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Can you choose to just knock out an already knocked out creature when you use the melee spell attack from vampiric touch, and therefore repeatedly farm health from them?

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No.

You can only render them unconscious when you "reduces a creature to 0 hit points". If you hit them when they are at 0hp you are not "reducing" them. You would score a critical hit, for which you would gain hp. After that the creature is either dead or has failed 2 death saving throws depending if they are a special NPC..

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  • \$\begingroup\$ Keep in mind too that this could come from the perspective of a DM having an NPC do this to another NPC or even a PC. \$\endgroup\$
    – Javelin
    Oct 1, 2016 at 7:17
  • \$\begingroup\$ Knock out does not means the creatures drops to 0 hit point. Only that it's hit so hard that it loses consciousness. \$\endgroup\$ Oct 2, 2016 at 17:30
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    \$\begingroup\$ @AlexisWilke where exactly are you pulling that from? What constitutes "hit so hard it loses consciousness"? There are specific rules in 5e that state you can knock a creature out when you reduce it to 0 hit points so I'm really not sure what you mean. \$\endgroup\$ Oct 2, 2016 at 21:50
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Page 198 of the Player's Handbook reads:

Sometimes an attacker wants to incapacitate a foe, rather than deal a killing blow. When an attacker reduces a creature to 0 hit points with a melee attack, the attacker can knock the creature out. The attacker can make this choice the instant the damage is dealt. The creature falls unconscious and is stable.

You can definitely knock them out the first time with a Vampiric Touch. What I also read there though is the key phrase "reduces a creature to 0 hit points," because if you damage them again while they are unconscious in this way a few things happen, but most importantly you aren't dropping them to 0 hit points because they already were there.

Now let's look at a similar situation that I have thought about: A Vampire's Bite attack deals some piercing damage as well as some necrotic damage, and reduces the victim's maximum hit points equal to the amount of necrotic damage, and so on and so forth to creating a vampire spawn. What I had wondered at the time was How the heck can a Vampire produce Vampire spawn when they would just kill the victim?

The answer I concluded by myself was that they would do exactly what you are asking about doing: leaving the victim alive by only leaving them unconscious and not killing them whilst drinking their blood and dropping the victim's hit point maximum to 0 with the Necrotic damage.

So my answer is this: As it reads, it looks like you cannot repeatedly farm hit points from a creature you knocked out. However, making sense because of an interesting coincidence with actual vampires you probably could do that.

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  • \$\begingroup\$ Just in case any DMs have to deal with players using rule-lawyering to farm health from an actual vampire in the near future, you can also rule that you can't gain health from an undead foe. \$\endgroup\$
    – kettlecrab
    Oct 1, 2016 at 18:55

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