I've got to admit, I didn't even realize there was a way to interpret hit points beyond 'Life' until a few months ago, when a player from our game group brought it up. I understand the D&D ever increasing hit points puts a big big kink in the physics of any campaign world, but let's face it, it's a game convention because level advancement is part of the motivation to play. You as a player want to feel like your character is getting stronger. It's common in video games. It's common in tabletop RPGs.
But for those interested, here's a link to a lively discussion on the topic: https://www.reddit.com/r/rpg/comments/5663wv/read_robert_e_howard_if_you_want_to_understand/
I think the idea that hit points are a measure of fatigue or mental exhaustion is a stretch, and I find when it's explained as such a lot of hoops have to be jumped through. With that said, I want to avoid any confusion. Having a clear concept of what physical harm is can only add to the experience. To do this, however, I think Life has to be static.
I felt the best way of doing this was to base Life on the character's size and strength (Strength score = Life). Tiny, Small, and Medium sized creatures have 1d6, 2d6, 3d6 Strength, respectively. It's not a smooth progression, but it doesn't have to be. In fact, it leaves it open for players to create a character that begins with 1d6 Strength and 3d6 potential Strength, then gains 1 Strength until the maximum value when fully grown. Viola, you've watched your character grow up.
So next we need to look at Life in practice, in other words, combat. Characters have a set Life, so that means combat is extraordinarily dangerous. That means all the traditional damage values for weapons and criticals needs to be taken down a notch. However, I'm a big fan of realism (with a heavy lean towards grit). Weapons should still have the potential to kill a target outright. I'm walking a fine line here, so the end result will really have to be balanced.
Next, being wounded should inhibit a character's ability to fight. Enter the wound mechanic. Each time a character is hit/damaged that character accumulates a penalty to AC and attack (-1 for each time it's damaged). Wound penalties only go away after a full night's rest and Life only increases by 1 a night.
Again this needs to strike a fine balance. As such, every spellcasting class has its own version of healing, with clerics being the best at it. It also leaves open a truly gritty experience for players wanting to play the wounded warrior, fighting to the last man. To make this possible, however, I did away with negative hp, instead, a character drops to 0 Life and bleeds out. This leaves plenty of opportunities for another character to stem the bleeding, meaning once the character rests, it returns to 1 Life and is ready to fight another day (albeit at a distinct disadvantage).
BUT, we don't want to make it too easy, so last but not least, I've added an injury table for characters dropped to 0 Life because of a critical hit (it also does away with the need for a 'massive damage rule'). There's a chance to die outright, there's also a chance to lose some teeth. Either way, I think it adequately satisfies cravings for realism and risk, and though it puts characters at greater risk of losing their characters than RPGs like D&D, it leaves players the opportunity to battle through adversity. The theory goes that characters that are always at risk of death, even at full Life, will be willing to take more risks. That's the theory anyway.
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