Some stories are better when the injury and death are less forgiving than the game mechanics allow. For a campaign in which the easy healing of the default Pathfinder 2e rules can be fiction-breaking, consider using rules like these to add a sense of danger and finality to the fight.
The wounded condition is unchanged from the base rules. However, whenever a character receives the Wounded condition, they must make a Fortitude save with a DC equal to 10 + Character Level + Wounded value + Doomed value:
- Critical Failure: Immediate death
- Failure: Permanent Injury
- Success: Temporary Injury
- Critical Success: No injury
The Wounded condition is unchanged from the basic game, and represents active wounds that need to be healed and patched up lest they get worse.
Injuries represent long-term debilitations due to those wounds taken. If a character receives an injury from their Wounded roll, use the Injury Table to determine the nature of the wound.
Healing Injuries
Healing Injuries requires time and attention, or the aid of powerful magic.
INJURY RECOVERY CHECK: After resting for 8 hours (in addition to the normal benefits), an injured creature attempts a Fortitude save (Level appropriate DC) to recover from each temporary injury affecting them. Creatures who use a full 24 hours of downtime may add a +2 circumstance bonus to the roll.
ASSISTED RECOVERY: You may use the TREAT DISEASE Downtime action to assist a creature in its attempt to recover from an injury, with the following changes:
- The listed circumstance bonus is to the Injury Recovery Check instead of a saving throw against disease.
- The listed circumstance bonus stacks with the circumstance bonus for a full 24 hours of rest.
- The DC for this check is the level-based DC for the injured creature’s level.
- You take a penalty on this check equal to the injured creature’s Wounded value.
Magical Healing and Injuries
Injuries cannot be healed with most magical healing. Normal vitality-powered spells and effects like the heal spell restore HP, repairing only minor cuts and bruises. Such magic does more to restore a person’s stamina and fighting spirit–like accelerating natural healing.
The sound body spell and similar effects do not affect injuries, as these are conditions that are part of your normal state.
The restoration spell can heal a temporary injury (if it could treat the associated condition), but has no effect on a permanent one. A 4th-rank restoration spell can heal any temporary injury. A 6th-rank restoration spell can turn any permanent injury into a temporary one.
The regeneration spell will make one permanent injury into a temporary injury each round that it is affecting the target (target’s choice). If the target has no permanent injuries, it removes one temporary injury each round (target’s choice). These effects are in addition to the spell’s other effects.
Breath of life can completely prevent an injury from occurring by preventing the target from gaining the Wounded condition.
Other Optional Rulesets
For my Dark Sun campaign, we are also using the following optional rules (with links for the curious):
- Dark Sun Campaign Guide by Shawn Bowman
- Automatic Bonus Progression
- Gradual Ability Boosts
- Free Archetype (limited to psychic, psychic warrior, mind smith, and several custom archetypes inspired from the old 3.5e psionics books by Dreamscarred Press)
- Restricted Spells lists (mostly create food & water, and convenience spells like light)
- Believable Hunger and Thirst
- Monster Parts Crafting System (from Battlezoo Bestiary)
This is a lot to track, but we’re hopeful that it will give us some of that OG Dark Sun vibe. I’ll post updates as we see how it games out.
If you decide to try any of this (or have already used them), please let us know how it went by joining our Discord server.
Four Thieves Gaming 
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