Injury, Death & Healing

Posted by EarthDragon on 1st September 2015.

Vitality and Wound Points

The Vitality and Wound Points system was originally presented in the 3.5 source Unearthed Arcana.

The vitality and wound points system was originally developed as a more cinematic method of handling damage than the traditional hit point system. The system allows for characters to improve the amount of punishment they can withstand as they go up in level, while still allowing for a single lucky attack to take down a character.

Metagame Analysis: Vitality And Wounds

Under this system, characters should be more wary in combat, which can turn deadly in the space of a few lucky rolls. But they can also bounce back from a fight much more quickly. A very weak creature in this system tends to be tougher to kill than in a standard d20 game, since its Constitution score is often higher than the number of hit points it might have had. Very big creatures are also more durable, due to their size modifier. This is reflected in the CR adjustments given in the variant rules (the CR adjustments are mostly relevant to the DMs).

Creatures capable of dealing a large amount of damage on a single hit become significantly more deadly in this system, since a lucky attack roll can give a deadly blow to almost any character. For critical hits, the additional damage from bonus damage dice given in the standard rules(such as a flaming sword or a rogue’s sneak attack) is reduced to only 1 point per die in these rules, but deal normal damage on noncritical hits (you will soon see why). That’s still pretty scary when fighting a high-level rogue, but not quite as terrifying as facing the possibility of an extra 5 or 10 dice of wound point damage with a successful sneak attack critical hit.

Constitution damage is especially deadly under this rule, since every point of Constitution damage reduces wound points by 1 and every 2 points of damage reduces vitality by a number of points equal to the character’s HD. If a character’s Constitution is reduced to 0, they die, even if they have wound points remaining.

Vitality Points

Vitality points are a measure of a character’s ability to turn a direct hit into a graze or a glancing blow with no serious consequences. Like hit points in the standard d20 rules, vitality points go up with level, giving high-level characters more ability to shrug off attacks. Most types of damage reduce vitality points.

Characters gain vitality points as they gain levels. Just as with hit points in the standard d20 rules, at each level a character rolls a vitality die and adds his Constitution modifier, adding the total to their vitality point total. (And, just as with hit points, a character always gains at least 1 vitality point per level, regardless of their roll or Constitution modifier.) A 1st-level character gets the maximum vitality die result rather than rolling. The die that each character rolls is given in the table of class features in their class description, just like their hit points are in the standard d20 rules; vitality points are very much like the original d20 hit points in many ways, the real difference in the rules is in the wound points.

Wound Points

Wound points measure how much true physical damage a character can withstand. Damage reduces wound points only after all vitality points are gone, or when a character is struck by a critical hit. A character has a number of wound points equal to their current Constitution score.

Critical Hits

A critical hit deals the same amount of damage as a normal hit, but that damage is deducted from wound points rather than from vitality points. Critical hits do not deal extra damage; for that reason, no weapon in this system has a damage multiplier for its critical hits.

Any critical hit automatically overcomes a creature’s damage reduction, regardless of whether or not the attack could normally do so (unless the creature is immune to critical hits).

Most weapons retain their normal critical threat range. If a weapon normally has a critical multiplier greater than ×2, the weapon’s threat range expands by 1 point per additional multiplier, as indicated on the table below.

Multiplier New Threat Range
x3 19-20
x4 18-20
x5 17-20

Injury & Death

Vitality and wound points together measure how hard a character is to hurt and kill. The damage from each successful attack and each fight accumulates, dropping a character’s vitality point or wound point total until he or she runs out of points.

Nonlethal Damage

This system doesn’t differentiate between lethal and nonlethal damage. Attacks and effects that normally deal nonlethal damage reduce vitality points, except on a critical hit, in which case they reduce wound points.

0 Vitality Points

At 0 vitality points, a character can no longer avoid taking real physical damage. Any additional damage he receives reduces his wound points.

Taking Wound Damage

The first time a character takes wound damage—even a single point—he becomes fatigued. A fatigued character can’t run or charge and takes a -2 penalty to Strength and Dexterity until he has rested for 8 hours (or until the wound damage is healed, if that occurs first). Additional wound damage doesn’t make the character exhausted.

In addition, any time an attack deals wound damage to a character, he must succeed on a Fortitude saving thow (DC 5 + number of wound points lost from the attack) or be stunned for 1d4 rounds (during that time, any other character can take a standard action to help the stunned character recover; doing so ends the stunned condition).

0 Wound Points

Wound points cannot drop below 0; any damage that would cause a character’s wound point total to drop below 0 simply causes the character to have 0 wound points.

At 0 wound points, a character is disabled and must attempt a DC 15 Fortitude save. If they succeed on the save, they are merely disabled. If they fail, they fall unconscious and begin dying.


A disabled character is conscious, but can only take a single move or standard action each turn (but not both, nor can they take full-round actions). They move at half speed. Taking move actions doesn’t risk further injury, but performing any standard action (or any other action the DMs deem strenuous, including some free actions such as casting a quickened spell) worsen the character’s condition to dying (unless it involves healing; see below).


A dying character is unconscious and near death. Each round on his turn, a dying character must make a Fortitude save (DC 10, +1 per turn after the first) to become stable.

If the character fails the save, they die.

If the character succeeds on the save by less than 5, they do not die but do not improve. They are still dying and must continue to make Fortitude saves every round.

If the character succeeds on the save by 5 or more, but by less than 10, they become stable but remain unconscious.

If the character succeeds on the save by 10 or more, they become conscious and disabled.

Another character can make a dying character stable by succeeding on a DC 15 Heal check as a standard action (which provokes attacks of opportunity).


If a character dies from their injuries, they are dead, and may not be brought back to life via the usual means available in typical campaigns. The Raise Dead, Reincarnate, and Resurrection spells are not known within the Unification or their surrounding lands.

There are two ritual incantations that are known, however, which can restore life to the recently departed, with varying risks and penalties, namely the Snatch From Death and Return From the Grave rituals, however, they are complex and costly to perform, and there are risks to both the recently deceased and to those performing the rituals.

Aside from the often prohibitive cost in performing these rituals, not to mention their risks and inherent restrictions on casting, there is a more pragmatic and simple reason why the majority of the population of the Unification, even among the wealthy and adventurous types, do not often resort to these rituals - reincarnation. It is widely accepted within The Unification and in all of its surrounding environs that, through the course of one's life, one's deeds build up a store of karma (be it good or bad) and, depending upon one's station in life, it is highly likely that anyone who has made a name for themselves (which includes most adventurers who weren't unfortunate enough to die on their first outing) will return in a new body soon after an untimely death.

The exact nature of the reincarnated form is based upon one's status and accumulated karma. Reincarnation is dealt with in a separate section, and the rituals that can be used to return a deceased character to life (if one does not wish to take their chances on reincarnation) are detailed in the Magic section under Incantations).

Stable Characters and Recovery

A stable character is unconscious. Every hour, a stable character must succeed on a Fortitude save (DC 10, +1 per hour after the first) to remain stable.

If the character fails the save, they become dying.

If the character succeeds on the save by less than 5, they do not get any worse, but do not improve. They are still stable and unconscious, and must continue to make Fortitude saves every hour.

If the character succeeds on the save by 5 or more, they become conscious and disabled.

An unaided stable, conscious character at 0 wound points has a 10% chance to start recovering wound points naturally that day.

Once an unaided character starts recovering wound points naturally, they are no longer in danger of dying.

Recovering With Help

A dying character can be made stable with a DC 15 Heal check (a standard action that provokes attacks of opportunity). One hour after a tended, dying character becomes stable, roll d%. They have a 10% chance of regaining consciousness, at which point they become disabled. If they remain unconscious, they have the same chance to regain consciousness every hour. Even while unconscious, they recover wound points naturally, becoming conscious and able to resume normal activity when their wound points rise to 1 or higher.

Special Damage Situations

The vitality point system changes the way some special damage effects work.

Coup de Grace

A coup de grace functions normally in that it automatically hits and scores a critical hit (and thus the damage dealt is applied to the target’s wound points). If the defender survives the damage, they must make a Fortitude save (DC 10 + the amount of damage dealt) or die.

Massive Damage

The massive damage rule does not apply under this system.


After taking damage, a character can recover vitality and wound points through natural healing (over the course of hours or days), or by magic. In any case, a character can’t regain vitality points or wound points above their full normal totals.

Natural Healing

Characters recover vitality points at a rate of one vitality point per hour per character level.

With a full night’s rest, a character recovers 1 wound point per character level (minimum 1 per night), or twice that amount with complete bed rest for 24 hours. Any significant interruption during the rest period prevents the character from healing that night.

Assisted Healing

A character who provides long-term care doubles the rate at which a wounded character recovers lost vitality and wound points.

Magical Healing

Spells that heal hit point damage work somewhat differently in this system. For spells that heal a variable amount of hit point damage based on a die roll (such as cure light wounds), apply the actual die roll as restored vitality points, and any modifier to the die roll (such as caster level, for cure spells) as restored wound points.

For example, cure moderate wounds heals 2d8 points of damage, +1 point per caster level (maximum +10). Under this system, a 10th-level cleric could cast it to heal 2d8 vitality points and 10 wound points.

Spells or effects that return a number of hit points not based on a die roll, such as heal, apply the healing to lost wound points first, then to lost vitality. For example, an 11th-level cleric casting heal has 110 points of healing to apply. If the target has taken 12 points of wound damage and 104 points of vitality damage, the spell heals all the wound damage and 98 points of the vitality damage, leaving the target with only 6 points of vitality damage remaining.

NPCs and Monsters

Vitality points are only granted by the “heroic” classes, such as the standard character classes and various prestige classes. The NPC classes—adept, aristocrat, commoner, expert and warrior—grant no vitality points (either at 1st level or thereafter). Such characters have wound points equal to their Constitution score. Thus, a typical 1st-level athaotin warrior has no vitality points and 12 wound points. All damage dealt to such creatures is applied to their wound points.

Most monsters, on the other hand, have both wound points and vitality points. For Small, Medium and Large creatures, a monster’s wound point total is equal to its current Constitution score. Creatures smaller or larger than that have their wound point total multiplied by a factor based on their size, as indicated on the table below.

A monster’s vitality point total is equal to the number of hit points it would normally have, based on its type and Constitution score. The DM may choose not to assign vitality points to creatures that pose little or no threat to PCs, such as domesticated herd animals.

Size Wound Point Multiplier
Fine ×1/8
Diminutive ×1/4
Tiny ×1/2
Small x1
Medium x1
Large x1
Huge x2
Gargantuan x4
Colossal x8
Creatures Without Constitution Scores

Some creatures, such as undead and constructs, do not have Constitution scores. If a creature has no Constitution score, it has no vitality points. Instead, it has wound points equal to the number of vitality points it would have based on its HD and type. Such creatures are never fatigued or stunned by wound damage.

Bonus Hit Points

If a creature would have bonus hit points based on its type, these are treated as bonus wound points. (For example, a Medium construct gets 20 bonus wound points.) The same holds true for any permanent effect that increases a character’s hit point total (such as the Toughness feat, which adds 3 to the character’s wound point total).

Damage Reduction

Damage reduction functions normally, reducing damage dealt by attacks. However, any critical hit automatically overcomes a creature’s damage reduction, regardless of whether the attack could normally do so. For example, a critical hit against a creature with DR 5/bludgeoning overcomes the creature’s damage reduction even if it was hit with a weapon that does not deal bludgeoning damage.

Fast Healing

Creatures with fast healing regain vitality points at an exceptionally fast rate, usually 1 or more vitality points per round, as given in the creature’s description (for example, a vampire has fast healing 5).

If a creature with fast healing has no Constitution score, fast healing restores lost wound points instead. The same doesn’t apply to creatures that have no vitality points but do have a Constitution score (such as a human warrior or domestic animal). Such creatures gain no benefit from fast healing.


All damage dealt to creatures with regeneration is vitality point damage, even in the case of critical hits. The creature automatically heals vitality point damage at a fixed rate per round, as given in the entry (for example, a troll has regeneration 5). A regenerating creature that runs out of vitality points becomes fatigued just as if it had taken wound point damage. Excess damage, however, does not reduce its wound points. Certain attack forms, typically fire and acid, automatically deal wound damage to a regenerating creature, though it may attempt a Fortitude save (DC 10 + damage dealt) to convert this to vitality damage, which it can regenerate normally. Otherwise, regeneration functions as described in the standard rules and in individual monster descriptions.

Monster Challenge Ratings

This is mainly for the reference of the DMs as the CRs of monsters affects the number of experience points awarded as a result of encounters. Colossal and Gargantuan creatures have their CR increased by 1 unless they do not have a Constitution score.

Creatures with a fractional CR have their CR increased to the next highest fraction under these rules. Thus, the kobold (normally a CR 1/4 creature) would become a CR 1/3 creature under these rules, while a goblin (normally a CR 1/2) would become a CR 1 creature.