I'm perfectly fine with how healing and hit points are handled for my general d&d fantasy games.
However, I'm putting together a grittier game where wounds fester affect you as they accumulate.
I think the Exhaustion rules could handle this just fine. I'm looking for ideas and suggestions on how to implement them to show grievous injury and festering wounds.
As I think about, I'll probably use them for disease as well.
Thoughts?
The variant I've been working on (and testing) for a while goes like this:
Every time you drop to 0hp, you take a wound. Every wound you have adds one level of exhaustion.
It's possible to heroically shrug off wounds for a short time - a wounded character may, at the start of their turn, attempt a Constitution saving throw with DC equal to 5 times their current level of exhaustion. If they succeed, they can ignore the effects of exhaustion caused by wounds for that round.
Curing a wound can be done in four ways:
1) After a full day of rest, make a Constitution saving throw with DC equal to 15 + the current exhaustion level. Success cures one wound but not the level of exhaustion.
2) After a full day of rest, make (or have made for you) an Intelligence[Medicine] roll with DC equal to 5 + your current exhaustion level. Success cures one wound and its level of exhaustion. A margin of success over 20 cures all wounds and all wound-related exhaustion.
3) Any magical healing able to remove a level of exhaustion may be used to remove the wound, instead. A magical healing effect which removes all exhaustion removes all wounds as well.
4) An effect which causes you to regenerate will cure one wound every minute. The level(s) of exhaustion remain.
I have a couple of other exhaustion effects, too - sleeping in medium (or heavy) armour means you need to make a DC 5 (or 10) CON save in order for the sleep to remove existing exhaustion.
I have only one gaming group playing with these rules, but it's giving a really nice gritty feel. They're going on missions with a couple of weeks between them game time but (usually) a gruelling schedule on mission (often they have a set number of days (or hours) to complete a task, so when to take a long rest becomes a hard choice.
It wouldn't work for everyone, but it's great for that game.