Taking damage in Dungeons and Dragons (or in nearly any roleplaying system) does not equate to

actually being struck or injured, at least in my opinion. It refers instead to “Plot Armour” being
removed, or if you prefer, your character growing too tired to dodge. Hit by a glancing blow from an
Orc? It is far more likely that it simply bounced off your armour and left you staggered, or you
deflected the strike but it left your muscles strained and sore. You may not be able to block it quite
as easily next time.
Where this falls apart is in the last few hit points. Following this system, instead of slowly being
whittled down with a dozen cuts and bruises, you go from “tired” to “nearly dead.” I propose instead
that you operate on a wound system. This allows for short (and potentially long) term injuries that
will allow the character to keep on trekking forward, but with a very clear penalty. My goal with this
particular system is making something simple and easy to learn with the possibility for injuries that
hamper players but don't prevent them from moving forward, unless they choose to stay fighting
and risk more significant injury.

Characters have Wound Points equal to their ​Constitution Score (NOT modifier) + their
Proficiency Bonus.​ As soon as they are reduced to zero Hit Points, they will begin taking Wound
Damage instead of Hit Point damage. No damage reduction from any source applies to received
Wound Damage.
They may remain alert and keep fighting, but must make a saving throw against Exhaustion (DC10
CON Save) each round they take an action other than moving. If a character takes Wound Damage,
they have two options: they may either choose where they took the damage, or roll on the
appropriate Wound Table to seek more favourable results. If they choose the result of the damage,
they may not select the beneficial options.
This allows for a quick resolution and better flow of combat, which can often drag
when faced with difficult decisions or information-heavy rules. ​(Note: If your players are 
particularly indecisive, you may simply dictate that they must roll as opposed to choosing.)
If a character takes Wound Damage but is not reduced to zero Wound Points, they roll on the Minor
Wounds Table. If a character is reduced to zero Wound Points, they roll on the Major Wounds Table,
potentially fall unconscious, and if unconscious, begin to make death saving throws as per normal 5e
rules. If a character rolls the same result twice, they may either re-roll or keep the result but suffer
additional penalties at the DM’s discretion.
All Minor Wounds can be healed with Lesser Restoration, a DC 13 Medicine check which can be
attempted once per short or long rest, or three days spent without taking any Wound Damage.
Major Wounds are more complex, and treatment options are listed in the consequences.

Minor Wounds
D12 Consequence

Blurred Vision:​ You have disadvantage on Wisdom (Perception) checks that rely on sight and
1-2
on ranged attack rolls.

Ringing Ears:​ You have disadvantage on Wisdom (Perception) checks that rely on hearing and
3-4
your AC temporarily drops by one.

Limp:​ Your walking speed is reduced by 5 feet. You must make a DEX saving throw (DC10)
5
after using the Dash action. If you fail the save, you fall prone.
6 Wrenched Limb:​ You cannot use reactions and have disadvantage on melee attack rolls.

Teeth Knocked Out:​ You have disadvantage on Persuasion checks. When you cast a spell with
7-8 a verbal component there is a 25% chance the spell will not work. If the spell fails, you still used
your action to try to cast it, but the spell did not use any slots or material components.

9-11 Keep Moving Forward:​ You may spend one Hit Die+CON and regain that many Hit Points.

12 Unbreakable:​ You may spend one Hit Die and regain that many Wound Points.

Major Wounds
D12 Consequence

Lose an Eye or Ear:​ Suffer a Festering Wound with (DC17). Magic such as Regenerate can
1
restore the lost eye or ear.

Lose a Foot or Hand:​ Suffer a Festering Wound with (DC17). Magic such as Regenerate can
2
restore the lost appendage.

Lose an Arm or Leg:​ Suffer a Festering Wound with (DC17). Magic such as Regenerate can
3
restore the lost limb.

Broken Arm or Hand:​ Make a CON saving throw (DC15). On a fail you fall unconscious as
normal. If you succeed, gain one Hit Die+CON to Hit Points. You cannot hold more than one
object, or hold a two-handed object. The injury heals if you receive Lesser Restoration.
4
Alternatively, the injury heals after someone sets the bone with a Medicine check (DC15) and
you spend thirty days without taking Wound Damage, or fifteen days with magical healing once
per day and no Wound Damage.

Broken Leg or Foot:​ Make a CON saving throw (DC15). On a fail you fall unconscious as
normal. If you succeed, gain one Hit Die+CON to Hit Points. Your walking speed is halved and
you must use a cane or crutch to move. You fall prone after using the Dash action. You have
5 disadvantage on Dexterity checks made to balance. The injury heals if you receive Lesser
Restoration. Alternatively, the injury heals after someone sets the bone with a Medicine check
(DC15) and you spend thirty days without taking Wound Damage, or fifteen days with magical
healing once per day and no Wound Damage.

Internal Injury:​ Make a CON saving throw (DC16). On a fail you receive one failure to your
Death saves and fall unconscious. If you succeed, gain one Hit Die+CON to Hit Points.
Whenever you attempt an action in combat, you must make a CON saving throw (DC13). On a
6-7
failed save, you lose your action and can't use reactions until the start of your next turn. The
injury heals after 10 days of resting, or by receiving magical healing of 3rd level or higher during
a long rest.

Festering Wound:​ Make a CON saving throw (DC16). On a fail you receive one failure to your
8 Death saves and fall unconscious. If you succeed, gain one Hit Die+CON to Hit Points. Your
Wound Point maximum is reduced by two every 12 hours. If your Wound Point maximum drops
to zero, you die. The wound heals after you receive magical healing of 3rd Level or Higher.
 Alternatively someone can tend to the wound and make Medicine checks (DC16) once every 12
hours and heal the wound after 10 successful checks.

Adrenaline Rush:​ Gain two Hit Dice+CON to Hit Points. After the fight ends or 10 rounds pass,
9-11
you are afflicted with three levels of Exhaustion.

Last Stand:​ Gain two Hit Dice+CON to Hit Points. Gain one additional Hit Die for each
12
downed party member. Take one free action.

Optional Variants: 
Unforgiving Wounds:​ Any Wound Damage taken can only be healed over the course of a Long Rest,
or with a Healing Spell of 3rd Level or Higher. This healing will effect either Wound Damage or Hit
Points - not both. In addition, when “gaining a Hit Die+CON” as a result of a roll, you must SPEND a
Hit Die from your pool. ​Vary the number of Long Rests or the level of Healing Spell if you wish to make 
Wound Damage take longer to recover. 
Caught Unawares:​ Any damage taken during a surprise round or while a character is Unconscious,
Stunned, Paralyzed, or Incapacitated goes straight to Wound Points. If the damage is taken during a
surprise round, the character must make a ​Dexterity or Constitution saving throw with a DC of 10
or half the damage, whichever is greater​ and if they succeed the damage goes to Hit Points
instead. If the character is suffering from one of the above conditions, they may not make such a
saving throw. 
Monsters Have Lives Too:​ Other creatures (read: ​everything that isn’t a player​) gain Wound Points.
When they begin to take Wound damage unless they have a pressing need to continue fighting, they
ought to try and flee or bargain for their life. 
You Mean Herbs Are Actually Useful!?:​ Recovering Wound Damage requires a specific herb or herbs.
Even magical healing will not properly knit the body together without the healer having access to the
specific herb(s). A D
​ C 13 Medicine check​ will allow a healer with access to the resource to return ​1d4
+ the Healer’s Proficiency Bonus Wound Points​ to the character. I have used this rule in a previous
campaign, and it made for a very interesting economy as a result of the necessity of the herb. 
Debilitating Blow:​ If a character takes half their life or more (​ including Wound Points)​ in a single
blow, roll on the Major Wounds Table. If they drop to zero in a single blow, roll twice on the Major
Wounds Table. 
Big Damn Heroes:​ Never roll on the Major Wounds Table. Also, when potentially suffering an injury,
make a ​Dexterity or Constitution saving throw with a DC of 10 or half the damage, whichever is
greater.​ On a success, no injury is suffered.