection spells.

Consider the following:

Regeneration can grow back an ear but is a 7th level spell.

Revivify can't grow back the missing ear, but can bring you back from the dead

Balance was almost certainly not a consideration for these spells in the way that you are trying to balance your spells.

Revivify was most likely lowish level because the developers needed to give players a way to not lose their characters.

Regeneration is high level not because growing back an ear is super powerful, but because growing back an ear is effectively irrelevant, and the key part of the spell is regaining 1hp per turn for an hour and being effectively unkillable without specific actions beyond the norm.

So how would you measure these spells?

You need to ask your players questions like "If you lost a limb at level 2 would you be ok to wait until 5th level spells became available?". In that manner you agree the kind of game you want to play, and then balance isn't really a concern at all.

All these spells do is remove an inconvenience, how much that matters is a table discussion.

  • \$\begingroup\$ effectively unkillable - Well that's a huge overstatement. It just takes 3 attacks or other damage sources to kill someone who has Regenerate cast on them. (At least one of them an actual attack from within 5 feet, else 4 damage sources between their turns, e.g. two ranged attackers with Extra Attack.) One to knock them to 0 hp, and two more to deliver 1 or 2 failed death saves. You don't regen if you're dead at the start of your turn. I wouldn't want to trust my life to an enemy moving on and not finishing off the creature that keeps popping back up every round. \$\endgroup\$ Feb 4, 2022 at 11:19
  • \$\begingroup\$ It is a powerful non-concentration spell, though, which could make someone death-proof in a lot of situations, including RAW swimming through lava for an hour, if their max HP is high enough to not drop to -max_hp and die outright. Or wait, the spell doesn't say it ends if the target dies, or anything about not being dead to gain an HP at the start of your turn. But can you regain HP when you're dead? Healing spells don't explicitly say they don't work on corpses, either, except for targeting restrictions (a creature, not an object such as a corpse). \$\endgroup\$ Feb 4, 2022 at 11:20
  • \$\begingroup\$ @petercordes with the caveat of 'without specific actions beyond the norm'. Normally DMs don't have the NPC's mercilessly butcher unconscious players, but it's quite possible once the enemies cotton onto what is happening of course. \$\endgroup\$
    – SeriousBri
    Feb 4, 2022 at 13:46
  • \$\begingroup\$ Yeah, in most games the tone is "heroic adventure", not "grimdark / game of thrones intrigue". So yes, it's normal for enemies to move on after a KO without killing, and not to focus-fire too heavily. But making them play whack-a-mole is very likely to change things, unless the DM chooses to have enemies ignore what's going on. \$\endgroup\$ Feb 4, 2022 at 13:59

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