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Most healing spells detail how many hit points they restore. However, hit points are an abstraction and may not even represent physical injuries. How do you determine what degree of healing spell is required to correct injuries in fiction?

It is clear by contrast with spells that explicitly will restore lost limbs that most healing spells will not handle that, but what degree of healing is required to mend a broken bone or a sprained ankle? What is required to heal an evisceration that has not yet proven fatal?

This could impact in-fiction descriptions of the results of healing spells between PCs, but the more significant motivator is presenting resource management and moral questions using NPCs. Will the PCs aid a traveller or conserve the resources for themselves for later? How will they triage a village with significant needs for healing? But to present these questions in fiction, it is necessary to know how far they can actually stretch their resources.

You basically... can’t.

The abstraction that is hp is nebulous and fluid; it’s not an abstraction for any one thing, it’s not even an abstraction for the same thing at a given time. If someone loses hp because a goblin slashes them with a sword, and then someone uses crusader’s strike to inspire them to greatness, they are healed a certain amount of hp. Here, hp was lost due to injury (probably?) but the damage healed was more inspirational in nature.

The best single thing we can call hp is probably “plot armor,” because that is effectively what it is. That is both its narrative and its mechanical role. Characters have hp because our plots and narratives want them to withstand more punishment than anyone realistically could. Characters survive blows—losing only hp, but otherwise being uninhibited by any injury—because we want to see more of them. And plot armor is always a matter of hand-waving. Good authors can make it more subtle and hide it, but it’s still there because of the demands of the plot.

In short, plot armor is not an effect, it is a cause. The narrative warps to reflect its needs, rather than it reflecting the events of the narratives events. And hp is basically a measure of plot armor—which makes it a little more reflective of narrative events, but only so much.

Finally, stuff like broken bones and sprained ankles—even the lost limbs mentioned by regenerate et al.—just... don’t factor into the system at all. No amount of lost hp causes those things, and those things aren’t defined as costing a certain amount of hp. In fact, those things aren’t defined at all. No effect in the game, anywhere, causes such injuries. As far as the game is concerned, therefore, they cannot happen, and it isn’t the rules’ responsibility to explain how to handle it if a DM decides to houserule things to add them. Instead, that DM is left on their own to handle it, and most DMs simply... don’t bother. Such injuries are either not part of the game at all, or they are matters of pure fiat that the DM is using, effectively, to railroad the players at particular points. You see that kind of thing in video games too—characters that have taken and dealt literally hundreds of attacks suddenly become injured by the plot, and no amount of your usual healing options help—you are forced by the plot to do whatever it is that the plot demands at that point.

A really fleshed out injury system could avoid all of those problems, but D&D 3.5e doesn’t provide one. It is a system that wants to focus on heroic epics—it doesn’t want anyone sidelined by injury, it doesn’t want to focus on the logistical hurdles such an injury causes, it wants to get on with the next adventure.

This is something that each GM (hopefully with buy-in from his or her group) need to settle for themselves. As this answer makes clear, the interpretation of hit points has fluctuated from edition to edition, and even with 3.5e (which is what this question asks about) there are two competing interpretations:

• The ability to take physical punishment, and


• The ability to reduce physical punishment as given.

Both of these end up being fairly cartoonish or cinematic in D&D, with the former leading to Rocky-style or Die Hard-style ability to keep functioning long after your brain and internal organs should be internally liquefied, and the latter leading to plot armor where no matter what seemingly happened, it didn't actually do much real damage.

But as you say, there is at least one more data point to consider: The Regenerate spell, which establishes pretty unambiguously that at least one spell really does repair grievous physical harm suffered by the target. But whether that implies that the Cure Foo Wounds should act in the same way by analogy, or whether the exception here means that only Regenerate has that property is not obvious to me.

I lean toward the latter, intellectually, but in play I am usually swept up in whatever the dramatic need at the moment is.

I don't think I have ever been in a game that treated these consistently, or even tried to. Certainly I've never run one that tried to be consistent. The demands of an interesting narrative sometimes mean that the Ogre's club just broke three of Blud the Barbarian's ribs, but he manfully shrugs it off. Sometimes it means that even though he was point blank for the dragonfire, he ducked his seven foot frame behind his tiny buckler and shrugged it off. And it almost certainly means different things for Frailheart the Wizard as opposed to that Ogre or Dragon.