I got most of this on a furum, reddit i think. We used it since 2014. It s use in concert with the 2014 dmg more realist hp were you need healing kit to grt hit dices heal on a rest and where long rest dont heal back any hp, but just give back hit dices.
We really like this house rule. And with 2024 mega boost to healing, it s better than ever. We had a few TPK but when we adapted, the game got ... Better. Don t know for you, but 2024 is the best d&d version ever, except for the 0 hp rule, healing word get back and fight...
Part 4 House Rules: Negative Hit Points Rule
Negative Hit Points Mechanic
When damage reduces you to 0 hit points and there is damage remaining, you gain a number of special points called negative hit points equal to the remaining damage. Negative hit points are not considered hit points. They persist between turns, and there is no limit on how many negative hit points you can accumulate. If your total number of negative hit points equals or exceeds your hit point maximum, you die.
Example:
A cleric with a maximum of 12 HP currently has 6 HP. If she takes 14 damage, she is reduced to 0 HP, but 8 damage remains. She falls unconscious, and the remaining damage is converted into 8 negative hit points. If she is hit again for 4 or more damage, she dies.
Exhaustion from Dropping to 0 HP:
Dropping to 0 HP or less grants 1 level of exhaustion (maximum 1 per day, even if you fall multiple times).
You gain 1 additional level of exhaustion per day if you remain at less than 1 HP.
A long rest at 1 HP or more is required to remove each level of exhaustion.
Death Saving Throws:
The death saving throw mechanic still applies (Player’s Handbook, p. 28).
A creature can be stable with negative HP.
A creature dies after 3 failed death saves.
Stabilizing a Creature:
If healing is unavailable, stabilization prevents further death saving throws.
Healing first reduces negative hit points. If healing reduces negative HP to 0, any remaining healing applies to positive HP.
A DC 10 Wisdom (Medicine) check can stabilize an unconscious creature.
Any magical healing stabilizes a creature if it does not restore HP above 0.
A stable creature does not make death saves but remains unconscious.
If a stable creature takes damage, it must restart death saves.
A stable creature regains 1 HP after 1d4 hours, becoming conscious even if it still has negative HP.
Special Rule: Effects That Restore 1 HP or More at 0 HP
Any feature that grants HP when a creature reaches 0 HP applies those hit points to the negative total instead.
The creature can act normally, even with negative HP, as if at positive HP.
If the creature takes further damage and still has negative HP, it falls unconscious immediately and begins death saves.
If the negative HP total equals or exceeds the creature's maximum HP, it dies.
Example:
An orc player has 8 HP at level 1. He takes 13 damage, reducing him to -5 HP. However, his racial trait grants him 1 HP instead of dropping to 0, leaving him at -4 HP. He can continue fighting normally. However, if he takes any further damage, he immediately falls unconscious and starts death saves. If his negative HP reaches -8, he dies instantly.
Rollback Post to RevisionRollBack
To post a comment, please login or register a new account.
I got most of this on a furum, reddit i think. We used it since 2014. It s use in concert with the 2014 dmg more realist hp were you need healing kit to grt hit dices heal on a rest and where long rest dont heal back any hp, but just give back hit dices.
We really like this house rule. And with 2024 mega boost to healing, it s better than ever. We had a few TPK but when we adapted, the game got ... Better. Don t know for you, but 2024 is the best d&d version ever, except for the 0 hp rule, healing word get back and fight...
Part 4 House Rules: Negative Hit Points Rule
Negative Hit Points Mechanic
When damage reduces you to 0 hit points and there is damage remaining, you gain a number of special points called negative hit points equal to the remaining damage. Negative hit points are not considered hit points. They persist between turns, and there is no limit on how many negative hit points you can accumulate. If your total number of negative hit points equals or exceeds your hit point maximum, you die.
Example:
A cleric with a maximum of 12 HP currently has 6 HP. If she takes 14 damage, she is reduced to 0 HP, but 8 damage remains. She falls unconscious, and the remaining damage is converted into 8 negative hit points. If she is hit again for 4 or more damage, she dies.
Exhaustion from Dropping to 0 HP:
Dropping to 0 HP or less grants 1 level of exhaustion (maximum 1 per day, even if you fall multiple times).
You gain 1 additional level of exhaustion per day if you remain at less than 1 HP.
A long rest at 1 HP or more is required to remove each level of exhaustion.
Death Saving Throws:
The death saving throw mechanic still applies (Player’s Handbook, p. 28).
A creature can be stable with negative HP.
A creature dies after 3 failed death saves.
Stabilizing a Creature:
If healing is unavailable, stabilization prevents further death saving throws.
Healing first reduces negative hit points. If healing reduces negative HP to 0, any remaining healing applies to positive HP.
A DC 10 Wisdom (Medicine) check can stabilize an unconscious creature.
Any magical healing stabilizes a creature if it does not restore HP above 0.
A stable creature does not make death saves but remains unconscious.
If a stable creature takes damage, it must restart death saves.
A stable creature regains 1 HP after 1d4 hours, becoming conscious even if it still has negative HP.
Special Rule: Effects That Restore 1 HP or More at 0 HP
Any feature that grants HP when a creature reaches 0 HP applies those hit points to the negative total instead.
The creature can act normally, even with negative HP, as if at positive HP.
If the creature takes further damage and still has negative HP, it falls unconscious immediately and begins death saves.
If the negative HP total equals or exceeds the creature's maximum HP, it dies.
Example:
An orc player has 8 HP at level 1. He takes 13 damage, reducing him to -5 HP. However, his racial trait grants him 1 HP instead of dropping to 0, leaving him at -4 HP. He can continue fighting normally. However, if he takes any further damage, he immediately falls unconscious and starts death saves. If his negative HP reaches -8, he dies instantly.