Constitution Damage

This system is a modified version of Vitality/Wounds from Monte Cook’s Unearthed Arcana. In it, your HPs function differently, and instead of Negative HPs, when you run out of HPs, damage goes straight to your Con score.

Hit Points are superficial bumps, bruises, and scrapes. Your experience in combat represents your ability to avoid lethal blows, turn what could have been fatal into something that merely wears you down over time. You recover HPs quickly, and you don’t die of losing them. The number of them, how you roll for them, and how many you get, are all unchanged. There are two major differences, however.

  • You recover HPs very quickly: 1 per character level per hour (double that for long-term care).
  • Once you run out of HPs, damage counts directly against your Con score.


Constitution Points represent serious, mortal injuries from which you could easily die. These are somewhat like Negative HPs, but they are also quite literally your Constitution score.

  • You only take Constitution Point damage once you run out of HPs.
  • When you lose Constitution, you also lose anything based on that score.
  • You recover Con points at a rate of 1 per character level for 8 hours sleep (double for 24 hours rest, triple for long-term care).
  • Every die of healing restores 1 Con point (all healing restores Con points before HPs)


Taking Constitution damage at all does two things.

  • You become fatigued (but further Con damage doesn’t make you exhausted).
  • You must roll Fortitude (DC 5 + Con damage) or be stunned for 1d4 rounds.

Anyone can use a standard action to end your stunned effect (e.g., slap across the face, cold water, shouting “WAKE UP DAMNIT!”).

Once you get to Constitution 0, two more things happen.

  • You become disabled. If you take a standard action, you start dying.
  • You must make a Fortitude save (DC 15) or, again, start dying.

Note that the GM might rule an action that is particularly strenuous is the equivalent of a standard action even if it isn’t one technically

Once you are dying, you must make a Fortitude save every round (DC 10 + 1 per round of dying). There are several potential results:

  • fail: you are dead
  • succeed: you are still dying
  • succeed by 5: become stable
  • succeed by 10: become conscious and disabled

Treat Injury (DC 15) can render you stable instead of dying.

If you become stable, make a Fortitude save every hour (DC 10 +1 per hour).

  • fail: you are dying
  • succeed: remain stable
  • succeed by 5: conscious and disabled

While you’re stable, once a day, you have a 10% of starting to recover Con points naturally.

Coup de grâce damage applies directly to Constitution.

Size categories for NPCs can affect HPs. Multiply the total number like so:

  • Fine x 1/8
  • Diminutive x 1/4
  • Small, Medium, Large x 1
  • Huge x 2
  • Gargantuan x 4
  • Colossal x 8
  • Ginormous x 16

Anyone or anything without a Constitution score has only HPs, and dies when it gets to HPs 0.

Massive damage and non-lethal damage do not exist in this system.

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