Skill Based Healing (3.5e Variant Rule)

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Reasons for Changes[edit]

The Heal skill represents a major investment for a character. However, outside of a few narrow uses, the skill is entirely ignored by the players.

The Heal skill itself is hard to use. It does not fit into the game as the game is played. First Aid is useful at lower levels, but the spell cure minor wounds is far more reliable. A single use object of cure light wounds is so cheap that even the poorest of characters can have one in case of emergency. If you do not intend to fully commit to healing, it is far easier, more reliable, and more effective to use a minor magic item.

Long Term Care requires that the party rest for twenty four hours. Most parties do not want to rest that long. They want to rest for a night, then continue adventuring. In many cases, they simply do not have time to rest that long. The practical upshot is that Long Term Care is so cumbersome to use that most players do not consider it worth the skill points. Many games house-rule Long Term Care into working overnight simply so that the skill can have any impact on the game at all.

In comparison, cure spells work immediately. Cure spells work in combat. Cure spells have no chance of failure. Cure spells are renewed every day. Cure spells quickly increase in effectiveness. Cure spells are easy for the players to use and have a big payoff.

Treat wound, treat poison, are treat disease never discussed and rarely used in the course of an entire campaign.

In order for the Heal skill to be attractive to players, it must work in combat; must have no or low chance of failure; must increase in effectiveness with levels; and must have a good payoff as a skill. This article poses one possible way to do this.

These rules change the core dynamic of the d20 system. The cleric is no longer the only healing engine. Any character could become the healer. This change of dynamic requires that the cleric give up the ability to channel positive energy into healing spells. It may be necessary to remove the cure spells from the cleric's spell list.


The rules for using Heal skill based healing are as follows:

  • Your uses of Heal per day is determined by your ranks in Heal. If you have Skill Focus (Heal), you gain bonus points.
  • For Pathfinder games, Skill Focus (Heal) bonuses acts as additional ranks, to counteract the lack of overall ranks available.
  • Using the Heal skill in combat is a standard action. You may use any of cure spell allowed by your ranks.
  • Using the Heal skill in combat triggers an attack of opportunity.
  • Your caster level is equal to your character level (including level adjustments).
  • There are no Wisdom bonuses or restrictions.

Your skill ranks determine what you can do with the heal skill:

Table: Healing Points
Ranks Heal
Skill Focus (Heal)
Bonus Points
Available Effects
1 1 0 cure minor wounds (1/2 pt)
2 1 0 detect poison (1/2 pt)
3 1 0
4 1 1 cure light wounds (1 pt)
5 2 1 delay poison (1pt)
6 4 3 cure moderate wounds (2 pt)
7 7 3 lesser restoration, remove paralysis (2 pt)
8 10 6 cure serious wounds (3 pt)
9 15 6 remove disease, remove blindness/deafness (3 pt)
10 20 10 cure critical wounds (4 pt)
11 27 10 neutralize poison, restoration (4 pt)
12 34 15 mass cure light wounds (5 pt)
13 43 15 raise dead (5 pt)
14 53 21 heal (6 pt)
15 64 21
16 77 28 resurrection (7 pt)
17 90 28 regenerate, greater restoration (7 pt)
18 106 28 mass cure critical wounds (8 pt)
19 121 28
20 140 28 mass heal (9 pt)
21 157 28 true resurrection (9 pt)
22 175 28
23 195 28

Healer's Kit[edit]

This item now provides +2 HP to every heal use (up to 10 uses).

The Fluff[edit]

In order to understand healing, we must revisit hit points. "Hit Points" are an abstraction used to determine if a character is up and active or down and disabled. Hit points do not represent actual toughness or actual damage. Instead, they represent a combination of physical toughness, luck, training, karma, chi, or any other measure of physical well-being that you can imagine.

"Healing" represents any additions to hit point, including physical repair, rest, renewed luck, increased karma, aligned chi, improved confidence, and any other measure that improved overall well-being that you could imagine. For example, the doctor could tell you, "It's just a flesh wound." Knowing that you are not seriously wounded, you are now psychologically ready to renew the fight.

In standard d20, the cleric casts heal spells. What exactly are these heal spells if they do not heal physical damage? These spells could be renewed divine blessings or realignment of your chi. To understand healing better, we must pose some theory of healing that allows a skill to work quickly.

Combat tears away the life energies of a creature. These energies protect a being, but they can not protect a being indefinitely. A person with the Heal skill is trained in fixing and renewing the life-energies of a creature. In battle, they keep these energies whole so that their allies do not take mortal blows. Outside of battle, they rejoin the tatters and tears that are a person's life-field.

Too Good to Avoid[edit]

A side affect of this system is that Heal becomes so good that all characters must take it. You may wish to restrict these bonuses to one character. Alternatively, you may want to give Heal ranks to all characters based on their level, while reducing the overall number of points that each rank gives. Each character gets their maximum possible ranks in Heal for free. This change relieves any single character from being "the healer", and distributes responsibility around the party. If you do this, you should remove all healing from the clerical classes, and possibly all healing from magic items as well.

This may seem strong, but with the cheapness of wands of cure light wounds, healing is already cheap.

Magics, Metamagics, and Healing[edit]

The Heal skill works with metamagic items and items that otherwise enhance healing. Each +1 of metamagic causes a heal to take another +1 uses. You may not adjust a heal to use more uses than healing attempt that you could do without metamgagic.

If you wish to add addition spells into the Heal skill, their required ranks should be equal to Required Spell Level x 2 + 3.


With healing comes harm. Consider allowing characters of evil alignment to use this skill to inflict harm effects upon others, but not heal.

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