Esoteric Enterprises deals with the "HP as not-getting-hit points vs HP as meat points" debate by separating HP into two pools, Grit and Flesh.
Grit is your not-getting-hit points. It's easy to replenish, as long as you have at least one Flesh left, a ten minute rest can get it all back. Damage to grit is near misses, superficial injuries, and being worn down so you don't dodge the next attack.
Flesh is your meat points. It's harder to replenish, requiring medical intervention, magical healing, or days of recuperation. Damage to flesh is genuine physical wounds, though not necessarily the kind that inflicts permanent injuries (those are covered by the horrible wounds table).
Mechanically, I like this a lot. It means that you can shrug off chip damage, at a cost (resting means wandering monster tables) but a certain density of damage is trouble. It means most of the time, you're never more than a rest away from having at least some HP, but taking a lot of damage still hurts. It allows the game to have special attacks that ignore Grit and hit Flesh directly, or attacks that have different consequences when they hit Grit vs Flesh. Most Esoteric Enterprises PCs have low AC values, but Grit presents an alternate way of systematizing the dodging of attacks.
What's harder is coming up with good, convincing descriptions of hits to Grit. Not for the players. They can see their character sheets and they know where the damage is hitting them (first Grit, then Flesh). If I say "you get hit for X damage" then they know whether the shot was a near miss, a glancing blow, a serious wound, etc based on how much HP they lost from which category.
NPCs are harder. If someone shoots a Cult Magister for 8 points of damage, that doesn't get through his Grit to his Flesh. He hasn't taken any serious physical injury from the attack. That's hard to describe in a way that feels impactful, while still communicating that he's got a buffer left. If I say "the handful of buckshot hits the doorframe, spraying his face and hands with wood splinters" then it sounds like the player just missed.The players know he took damage, they saw the die roll. But it feels different.
When I played 5E, Pathfinder, etc, the convention was to have characters appear "bloodied" when they reached half HP or less. Before that, they might be scratched or bruised, but the DM didn't bother describing them as visibly injured. I think there's an obvious analogue here to Grit vs Flesh. It might not be satisfying to describe hits on Grit as a near miss, but making the transition to Flesh as clear as possible is important. The players know when a hit "connects" for the first time that they've chewed through the rind, and are about to get a taste of the juicy center.
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