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Most healing spells detail how many hit points they restore. However, hit points are an abstraction and may not even represent physical injuries. How do you determine what degree of healing spell is required to correct injuries in fiction?

It is clear by contrast with spells that explicitly will restore lost limbs that most healing spells will not handle that, but what degree of healing is required to mend a broken bone or a sprained ankle? What is required to heal an evisceration that has not yet proven fatal?

This could impact in-fiction descriptions of the results of healing spells between PCs, but the more significant motivator is presenting resource management and moral questions using NPCs. Will the PCs aid a traveller or conserve the resources for themselves for later? How will they triage a village with significant needs for healing? But to present these questions in fiction, it is necessary to know how far they can actually stretch their resources.

You basically... can’t.

The abstraction that is hp is nebulous and fluid; it’s not an abstraction for any one thing, it’s not even an abstraction for the same thing at a given time. If someone loses hp because a goblin slashes them with a sword, and then someone uses martial spirit to inspire them to greatness, they are healed a certain amount of hp. Here, hp was lost due to injury (probably?) but the damage healed was more inspirational in nature.

The best single thing we can call hp is probably “plot armor,” because that is effectively what it is. That is both its narrative and its mechanical role. Characters have hp because our plots and narratives want them to withstand more punishment than anyone realistically could. Characters survive blows—losing only hp, but otherwise being uninhibited by any injury—because we want to see more of them. And plot armor is always a matter of hand-waving. Good authors can make it more subtle and hide it, but it’s still there because of the demands of the plot.

In short, plot armor is not an effect, it is a cause. The narrative warps to reflect its needs, rather than it reflecting the events of the narratives events. And hp is basically a measure of plot armor—which makes it a little more reflective of narrative events, but only so much.

Finally, stuff like broken bones and sprained ankles—even the lost limbs mentioned by regenerate et al.—just... don’t factor into the system at all. No amount of lost hp causes those things, and those things aren’t defined as costing a certain amount of hp. In fact, those things aren’t defined at all. No effect in the game, anywhere, causes such injuries. As far as the game is concerned, therefore, they cannot happen, and it isn’t the rules’ responsibility to explain how to handle it if a DM decides to houserule things to add them. Instead, that DM is left on their own to handle it, and most DMs simply... don’t bother. Such injuries are either not part of the game at all, or they are matters of pure fiat that the DM is using, effectively, to railroad the players at particular points. You see that kind of thing in video games too—characters that have taken and dealt literally hundreds of attacks suddenly become injured by the plot, and no amount of your usual healing options help—you are forced by the plot to do whatever it is that the plot demands at that point.

A really fleshed out injury system could avoid all of those problems, but D&D 3.5e doesn’t provide one. It is a system that wants to focus on heroic epics—it doesn’t want anyone sidelined by injury, it doesn’t want to focus on the logistical hurdles such an injury causes, it wants to get on with the next adventure.

This is something that each GM (hopefully with buy-in from his or her group) need to settle for themselves. As this answer makes clear, the interpretation of hit points has fluctuated from edition to edition, and even with 3.5e (which is what this question asks about) there are two competing interpretations:

• The ability to take physical punishment, and


• The ability to reduce physical punishment as given.

Both of these end up being fairly cartoonish or cinematic in D&D, with the former leading to Rocky-style or Die Hard-style ability to keep functioning long after your brain and internal organs should be internally liquefied, and the latter leading to plot armor where no matter what seemingly happened, it didn't actually do much real damage.

But as you say, there is at least one more data point to consider: The Regenerate spell, which establishes pretty unambiguously that at least one spell really does repair grievous physical harm suffered by the target. But whether that implies that the Cure Foo Wounds should act in the same way by analogy, or whether the exception here means that only Regenerate has that property is not obvious to me.

I lean toward the latter, intellectually, but in play I am usually swept up in whatever the dramatic need at the moment is.

I don't think I have ever been in a game that treated these consistently, or even tried to. Certainly I've never run one that tried to be consistent. The demands of an interesting narrative sometimes mean that the Ogre's club just broke three of Blud the Barbarian's ribs, but he manfully shrugs it off. Sometimes it means that even though he was point blank for the dragonfire, he ducked his seven foot frame behind his tiny buckler and shrugged it off. And it almost certainly means different things for Frailheart the Wizard as opposed to that Ogre or Dragon.

I will quote snippets from the Player's Handbook here. If any of them are too much, tell me, and I'll trim them. :) The post goes into a digression on what damage means with regards to killing a creature, but as a summation to get to the main point.

Hit points are described in the rules on page 136 of the Player's Handbook as "...how much punishment you can take..." While you can certainly play this way, I find the description of hit point loss given on page 145 of the Player's Handbook more compelling:

"[hit points] mean two things in the game world... ability to take physical punishment... ability to turn a serious blow into a less serious one. ...divine favour or inner power ...[independent] of hit points, a dagger through the eye is a dagger through the eye. ...Damage gives you scars...[damages] your armour...gets blood on your tunic."

Further, you have basically four possible states of health: Fine, disabled, dying, and dead, and you're fine until 0 hit points. Massive damage is also not an optional rule, and the 50-point threshold suggests that there's an upper limit to how much damage you can take and still call yourself "mortal" - ie., with a high enough Fortitude save. For example, "Yes, that is just an armour dent, but it's a four-inch deep armour dent. How are you still alive?"

Going to the suggested section on helpless defenders on page 153 of the Player's Handbook, we find: "...bound, sleeping, paralyzed, unconscious...at your mercy." A critical hit is automatic, and the target also dies on a failed fortitude save of DC 10 + damage dealt.

Let's assume a reasonably-competent sword-and-board fighter - Not an optimized build in the rules, but it'll prove the point. At level 1, with a +2 strength bonus and 1d8+2 damage, on a critical hit they do 2x1d8+2, or 13 damage.

With a DC 23 fortitude save or death, a creature needs a fortitude saving throw of +3 to save on a natural 20, which is a critical success in any case. To have a 50% chance of living, a creature would need a +13 fortitude saving throw, which is well into the point the character has transcended ordinary mortal limits - Which is any character above character level 6. Reference:

https://thealexandrian.net/wordpress/587/roleplaying-games/dd-calibrating-your-expectations-2

So, what does it mean when you have a positive hit point total? You've taken superficial or "surface" damage; your armour is dented or has missing scales or chain links; the divine favour given to you by your deity, which normally causes events to favour you, has waned; you've got a bloody nose and/or a scratched torso...

But you haven't taken any "real" damage. None of your wounds are bleeding freely. You don't have any broken bones, or even bruised ribs (that'd be disabled). If you have bruises, they aren't enough to impair you. You aren't missing any limbs. I would argue that "missing a limb" is one of the things that happens no earlier than -1 hit points, and should perhaps be reserved for -10 or lower hit points.

So, if you're wondering how to triage a village, or what damage means, anyone of 0 hit points is stable as long as they don't move - Think broken ribs or bones; spinal damage; bruised organs; concussion - things that could kill them if they move. Which brings us to dying. This is anyone bleeding from a major wound, internal or external. I emphasis bleeding here, as it's a very plausible explanation for many creatures for why they're losing 1 hp/round. They should be treated first. Dead is, of course, dead, and the power to raise the dead is costly, won't always be accepted, and needs to be measured in very deliberate triage.

Anyone of positive hit points is more-or-less fine, and is probably either at the tavern getting drunk and boasting, or at the local church praying and waiting.