I have been playing 4e for almost 3 years now and have noticed that the average character has the capacity to take massive amounts of damage each day without any ill effects the next day. I have even worked out through math that the average fighter can, over the course of one day, take almost four times his hit points in damage and still be at full health at the end of the day. That is without counting in the fact that leader types grant even greater levels of damage-taking abilities. Even if a character is at 1 hp at the end of the day, he wakes up at full hp and is ready to go as if nothing happened the previous day.

4e has no "carry over damage," unlike previous D&D editions that had damage heal slowly over time, with magic healing, and with potions.

It is not my intention to add a death spiral to D&D; that is not something that would be beneficial to the game and it would change the game entirely. What I am looking for is a way to adjust the healing and damage system in place to make it feel more like past editions.


6 Answers 6


First of all, this is not so much a problem, as a design decision. 4e is purposefully designed to let characters start afresh every morning, to make encounter design easier for the DM (and published adventures). Another thing worth noting is the fact that hit points are highly abstract, and don't necessarily represent physical damage characters sustain:

Hit points represent more than physical endurance. They represent your character’s skill, luck, and resolve—all the factors that combine to help you stay alive in a combat situation. - PHB293

In fact, as the term bloodied suggests, until the character has lost half of their hit points, they're not even that. With this out of the way...

Two ideas come to mind. One is to limit the amount of healing surges a character regains with each extended rest. Probably a flat value modified by sleeping conditions and available medical care, something along the lines of:

Everyone regains 3 healing surges after an extended rest. Following circumstances may increase this number:

+1 - Moderate Heal check / +2 - Hard Heal check

+1 - Moderate Endurance check / +2 - Hard Endurance check

+1 - Decent sleeping conditions (warm bed roll, rations & water) / +2 - Excellent sleeping conditions (hard bed, hot meal and grog)

These numbers, of course, are not at all tested, and can be modified according to your preferences. This doesn't really change the balance of the game, as long as you're careful with the number of encounters you throw at the tired party.

The second idea is to award a wound condition to a character every time they drop below 0 hp. Broken leg, -2 to speed. Fractured arm, -1 to attack rolls, etc. Each damage type could impose its own wound - WFRP had something along these lines, IIRC, and so can be used for inspiration. Healing these wounds may require time, ritual magic, or burning healing surges at the end of an extended rest (in which case these two can be combined). Note that this actually changes the way characters operate, and so should be approached with extreme caution.



Hitpoints are a fundamental component of the tactical game and directly provide for elements of heroism and adventure. A game with realistic combat would suggest that most wounds would take a character out of play for months. (See how injuries work in Ars Magica. One good swipe with a sword and a character can be on enforced bed-rest for a year.)

I'm going to recommend @Magician's take on "not having death be dying" for a look at how to have grevious wounds replace the revolving door of death (which does actually quite up the realism). It's not even enough to hide HP (as discussed here, in context of video games). Any "realistic" combat system will generally have the first good blow decide the fight with a very rapid death-spiral.

D&D is not designed nor balanced for this. It's far easier to take the flavour of D&D and port it to another game that has the deadly-injury mechanics you want.

However, if we want to add realism, we start by looking at the practice of treatment during the crusades, which equates to roughly the technical era of D&D.

We begin by describing what an adventurer at 0 HP has suffered. They are, by definition, bloodied and incapacitated. Looking here most wounds will be leg wounds with mostly soft-tissue damage. (ow). Looking at this horribly formatted post, the consensus seems to be that months of light activity are required to restore a deep leg wound or equivalent. With modern healing.

To be truly brutal to your players, grab the Ars Magica rules on wounds. Doing less than 1/4 their HP inflicts a light wound, 1/4 to 1/2 medium, 1/2 to 3/4 heavy, and anything beyond that incapacitating. Every light wound they get takes at least a week to heal with good medical rest and reduces their HS total by 1. Medium by 3, Heavy by 5, and Incapacitating by "you don't get any healing surges."

Thus, after one fight, Realistically speaking, anyone who's been injured needs to have a few weeks to a year of bed-rest and recovery. This is why D&D doesn't try for realism. Don't bother with penalties to-hit and to AC, as that will severely imbalance the game. Just adding light, medium, heavy, and incapacitating wounds as complications after a short rest should do the trick neatly. Be prepared for your characters to choose not to adventure, though.

  • \$\begingroup\$ I might try a scaled back version of this, with the wounds being more negligible and only being placed on when bloodied, and effecting the next days HS value. 1 wound placed on every time a character is bloodied, and each wound removes a HS from the next day. having wounds heal over a few days in stead of weeks would work better in the D&D system. Maybe healing 1 wound every two days or so? making them more abstract to fit the system. \$\endgroup\$
    – Rent_ZHB
    Commented Mar 28, 2011 at 15:59

I have a couple ideas. The first isn't to change the system itself, but to adjust the availability of Healing Surges. I regularly charge surges on failed skill challenges. The player who trips and rolls down the hill isn't going to die to a skill check, but he will lose some surges. I've also fast forwarded through a few trivial fights, but charged the PCs surges.

There are some options along those lines if you are willing to much with the system. Just treat surges as a resource. Ritual casting comes to mind. I've heard a lot of complaints that rituals are too slow to be useful. Give the PCs an item that halves the time of a ritual once per day, but costs 3 surges to use. Or something along those lines. You'll have to tweak the numbers.

My other suggestion is to add some penalties for getting hit hard. I got this idea from Game of Thrones d20. In that system when you took damage above a set shock value, you made a save or were stunned for a number of rounds. I think something similar could work in 4e. Use bloodied or surge values as a trigger. When a single attack does that much damage, make a save or be dazed or stunned. I don't think this necessarily translates into fixing the problem of PCs having too much HP, but it will make combat more lethal.

  • 1
    \$\begingroup\$ i have little problems with lethality in combat but I like the suggestion of having healing surges be used in rituals and such, it gives an abstract damage without damage fell. \$\endgroup\$
    – Rent_ZHB
    Commented Mar 28, 2011 at 2:03
  • \$\begingroup\$ Good idea of using surges as a cost of failing a skill challenge. I will remember that one. \$\endgroup\$
    – C. Ross
    Commented Mar 28, 2011 at 19:14
  • \$\begingroup\$ @C. Ross, TY but I can't take credit for it. It was in several LFR mods and for the longest time I assumed that was how you were supposed to punish certain failures. \$\endgroup\$
    – valadil
    Commented Mar 28, 2011 at 19:50

I've been playing the game for about as much time as you did and I came to the same conclusions.

What I have done for the last few sessions (since we started a new game) was to make my players use their healing surges during the night (long rest) in place of getting full HP in the morning. A new batch of healing surge is given to them when waking up as it already is for action points.

This way, if a character is badly hurt and has less than 4 healing surges he won't have full HP the next morning.

Ex : Full HP : 100 Surge value : 25 Healing surges : 8

Going to sleep with 18 HP and 2 Healing surges, the character would wake up with 50 HP healed (2x Surge value) for a total of 68 on 100 and 8 new healing surges. He could use some of his healing surges during an extra short rest but they would be lost for the day.

I feel the game is a bit more realistic this way and it makes the squishy characters squishier.

  • \$\begingroup\$ Did this result in the characters stopping early more often? It seems that rational folks would not willingly go below 4 surges when given a chance. \$\endgroup\$
    – Pat Ludwig
    Commented Mar 28, 2011 at 19:21
  • \$\begingroup\$ @Pat Ludwig Since all classes don't have the same amount of healing surges per day, no. For exemple, in this one game, i have a warden (9+CON surges per day) who uses constitution as his main stat and a ranger (6+CON surges per day) who maxed his strenght for his two weapon fighting. \$\endgroup\$
    – Monkios
    Commented Mar 29, 2011 at 13:27

Here is something that you might give a try.

Every time a character is bloodied, roll a dice; d4 for heroic level, d6 for paragon, d10 for epic tier. The number you roll is the number of "carry over damage". These are not more damage but a small portion of the points of damage already taken that are taking a toll on the character. These points can not be healed by a healing surge. They can only be healed by magic or by 2 points (per tier) plus constitution modifier per day after an extended rest.

This should give you a simple method for incorporating carry over damage, without seriously burdening the system.

As a character is bloodied through out a day of adventuring they will experience something like combat fatigue. Magical healing off sets this but as the parties power wanes through the day the points would begin to accumulate. You could even include penalties for skills that are strength, constitution or dexterity based if a character has over a certain percentage of carry over points against their total.

  • \$\begingroup\$ i like this it add "carry over damage" without making it detrimental to the parties health. one question is would the "magic healing" extend to healing powers? because if so it makes this damage almost void in a party with a leader (all parties should have one) \$\endgroup\$
    – Rent_ZHB
    Commented Mar 28, 2011 at 2:08
  • \$\begingroup\$ Hmmmm, I think I would add the caveat that only divine powers characters would fall under the magical affect and be able to heal this carry over damage. \$\endgroup\$ Commented Mar 28, 2011 at 12:37
  • \$\begingroup\$ but that would hugely over power clerics as a must have over all the other leader types, I think that no power based healing should heal the "carry over damage." \$\endgroup\$
    – Rent_ZHB
    Commented Mar 28, 2011 at 16:02
  • \$\begingroup\$ mmmm, good point. \$\endgroup\$ Commented Mar 29, 2011 at 0:26

The simplest way is to eliminate the "novel" elements of 4E...

  1. no spending surges without a power or spell based cause
  2. no base of Con for hitpoints; just use the per level dice. (Alternatively, cut the base to half-Con or 1/3 Con to retain some of the 4E toughness.

Those two changes will render PC's FAR more fragile.

  • \$\begingroup\$ WAY too fragile, and nigh-unplayable, I would say, regardless of any realism. \$\endgroup\$
    – YogoZuno
    Commented Mar 31, 2011 at 0:46
  • \$\begingroup\$ i second Yogo here, sorry not looking for fragility and if i did remove the con base from the players hp i would have to halve every monsters HP as well, as well as lower the damage out put of the monsters as to not be KO-ing the fighter when he is hit once. You never really touched on the heart of the question: day to day build up of damage. \$\endgroup\$
    – Rent_ZHB
    Commented Mar 31, 2011 at 5:14
  • \$\begingroup\$ @rent what part of "No spending surges" did you not get... that's the major portion of the damage not lingering. restrict healing surges, and you again make damage cumulative over the day. The ability to spend surges willy-nilly during rests is where most of the "fresh every fight" mode comes from. \$\endgroup\$
    – aramis
    Commented Apr 1, 2011 at 9:25
  • \$\begingroup\$ @aramis in your system you still have a full heal every extended rest, for you don't need to use healing surges for that. \$\endgroup\$
    – Zachiel
    Commented Apr 11, 2013 at 10:22

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