Diseases and Poisons
The basic Pathfinder rules for diseases and poisons don't necessarily mimic the progression of these afflictions in a believable way; a character with a few lesser restoration spells can simply ignore most diseases, and diseases and poisons that don't affect your Constitution score can never kill you. What's more, because these afflictions tend to affect ability scores, their effects can be unrealistically powerful—a poison that damages Intelligence can take down any creature of animal intelligence, regardless of CR. The following optional system presents progression tracks for diseases and poisons that cause the victim's situation to become increasingly worse.
Progression And End States
When a victim fails his initial save and is afflicted with a disease or poison, he immediately gains the effects of the first step down that affliction's progression track. For diseases, this is latent/carrier; for poisons, it's usually weakened. This replaces the affliction's normal effects (such as ability damage and ability drain), though many afflictions still produce additional symptoms. At the GM's discretion, truly deadly diseases and poisons might cause the victim to start further along the progression track than normal. All effects from disease and poison tracks are cumulative.
Most afflictions also have an end state—a point at which the disease or poison has progressed as far as it can. Once an affliction has reached its end state, the victim keeps all current effects (but doesn't suffer further effects) and can no longer attempt saving throws to recover from the affliction. By default, each disease and poison track has an end state of dead, but some afflictions have less severe end states, and others might progress only to a certain intermediate state at worst, allowing victims to continue attempting saves.
In general, whenever a victim fails a saving throw against her affliction, she moves one step further down the progression track, gaining the effects of the next state and keeping all previous effects, until she reaches the end state. If she's afflicted with a disease, she moves one step back toward healthy whenever she fulfills the conditions in the disease's Cure entry (usually by succeeding at one or more saves). Once she reaches healthy, she is cured. Poisons work differently—fulfilling the cure condition removes a poison from the victim's system, but she remains at the same step on the track and recovers gradually. (Treat a poison that has exhausted its duration in the same way.) For every day of bed rest (or 2 nights of normal rest), a victim recovers one step; this recovery is doubled as normal by Heal checks, and tenacious poisons might require a longer recovery period.
Usually, neutralize poison or remove disease immediately moves the victim to a healthy state on the respective track, and a heal spell will work for both. However, once the disease or poison has reached its end state, only a more powerful spell such as miracle or wish can remove its effects.
Some diseases and poisons cause the same effects as a condition (such as sickened) or render characters paralyzed. Effects that modify or remove those conditions (such as immunities) do not apply; only effects and immunities that help against diseases or poisons apply, as appropriate.
Diseases
The disease track simulates the progression of a disease, starting with incubation. Ignore any onset entry for a disease; the victim attempts saving throws at a rate based on the disease's frequency. At the GM's discretion, if the disease's Cure entry does not allow a cure, the disease's progression may be irreversible without the use of a heal spell, and even a successful remove disease only prevents further deterioration.
There are two different tracks: one for diseases that affect physical ability scores (such as bubonic plague or slimy doom), and one for those that affect mental ability scores (such as cackle fever or mindfire). Sample diseases can be found below.
Physical Disease Track
Healthy—Latent/Carrier—Weakened—Impaired—Disabled—Bedridden—Comatose—Dead
Latent/Carrier: A character in this stage has the disease, and may pass it on if contagious, but suffers no ill effects.
Weakened: A character weakened by a physical disease suffers all the effects of the sickened and fatigued conditions.
Impaired: A character impaired by a physical disease also suffers the effects of the exhausted condition. Whenever he takes a standard action, he must succeed at a Fortitude save at the same DC as the disease's DC or lose the action and gain the nauseated condition for 1 minute.
Disabled: A character disabled by a physical disease gains the disabled condition. If he takes a standard action, his hit points drop by 1 or to –1, whichever is worse.
Bedridden: A character rendered bedridden by a physical disease is awake and can converse, but he can't stand on his own or take any standard or move actions.
Comatose: A character rendered comatose by physical disease is unconscious and feverish. He can't be woken by any means as long as he remains in this state on the disease track.
Dead: The disease overcomes the body's immune system, and the character dies. The corpse may be still be contagious, and some diseases may have unusual effects after the character dies.
Mental Disease Track
Healthy—Latent/Carrier—Weakened—Impaired—Befuddled—Deranged—Comatose—Dead
Latent/Carrier: A character in the latent stage has the disease, and may pass it on if contagious, but suffers no ill effects.
Weakened: A character weakened by a mental disease suffers all the effects of the shaken condition. The DCs of her spells and spell-like abilities decrease by 2. If she is a spellcaster, she can no longer cast her highest level of spells.
Impaired: A character impaired by a mental disease no longer adds her mental ability score modifiers to the number of uses per day of pools (such as an arcane pool or a ki pool), abilities (such as channel and lay on hands), and bonus spells per day. Her DCs decrease by an additional 2. If she is a spellcaster, she can no longer cast her 2 highest levels of spells.
Befuddled: A character befuddled by a mental disease is losing her grasp on thought, reality, and self. She has a 50% chance each round to take no relevant action, instead babbling randomly, wandering off, or talking to unseen things.
Deranged: A character rendered deranged by a mental disease is almost entirely disconnected from reality. Her mind filters and twists all external stimuli into strange forms.
Comatose: A character rendered comatose by a mental disease has lost all grip on reality and entered an inner world of dreams. She can't be woken by any means as long as she remains in this state on the disease track.
Dead: The disease has harmed the character's brain beyond repair, killing her. The corpse may still be contagious, and some diseases may have unusual effects after the character dies.
Poisons
The poison track simulates the progressive effects of poison in the body. A character who is poisoned rolls a saving throw after the listed onset at the listed frequency. On an initial exposure to poison, regardless of whether her save succeeds, a victim takes an amount of poison damage equal to the poison's DC – 10, divided by 2 (for example, 5 points of poison damage for a DC 20 poison). This is hit point damage, not ability damage. If a victim is exposed to additional doses of the same poison, a failed save progresses the poison track by one step and increases the duration by 50%, but doesn't increase the DC.
Strength Poison Track
Healthy—Weakened—Impaired—Staggered—Immobile—Dead
Weakened: A character weakened by Strength poison suffers a –2 penalty on Strength-based attack rolls, damage rolls, skill checks, and ability checks. Her carrying capacity is divided by 3. She is always considered to be carrying at least a medium load.
Impaired: A character impaired by Strength poison experiences rapid muscle atrophy. She takes an additional –2 penalty on the affected Strength-based rolls, and is always considered to be carrying at least a heavy load.
Staggered: A character staggered by Strength poison is so weakened that she suffers the effects of the staggered condition (except she can take a full-round action if it is purely mental).
Immobile: A character rendered immobile by Strength poison cannot move her body at all. She is helpless and can take only purely mental actions.
Dead: All the character's muscles cease functioning, including the heart.
Dexterity Poison Track
Healthy—Sluggish—Stiffened—Staggered—Immobile—Dead
Sluggish: A character rendered sluggish by Dexterity poison has dulled reactions. He takes a –2 penalty on Reflex saves and all Dexterity-based attack rolls, ability checks, and skill checks, as well as to AC.
Stiffened: A character stiffened by Dexterity poison feels numb and stiff. He is considered flat-footed and is denied his Dexterity bonus to AC, even if he has uncanny dodge. He can't make attacks of opportunity.
Staggered: A character staggered by Dexterity poison is so slowed and stiffened that he gains all the effects of the staggered condition (except that he can take a full-round action if it is purely mental).
Immobile: A character rendered immobile by Dexterity poison cannot move his body at all. He is helpless and can take only purely mental actions.
Dead: The character's body becomes completely incapable of movement and dies.
Constitution Poison Track
Healthy—Weakened—Impaired—Disabled—Unconscious—Dead
Weakened: A character whose health is weakened by Constitution poison takes a –2 penalty on all Fortitude saves and Constitution checks. Every time she attempts a Fortitude save against the poison, whether she succeeds or fails, she takes damage as on initial exposure.
Impaired: A character impaired by Constitution poison takes an additional –2 penalty on the above checks.
Disabled: A character disabled by Constitution poison gains the disabled condition. If she takes a standard action, her hit points drop by 1 or to –1, whichever is worse.
Unconscious: A character rendered unconscious by Constitution poison enters a state of shock and can't be woken by any means as long as she remains in this state.
Dead: The character's immune system is ravaged by the poison, and she expires.
Intelligence Poison Track
Healthy—Weakened—Impaired—Animalistic—Comatose—Dead
Weakened: A character whose reason is weakened by Intelligence poison takes a –2 penalty on all Intelligence-based skill checks and ability checks. A character with spellcasting based on Intelligence decreases his DCs by 2 and can no longer cast his highest level of spells.
Impaired: A character impaired by Intelligence poison does not add his Intelligence bonus to the number of uses per day of pools and abilities (such as an arcane pool) and does not gain bonus spells per day from his Intelligence. He takes an additional –2 penalty on the above Intelligence-based rolls. An Intelligence-based caster reduces his DCs by an additional 2, and he can no longer cast his 2 highest levels of spells.
Animalistic: A character rendered animalistic by Intelligence poison suffers the same effects as from a feeblemind spell, except his Charisma and Charisma-based skills are unaffected.
Comatose: A character rendered comatose by Intelligence poison is no longer able to process thoughts. He cannot be woken by any means as long as he remains in this state.
Dead: The character's brain stops functioning, and he dies.
Wisdom Poison Track
Healthy—Weakened—Impaired—Confused—Comatose—Dead
Weakened: A character whose awareness is weakened by Wisdom poison takes a –2 penalty on all Wisdom-based skill checks and ability checks, as well as on Will saves. A character with spellcasting based on Wisdom decreases her DCs by 2 and can no longer cast her highest level of spells.
Impaired: A character impaired by Wisdom poison does not add her Wisdom bonus to the number of uses per day of pools and abilities (such as a ki pool) and does not gain bonus spells per day from her Wisdom. She takes an additional –2 penalty on the above Wisdom-based rolls. A Wisdom-based caster reduces her DCs by an additional 2, and can no longer cast her 2 highest levels of spells.
Confused: A character who's confused by Wisdom poison has difficulty processing reality and is dangerous to herself and others. Each round, she rolls on the chart from the confusion spell to determine her actions.
Comatose: A character rendered comatose by Wisdom poison is no longer able to experience reality or receive sensory information. She can't be woken by any means as long as she remains in this state.
Dead: Forever lost in her own inner reality, the character's brain stops working, and she dies.
Charisma Poison Track
Healthy—Weakened—Impaired—Pliable—Catatonic—Dead
Weakened: A character whose sense of self is weakened by Charisma poison takes a –2 penalty on all Charisma-based skill checks and ability checks. A character with spellcasting based on Charisma decreases his DCs by 2 and can no longer cast his highest level of spells.
Impaired: A character impaired by Charisma poison doesn't add his Charisma bonus to the number of uses per day of pools and abilities (such as lay on hands) and doesn't gain bonus spells per day from his Charisma. He takes an additional –2 penalty on the above Charisma-based rolls. A Charisma-based caster reduces his DCs by an additional 2, and can no longer cast his 2 highest levels of spells.
Pliable: A character rendered pliable by Charisma poison has little sense of self and will go along with nearly anything. Bluff, Diplomacy, and Intimidate checks automatically succeed against a pliable character, except Diplomacy checks to improve a pliable character's attitude, which have the normal DC. This still does not allow characters to whom the pliable character is unfriendly or hostile to make requests of the pliable character using Diplomacy.
Catatonic: A character rendered catatonic by Charisma poison can see, hear, and process his environment, but has lost all agency and can't interact with the world in any way.
Dead: The character loses even autonomic functions, and dies.
Sample Diseases
Examples of diseases that use the various tracks are given below. If a disease does not specify an effect, it imposes only the effects for the victim's state on the pertinent track.
Blinding Sickness
Type disease, ingested; Save Fortitude DC 16
Track physical; Frequency 1/day
Effect At the impaired state, also become permanently blind
Cure 2 consecutive saves
Bubonic Plague
Type disease, injury or inhaled Save Fortitude DC 17
Track physical; Frequency 1/day
Cure 2 consecutive saves
Cackle Fever
Type disease, inhaled; Save Fortitude DC 16
Track mental; Frequency 1/day
Cure 2 consecutive saves
Dementia Dust
Type disease, inhaled; Save Fortitude DC 14
Track mental; Frequency 1/week
Effect Even if the disease is removed with remove disease, condition does not improve without greater restoration or heal
Cure magic only
Demon Fever
Type disease, injury; Save Fortitude DC 18
Track physical; Frequency 1/day
Effect At the impaired state, penalties from the weakened state become permanent until victim receives heal or restoration
Cure 2 consecutive saves
Devil Chills
Type disease, injury; Save Fortitude DC 14
Track physical; Frequency 1/day
Cure 3 consecutive saves
Filth Fever
Type disease, injury; Save Fortitude DC 12
Track physical; Frequency 1/day
Cure 2 consecutive saves
Leprosy
Type disease, contact, inhaled, or injury; Save Fortitude DC 12
Track physical (special); Frequency 1/week
Effect Healthy—Latent/Carrier—Sluggish—Stiffened; sluggish and stiffened are as Dexterity poison, stiffened is an end state
Cure 2 consecutive saves
Mindfire
Type disease, inhaled; Save Fortitude DC 12
Track mental; Frequency 1/day
Cure 2 consecutive saves
Mummy rot
Type disease, injury; Save Fortitude DC 16
Tracks physical and mental (special); Frequency 1/day
Effect No latent/carrier state; victim suffers all penalties from progressing on both the physical and mental disease tracks
Cure remove curse and remove disease within 1 minute of each other
Red Ache
Type disease, injury; Save Fortitude DC 15
Track physical; Frequency 1/day
Cure 2 consecutive saves
Shakes
Type disease, contact; Save Fortitude DC 13
Track physical; Frequency 1/day
Cure 2 consecutive saves
Slimy Doom
Type disease, contact; Save Fortitude DC 14
Track physical; Frequency 1/day
Effect At the impaired state and beyond, penalties from the weakened state become permanent until the victim receives heal or restoration
Cure 2 consecutive saves
Sample Poisons
Examples of poisons that use the various tracks are given below. If a poison does not specify an effect, it imposes only the effects for the victim's state on the pertinent track.
Type poison, contact; Save Fortitude DC 20
Track Constitution (special); Onset 1 minute; Frequency 1/round for 6 rounds
Effect Healthy—Weakened—Disabled—Dead
Cure 2 consecutive saves
Blue Whinnis
Type poison, injury; Save Fortitude DC 14
Track Constitution (special); Frequency 1/round for 2 rounds
Effect Healthy—Weakened—Unconscious; no end state
Cure 1 save
Deathblade
Type poison, injury; Save Fortitude DC 20
Track Constitution; Frequency 1/round for 6 rounds
Cure 2 consecutive saves
Green Lotus
Type poison, contact; Save Fortitude DC 18
Track Charisma (special); Onset 1 minute; Frequency 1/round for 6 rounds
Effect Healthy—Weakened—Impaired—Pliable—Pliable; the second pliable is an end state
Cure 1 save
Id Moss
Type poison, ingested; Save Fortitude DC 14
Track Intelligence; Onset 10 minutes; Frequency 1/minute for 6 minutes
Cure 1 save
Insanity Mist
Type poison, inhaled; Save Fortitude DC 15
Track Wisdom; Frequency 1/round for 6 rounds
Cure 1 save
Large Scorpion Venom
Type poison, injury; Save Fortitude DC 17
Track Strength; Frequency 1/round for 6 rounds
Cure 1 save
Small Centipede Poison
Type poison, injury; Save Fortitude DC 11
Track Dexterity; Frequency 1/round for 4 rounds
Effect Requires two failed saves to progress to each state past sluggish
Cure 1 save
Ungol Dust
Type poison, inhaled; Save Fortitude DC 15
Track Charisma; Frequency 1/round for 4 rounds
Effect Victim does not recover past weakened without heal or restoration
Cure 1 save
