A Primer on Hit Points and Healing in the new Dungeons & Dragons

Although I’ve written a lot about the various initiative systems in D&D, I could quite easily fill a lot of space talking about how healing has changed through the editions. For players moving from AD&D to 5E, the way healing works is likely to be quite strange. Yes, you still have spells that allow you to heal, but why are Hit Dice being used for healing? What are short and long rests?

The one thing that hasn’t changed in the new D&D is that hit points measure how long you can fight before falling unconscious (or dying). They represent a mix of actual health and physical fitness, along with a component of luck, skill, divine providence and fatigue.

As not every hit point lost represents an actual wound, characters can regain a portion of their hit points by resting. Actually trying to determine when a wound is real is very difficult, except in one occasion: when you’re dead, that last one? It was real!

Zero hit points and dying

Characters in D&D are either fine or they aren’t; a loss of hit points does not degrade their fighting capabilities. Previous editions of D&D had the concept of “negative hit points” – if you were on 3 hit points and took 8 damage, you were on -5 hit points and unconscious, and if your hit points hit a particular threshold (-10 in most editions), you died.

That’s not the way it works in the new edition. Instead, once you reach 0 hit points, you can’t lose any more. However, if the remaining damage (or new damage) equals or exceeds your maximum hit points, you immediately die. That’s one way of attaining instant death.

Once you’re on 0 hit points, you must make a Death Saving Throw at the start of each of your turns. On a 10+, you succeed. If you make three successful saves, you are stable and just remain unconscious for 1d4 hours; after that you wake up on 1 hit point. Unless you’re hit again (when you need to start making saves again) or get healed. Three failures on Death Saving Throws? You die. Try not to let that happen!

There are a couple of special cases worth noting with Death Saving Throws:

  • A natural 1 on the save counts as two failures.
  • A natural 20 on the save means you regain 1 hit point. As the saving throw is made at the start of your turn, you can take the rest of your turn normally (generally you pick up your weapon, stand up, and do something else).

In addition, if you take any damage while on 0 hit points, it immediately counts as a failed saving throw. If the damage came from a critical hit, it counts as two failed saving throws! (And when you’re unconscious, any attack made from within 5 feet of you that hits is automatically a critical hit!)

Note that Death Saving Throws are still saving throws, even if they don’t have any normal modifiers on the dice roll. Spells, feats and special abilities can affect them. In particular, halflings get to reroll 1s due to their Lucky trait!

Also: While you’re at 0 hit point, you can’t benefit from a short or long rest. You need to return to 1 hit point first!

Healing Spells:
Cure light wounds has been the primary way of healing characters since the earliest days of D&D, but there was a gap in the spell list which meant it was the only healing spell until the fourth level cure serious wound spell was achieved. That gap was plugged in 2E. From that, we get the 5E spell Cure Wounds: it heals damage proportional to the spell slot you use. It is cure light wounds, cure moderate wounds, cure serious wounds, cure critical wounds and other spells we hadn’t even named all rolled into one. It has a bonus equal to your spellcasting ability modifier on the hit points it heals.

Clerics who can’t get to their companions may find the healing word spell of use. It heals at range, but is only half as effective as cure wounds. However, it can be cast as a bonus action, which means you can still fight or cast other spells in the same round you use it. Swift healing at range was one of the best features of 4E, and it’s good to see it here.

There are also versions of both spells which affect several characters at once.

Potions of Healing: Magic items are going to be almost impossible to buy in the new D&D, with one exception: potions of healing. They cost 50 gp each, take an action to drink or administer, and restore 2d4+2 hit points. They take longer to use than in 4E, but they’re likely to be quite popular, although it’s uncertain as to how rich characters will actually be – treasure rewards don’t seem to scale up as much as in previous editions. Potions of healing are also coloured red, which probably is a reference to their colour in some very popular computer games…

Short Rests and Hit Dice: Characters in 4E could heal themselves from a pool of healing surges – each equal to a quarter of their hit points. A typical character might have 8 of them available each day, and they were also expended by healing magic (which would provide a bonus to the healing). Whenever a character took a rest between combats, they could use healing surges to regain hit points.

Part of this idea remains in 5E, but with a couple of changes. First of all, they’re called Hit Dice, and they’re equal to the number of dice you roll to determine your hit points. Whenever you rest for an hour or more, you may expend as many Hit Dice as you like, rolling them and adding the total to your current hit points. Your constitution modifier applies to each hit die rolled.

A Short Rest is defined as being a period of 1 hour or more when you get a chance to bind wounds and generally recover. There are several abilities possessed by characters that also recharge when you take a short rest. It’s a lot longer than the time in 4E, so won’t be as frequently employed.

It should be noted that healing surges and hit dice entered the game for two reasons. The first is to allow players to adventure without a cleric (or other healer). The second is due to the wand of cure light wounds in 3E. That wand cost a negligible amount of gold, and had fifty charges of 1d8+1 healing each. As a result, characters in 3E would typically be healed up to full after each fight. Hit dice are a lot more limited than either what you get in either 3E or 4E.

Long Rests and Full Healing: If you rest for eight or more hours, you get the benefit of a long rest: all your hit points are healed, and you regain half (rounded down) of your hit dice. For those who are used to AD&D, this is a major change in how the rules work. Without magic, it’d take weeks for a badly wounded fighter to get back on his feet! For those in 3E, it’s a change but they had wands of cure light wounds so it didn’t matter. For 4E players, this is less than they had, as they got all of their healing surges back!

Long rests are also where you regain spell slots and some of the more powerful class abilities.

To clarify how many Hit Dice you regain: it is half of your maximum Hit Dice, rounded down, with a minimum of 1 Hit Dice regained. (And no, you can’t regain more Hit Dice than you have). So if you have 5 Hit Dice and have spent 3, you will regain 2 Hit Dice with a long rest.

The minimum of 1 is confirmed in the errata to the Player’s Handbook.

Revivify: Although the classic spells of raise dead and resurrection are in the game, there is a new 3rd level cleric spell that offers an earlier solution to unfortunate death at low levels: Revivify brings back to life one character who died if you can get to them within a minute. The first time I saw this spell was during 3E, where you could only use it in reaction to someone actually dying. As revivify only restores 1 hit point, they are quite vulnerable if a fireball should strike them during the next round. This did, in fact, occur during my 3E Ruins of Greyhawk campaign – the only two times that character died in the combat were the initial death in that combat, and then again after he was revivified! Use with care!

Too much healing? Too little healing? Look in the DMG: The designers of the new Dungeons & Dragons are well aware that the amount of healing and how it works will not suit everyone; healing has changed a lot in the game over the years. I fully expect that the Dungeon Master’s Guide will have alternative systems. (Mike Mearls has indicated that a Wound/Vitality system similar to the d20 Star Wars system will be included). Even now, it’s pretty easy to eliminate hit dice if you like, eliminate short rests, or make short rests only take 5 minutes. They’re just rules.

A System for Grittier Healing: One way you could make healing less effective whilst still retaining most of the assumptions made by the 5E designers is to make the healing you gain from Hit Dice and Second Wind into Temporary Hit Points. (Temporary Hit Points don’t stack, but it’s easy enough to make an exception for these, or just say all hit dice you spend at one time go into one temporary HP pool). If you add this to a rule that you don’t recover all your hit points from a long rest – say, you recover half your level (minimum 1) in hit points for each full day of rest, then you have a system where “real” wounds need magic or a lot of rest to recover, but still allow you to refresh yourself and keep going… until you have a long rest, the temporary hit points go away, and you realise exactly how much punishment you’ve taken!


  1. John Shannon

    I’m still a little confused on the rule for how many hit dice come back after a long rest. Is it half of the hit dice you’ve used or half of your total hit dice.So if I’m 5th level and I use 2 HD, do I regain 1 hit dice or 2?


      • Soren

        No matter how many he has used, he will get two back if I’m reading it correctly. Even if you spent all five, you get back “half rounded down” = two.
        (Though never exceeding your maximum of course)


  2. robert

    Can you explain the healing pool as described in the paladin section in reference to lay on hands? How foes lay on hands work as a paladin then? How much does it heal? Where does this pool vome from? Sorry I just don’t seem to understand it yet.


    • merricb

      The basic idea is that a paladin can heal up to their level*5 hit points per day – a first level paladin can heal 5 hp, the second level 10 hp and so on. However, they don’t have to use it all in one shot. They can split it as they like, and keep some to use later.

      So, a 4th level paladin has a pool of 20 points of healing. They could use 5 points in one encounter to heal the rogue, leaving them with 15 points. The next encounter, they stabilise the dying cleric using 1 point, and then help the wizard with 10 points. That would leave them with 4 points of healing to use.

      After a long rest, the pool replenishes to its maximum amount – any healing not used from the previous day is lost.

      Does that help?


  3. Michael King

    Quick question about multiple creature healing spells (Prayer of Healing, etc).
    Do they roll the 2d8 for themselves?
    If I roll, do I roll the 2d8 separately for each creature or is it one roll heals that amount for all?


  4. spacewalker1

    Just to confirm your suspicion: the DMG does provide some alternatives for healing, both ones to make healing more difficult AND ways to make it easier (!).

    To make healing more costly, there are three modifications suggested:

    1) Make the use of a Hit Die for healing contingent on the use of a healing kit.
    2) Make gaining HP after a long rest also contingent on spending HD. I personally like this one.
    3) Change the length of time for the two rest periods: a short rest is eight hours, and a long rest is seven days. I think this would work well in conjunction with your idea of temporary HP described in the original post.


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