Slower / difficult healing rules for low magic campaign

Homebrew and House Rules

I'm looking at a way slow down healing for a low magic campaign. Magical healing will still be available but i'm trying to come up with ways to either make it less of a guarantee that it works, or slow down how quickly it takes effect.

A) Obvious answer to this is the spell works normally but takes minutes, hours, etc before the full effect can be seen.

B) Healing magic can only be used a limited number of times per day on the same person, thus emphasizing the utility of life saving magic but still requiring non-magical supplementary skills.

C) The spell requires a Heal Check which in some way effects the success of the spell. Perhaps the heal check determines if the spell gets full dice for the Cure X spell line. Or....something. I like this idea of requiring the heal check because it rewards a dedicated doctor / healer concept versus someone that has only limited healing abilities, even when casting the same spell.

D) The Heal Check as currently written under PF1 is simply too strong as it allows for full recovery in about 3 days from virtually any level of injury without the aid of magic. WITH the aid of magic I'd be fine with this as that is still a miraculous recovery, but otherwise is simply too good.

E) I'd REALLY like some rules on non-magical ways to account for non-combat healing such as surgery. Would combine well with # C. Are there any archetypes or rules variants that come to mind which do this sorta thing?

F) A cleric with the Healing Domain should get some form of bonus to their healing spells.

NOTE 1: No need to point out that this slows down recovery time between combat / adventures. That is exactly the point and the campaign setting and pacing has already been adjusted to account for that.

NOTE 2: other aspects of combat have already been reworked with variant rules so I'm focusing specifically now on how to recover from combat.

Huge difficult topic in many ways mostly due to the highly abstract nature of a system of hit points representing injuries/injury/damage ranging from trivial to life threatening and even including things like objects and things not really alive etc., ... Undead, Elementals, Constructs, Incorporeal beings.

A) How long do you wish for it to take? Will the type of injury make a difference in what sort of spell is needed? Probably the two main causes of poor healing results in a patient are nutrition and infection.

B) Will the number of instances of injury make a difference (i.e. 1001 cuts vs 1 nasty critical)?

C) Can go either way. That is the Heal Check effects the result of the Spell or the Spell effects the result of the Heal Check? Appears if the first is where you're leaning.

Part of the problem here is the same 10 pts of damage is not equal from instance to instance. 20 damage can be a very serious injury to a 24 HP wizard (never mind an 18 hp one) vs a 54 hp barbarian. This issue grows worse as both gain levels. Modify the Heal check based on the relative damage to the character perhaps?

Will the number of instances of injury play a role in the Heal DC. That is if the 20 points is the result of 6+ different instances of injury to be treated as the same as a single critical hit resulting in 20 damage? Do you make 6+ rolls vs 1 roll. Do work off the total damage regardless of the number of instances of injury? Or their nature and cause?

D) Agreed. It really makes not having access to magical healing almost moot (almost). But that's because generally speaking spending game time twiddling ones thumbs healing up is not how folks want to spend their gaming time. So they made it relatively painless and easy sacrificing a degree of realism in the process.

E) That's likely to get fairly involved really quickly if you move beyond something along the lines of Heal 5+ ranks means you can do "Surgery". Starting with defining what is meant by Surgery.

F) The nature of the bonus and its value will depend on how the above points are answered. The Obvious answer is something along the lines of +1/level of cleric/druid etc..

Sounds like the results you want would be achievable by just removing all magical healing and the Heal skill form the game entirely. Or, perhaps, also removing natural healing and only allow the basic rate of natural healing (1 hit point per night of rest) with the long-term care use of the Heal skill. I have no idea why you would ever want this, but that would be my solution.

I will just address cure spells, as those are the most common magical healing, not every possible method of healing.

You could try a variant of option A, where cure spells instead grant the equivalent of fast healing. The amount of healing would be based on the spell level. So a cure light wounds (1st level) that got a result of 5 total healing would heal the target 1 point over 5 rounds. A cure moderate wounds (2nd level) that got the same 5 points of healing would grant the equivalent of fast healing 2 over 3 rounds (only healing 1 on the third round).

This will slow healing but still make more powerful cure spells more effective, as they will work a bit faster. Likely you will have to make some rulings, such as making multiple cure spells overlap rather than stack (with higher level ones taking precedence over lower level ones). So casting 2 cure light wounds spells right after each other will only have an effect if one rolls higher healing, but that will only extend the fast healing time. A higher level spell will just overwrite the lower one with its higher fast healing and its own 'duration' even if that healing would be lower (or you can make your own call).

Also, you have to decide if this would now mean that cure spells are no longer technically instantaneous and are now considered to have durations, which means that they could technically be dispelled (which would make healing less certain), or just assume the spell is still instantaneous and the fast healing effect just happens. It also might make bleed attacks less dangerous, as even low-level healing spells will end most effects with their 1 healing per round unless you make a ruling that the healing and bleed just mitigate each other unless the healing occurs after the bleed effect.

Just a possible suggestion. You could always make the healing occur over minutes instead of rounds.

I'd replace all the normal healing spells with new ones. Maybe ones that allow you to recover more hp while resting or that give you the benefits of resting.
You could give them a casting time of a few minutes or make it a spell the caster has to maintain for most of the resting period.

Maybe instantaneous headling can still be limited in the form of fast healing or a transference of hp.

As far as the Heal skill is concerned, I'd get rid of treating deadly wounds and re-write all the skill unlocks, if you're using them at all. Maybe someone with 5/10/15/20 ranks in Heal can allow someone to heal multiple days of rest in one day, etc.

Surgery and're getting into sticky terrain, here. Hit points are a wonderful, elegant abstraction. But the moment we start trying to add in injury levels and types, we end up with a much more complicated system. Deadlands had one that seemed suitably gritty, but it was also tedious and messy and unintuitive.

The Heal domain...+1 to the skill/level, like alchemists with Craft (alchemy)?

What if, instead of magical healing going slower, you just made it less effective? Replace all the D8s in magical healing with, say, D4s? Reward folks with high Heal skill checks by letting them add in what they'd heal in their "heal lethal wounds" check into these spells, if an hour of rest is taken alongside the spell.

If a cleric has the Healing domain, put them back up to, say, D6s for healing spells. Channel Energy could get a nerf down to d4s too.

Recovery under the Heal skill seems OP until you look at HP as a measure of "how much of a movie-based action hero is your character" kind of way. As an abstraction of actual health and life related to any sense of realism, HP and the Heal skill don't compute at all.

Look no further than disease. A PC suffering from an illness that doesn't target their Con can fail every save and be reduced to 0 in a stat and still somehow be alive by PF1 standards.

The Heal skill then allows someone who's lost 4 points of ability damage to recover them fully with one complete day of recovery. IRL some folks who've suffered illness might never fully convalesce to full health, and in game your flagging nervous system is back online in 24 hours after a bout with tetanus.

So if we're just talking about healing rates being OP and we want to put a hard stop there, I'd say keep it simple and either have everything either take longer (minutes instead of rounds; days instead of hours, weeks instead of days, etc) or reduce the dice size of magical healing to make it less effective.

If our end-goal though is a grittier, more realistic game, consider hit points and ability damage as a whole. Think about variant rules such as the one that makes any type of ability damage lethal - reduced to 0 Dex? Your nervous system shuts down no longer sending signals to your muscles, your organs... you died.

Two thoughts here:

You could consider a wound point / vitality point system instead of hit points. Cure spells do full healing on vitality points, but only the level of the healing spell on wound points (Cure light heals 1 WP, Cure moderate heals 2, etc.) And its one or the other per casting, not both VP and WP.

You could borrow the condition track from star wars saga edition and the characters move down 1 level per quarter of their max hit points. Apply this condition as a modifier on the healing roll and/or require a higher level healing spell for each step on the condition track. For example, 3 steps down on the track is a -5 penalty and requires Cure serious or better.

Just some thoughts I'm considering for my next pathfinder game.

Sovereign Court

One possibility would be to make all Cure/etc spells into Scarify. That is, Cure spells only convert lethal damage into non-lethal, and then remove non-lethal from being healed by anything but time.

Healing Nonlethal Damage wrote:
Healing Nonlethal Damage: You heal nonlethal damage at the rate of 1 hit point per hour per character level. When a spell or ability cures hit point damage, it also removes an equal amount of nonlethal damage.

Same thing with Channel Energy, but to give the healing domain cleric a bonus, let it also fully heal 1 lethal damage per die in addition to converting damage to nonlethal.

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