TSW Blood/Fist Healing Guide

TSW Blood/Fist Healing Guide by dulfy

Hey everyone, after I published my AR/Blood healing build, there has being some requests for me to make one for Fist/Blood combination as well. I have played this build quite extensively in elite dungeons and nightmare dungeons (cleared both Polaris and Darkness War with this build, for Inferno I switch to AR/Blood sometimes as it is a bit easier on the group healing required for that instance).


  • Preamble
  • Builds
  • Discussion: Crit rating and crit chance
  • Discussion: OotW vs Empowerment
  • Discussion: Surgical Steel vs Creature Comfort
  • Discussion: Fired Up vs Radiance vs Cold Blooded
  • Discussion: Exquisite Corpse vs Angelic Aegis
  • Rotation
  • Gearing

High Crit: You will need a high crit rating for this build to take advantage of the elite passive, Empowerment. This passive will proc a heal that heals for 400-500 damage (depending on your heal rating and weapon power) everytime you crit a HoT (Heal over Time). Unlike Blood barriers, Fist HoTs stack so there are some Fist healing builds that take advantage of this by pretty much stacking every kind of HoT they can on the tank so that Empowerment procs constantly. There are some discussions on the crit rating and is conversion to crit chance below but at least up to 800 crit rating there are little to no diminishing returns (800 crit rating give you 21-22% crit chance depending on your World Domination bonus).

Transition to fist only: Blood is used here as a backup to Fist. There is some synergy between the two as you can use Scarlet Arts when you need to catch up on healing and on fights where bosses hit really hard you can mitigate some of the damage with a well placed Blood shield and then top the tank to full with Fist HoTs. Once you are abit geared, you can switch to Fist only and then couple it with Pistol for cleanse and Deadly Aim buff for your DPS and yourself. If you are looking for a Fist only healing guide, I highly recommend Escalith’s Fist healing build.

Fist/Blood vs AR/Blood: I like use AR/Blood early on as I find that build to be incredibly easy to heal and have much more group healing options. In addition, you can do a bit of DPS as well as the damage output gap between you and the DPS isn’t too large early on. In the endgame scene with Nightmare dungeons, I find it easier to heal with Fist/Blood for a couple of reasons 1) There are bosses that disappear, move around, teleport around, become untargetable, these scenarios are all bad for the AR and it is just less annoying with heal with Fist. 2) Once you have enough crit, the HoTs deliver a steady stream of healing with Empowerment passive. 3) A lot of the abilities in Nightmare dungeons will usually one shot people if they don’t move out/impair etc. If people are dead, you don’t need to heal them so less group healing is needed.


Early build – 78 points
It is always good to focus on one weapon at first so you get the most abilities out of it. Early dungeons don’t have much stuff that hit hard so Fist alone is more than enough. If you don’t have enough points consider dropping Shelter, you can without AoE heals for now.


  • Nurture
  • Shelter
  • Surgical Steel
  • Empathy


  • Nurturing Gift
  • Out of the Woods (Elite Passive)
  • Brawler (Hammer 1 AP passive)

The basic rotation is pretty much spam Nurture until you get 5 Fist resources and then use Surgical Steel as needed. If the you need top someone off quick then Empathy is your emergency heal.

Mid-game build – 202 points
At this stage, you will need to heal through some dungeons with high tank damage (i.e. Darkness War) and quite abit of AoE damage (i.e. Hell Raised). Your goal is to get some of the key Fist abilities first and the pick up the Blood Magic ones. Your crit rating at this point is probably still quite low so there is no rush to get Empowerment.

  • Cauterize
  • Surgical Steel
  • Empathy
  • Blood Shield
  • Angelic Aegis
  • The Scarlet Arts
  • Shelter


  • Hot Iron
  • Healing Sparks
  • Out of the Woods (Elite Passive)
  • Brawler (Hammer 1 AP passive)
  • Rapid Shield
  • Angel’s Touch

Endgame build – Non-specialized
The non-specialized build is what I run for most boss fights, there are some fights where there are more AoE damage or tank damage so I use a more specialized builds for those (described below).

  • Cauterize
  • Surgical Steel
  • Empathy
  • Blood Shield
  • Exquisite Corpse/Angelic Aegis
  • The Scarlet Arts
  • Fired Up


  • Hot Iron
  • Healing Sparks
  • Empowerment (Elite passive)
  • Brawler (Hammer 1 AP passive)
  • Making Amends
  • Shadow Medic
  • Angel’s Touch (if running Angelic Aegis) or Subtlety (hate reduction)

Endgame build – Heavy Tank Damage

Switched Fired Up with Radiance/Cold Blooded. Radiance is used as an emergency cooldown.

On bosses with a predictable damage pattern (i..e Nightmare Polaris last boss’s cleave, you will want to get a shield in between every cleave to mitigate the damage and then try to top the tank off with HoTs). If things go south, use Empathy, Scarlet Arts and then get make pop Radiance. Sometimes I will swap out Radiance with Cold Blooded as there are times where I can’t get in close enough to heal so I will pop Cold Blooded as I run towards the tank and spam Empathy, Surgical Steel (with 5 resources if possible) as I get in range and follow it with Scarlet Arts.


  • Cauterize
  • Surgical Steel
  • Empathy
  • Blood Shield
  • Exquisite Corpse/Angelic Aegis
  • The Scarlet Arts
  • Radiance/Cold Blooded


  • Hot Iron
  • Healing Sparks
  • Empowerment (Elite passive)
  • Brawler (Hammer 1 AP passive)
  • Making Amends
  • Shadow Medic
  • Subtlety/Angel’s Touch (if using Angelic Aegis)

Endgame build – Heavy AoE damage
For this build, you need to find a spot to fit Shelter in. I usually remove Empathy to fit Shelter in. If you need some more extra group heals then consider Hematic Rites from Blood or Vigour from Fist.

  • Cauterize
  • Surgical Steel
  • Shelter
  • Blood Shield
  • Exquisite Corpse
  • The Scarlet Arts
  • Fired Up


  • Hot Iron
  • Healing Sparks
  • Empowerment (Elite passive)
  • Brawler (Hammer 1 AP passive)
  • Making Amends
  • Shadow Medic
  • Subtlety (hate reduction)

1. Crit rating and crit chance %
The character stats window bugs out and tells you that you have over 99% crit chance even when naked. The way to get around this is to look at your character window after you just log on as they will display the correct values. To make the matters worse, the World Domination buff (from PvP) will change your crit chance around. I did a bit of number crunching and found the following.

At least up to 700 crit rating, there does not seem to be any sort of diminishing return. Your base crit chance is 5%, each PvP objective your faction controls will give you ~ 0.56 crit chance. So if your faction controls 1 PvP objective, the buff will tell you that you have 1 additional crit chance % but you actually have 5.6% if you strip naked (the numbers rounded up). If your faction controls 2, you get 6.1% base crit chance and 6.7% base crit chance if your faction controls 3 objectives.

Regardless of how much base crit chance you have, the conversion for converting crit rating to crit chance seems to be ~ 0.0206 for crit rating under 700 after several calculations using different data sets. This means that 1 crit chance % will required ~48.5 crit rating.

Assuming your faction suck and control 0 PvP objectives, here are a bunch of crit rating and their corresponding crit chance. Note that numbers past the 700 (i.e. those in bold) are not accurate due to diminishing returns.

Crit Chance % Crit Rating (rounded) Crit Chance % Crit Rating (rounded) Crit Chance % Crit Rating (rounded)
6 49 15 485 24 922
7 97 16 534 25 971
8 146 17 583 26 1019
9 194 18 631 27 1068
10 243 19 680 28 1117
11 291 20 728 29 1165
12 340 21 777 30 1214
13 388 22 825
14 437 23 874

The diminishing returns past the 700 mark seems to be small but noticeable. For example, with 0 PvP objectives in control, at 760 crit rating I have 20.2 crit chance % and at 911 crit rating I have 22.7 crit chance. These are a bit lower than what is predicted using the formula so that indicates a small diminishing returns in place after the 700 crit rating or 20% crit chance mark. This will be a bit more obvious once I get more data past the 700 crit rating mark.

2. Out of the Woods vs Empowerment

Both are passive elites so they conflict with each other. There have being significant debate/number crunching on the effectiveness of one over the other so I won’t reinvent the wheel here. Instead, I will direct you to the threads of interest. Escalith’s fist calculations and Shadai’s calculations. If you find the math confusing, the take home message is that Empowerment gets better with high crit ratings. When you are in crappy gear, stick with Out of the Woods and then switch to Empowerment as you get to 17-20% crit rating.

3. Surgical Steel vs Creature Comfort

I am personally biased towards Surgical Steel for two reasons 1) I use it as a burst heal to catch up on healing 2) It is a Burst ability so it will proc Healing Sparks, which in turn can crit and proc Empowerment. Now the description on Surgical Steel is a bit misleading, Surgical Steel is actually a heal that instantly heal 3 times, each time for around ~350 and then give out 4 (not 5) HoT ticks, each for 160 at ~ 3K heal rating with 5/5 Fist Resources . Empowerment has a chance to crit on each of these 4 HoT ticks and also the 4 HoT ticks from Healing Sparks. Keep in mind that because Empowerment cannot proc more than once per second and the Healing Sparks + Surgical Steel HoT proc at the same time for 4 times, the chance for one of them to proc Empowerment is 1-(1-x)^y where x is the crit chance (i.e. 0.2 for 20% crit chance) and y is the number of HoTs you have. In this case, assuming you have 20% crit chance, it would be 1-(1-0.2)^2 = 0.36 or 36% chance for one of them to trigger Empowerment proc every tick. This will deliver a lot of burst healing to your target.

Each resource will give you about 20% more healing than the tooltip description. So if you are using full 5 resources, you can estimate how much you heal by multiplying the tooltip number by 2.

Creature Comfort, on the other hand, will tick for ~300 HP per tick for 6 ticks but won’t trigger Healing Sparks. It is good for extended healing but I don’t find much use for it.

4. Fired Up vs Radiance vs Cold Blooded

Let me start off by saying that Cold Blooded is an absolute aggro magnet. I tend to not use it unless I really really need it. It is super powerful but it will pull the boss to you if the tank doesn’t have aggro or pull adds to you. You can be smart with it and couple it with Misdirection (for the next 8 seconds, 50% of the hate enemies gain towards you is instead transferred as hate towards your defensive target) but that takes up anther active slot.

I run Fired Up now as it doesn’t generate as much aggro and it has a shorter CD (25s). In most cases it is more than enough to top the DPS off and can be a handy backup for tank healing. Under heavy tank healing situations where you don’t need to do a lot of group healing (i.e. Nightmare Polaris last boss), Radiance is a nice cooldown for O’darn moments.

Some people use Radiance as a group heal by targeting each individual members with HoTs but I like my group heal to be non LoS dependent, one click, and doesn’t require me targeting each person in the group.

5. Exquisite Corpse vs Angelic Aegis

Exquisite Corpse may not heal for much but it only consume 2 resources and doesn’t have a cast time. There is a side effect to Exquisite Corpse which I am not sure if it is intended. Currently, this ability will absorb 50% of any hit, even if the hit is larger than the shield can reflect. This means that those 7-8k Charged Hacks or Cleaves will get reduced to half of their damage on whoever you cast them on.
Even if this side effect gets nerfed, Exquisite Corpse is still a strong shield and the reflected damage helps with DPS, even if minimal. If you find the Exquisite Corpse shield lacking, then Angelic Aegis with the passive will be handy for heavy tank damage fights.

I don’t have a fixed rotation as I believe healing to be reactive. What I have instead is a rough guideline that I follow. Before the fight begins, I spam Blood Shield on myself so get to upto 5 resources. If I know the tank will take a massive hit right away, I will put on Exquisite Corpse/Angelic Aegis on him/her so I don’t have to catch up on healing right away and risk pulling healing aggro.

If the tank took a hit, I will use Surgical Steel at 5 resources and Empathy to try and counter the damage. If that isn’t enough, then I will get a Scarlet Arts or two in. If that still doesn’t fix the damage, then it is time to pop Radiance/Cold Blooded. Between cooldowns I will usually spam Cauterize to build full fist resources for another Surgical Steel. If the tank’s HP is holding steady or nearly full then I will mix in Cauterize with Blood Shield to build both weapon resources at the same time. The Blood debuff for using abilities without the required resources only last for 7 seconds so you will be able to use Scarlet Arts every 7 seconds if you need it. The more Blood resources you build up before using it, the less health damage you will take. Just press F1 and then put a Cauterize on yourself if your HP start to dip a bit from the debuff.

On fights where tank takes predictable damage (i.e. Ur-Draug’s cleave), you can put up an Exquisite Corpse between every cleave to mitigate some of the damage (Angelic Aegis works as well but due to the cast time you may not able to get in every hit). The basic idea here is to use the barrier to mitigate the damage and then use HoTs to top the tank off.

Has I mentioned earlier, this build relies on high crit for Empowerment procs. You can get to 20% crit chance (~700 crit rating) without any sort of diminishing returns. There seem to be a minor diminishing returns past the 700 mark but it is not significant enough (at least to 900 crit rating where my last sample was). Stack as much crit as possible and when you finally hit major diminishing returns stack for Crit Power.

This means that you may need to re-glyph your items with Brutal glyphs (4x Pure Lu Runes). The market price for pure Lu glyphs seems to be around 100-120 k each. If you have a lot of Pax around, then you may consider glyphing your QL10 blue items. Otherwise, wait until you get purple items from the Nightwatch vendors or the PvP Venice vendors to glyph them.

If you are looking to gear up for Nightmares, I recommend you read my Endgame Gearing Guide. The take home message from that article is run elite dungeons until you have full QL10 blues, then do some Fusang PvP until you have some QL10 purples. This should allow you to cross the gear gap into Nightmares. Once you are running Nightmares, it is much easier to upgrade the items you brought with Black Bullions (assuming you can find a PuGs that can clear at least 4/6 or 5/6 of each Nightmare instance) since each upgrade kit costs only 20 Bullions rather than grinding 297 Black Marks of Venice for the PvP upgrade kits. In addition, Nightwatch Glyph kits drop frequently from Nightmare dungeons (we always get at least one in Nighmare Darkness War) so you can get a couple of purple glyphs fairly easily.

Generally you will want to wear at least one HP talisman (minor will be fine). This should get you should around ~3k HP, which will allow you to avoid some of the unavoidable one shot mechanics (i..e Macroshock in Nightmare Inferno).

In terms of signets, I find them a pain to farm since you need 100 identical green signets to make them into a purple. Below is a list of some signets you may consider. It is not a complete list but rather something to give you an idea of what’s available.

Slot Name Effects
Head/weapon Signet of Benediction When you heal a target there is a 20% chance they will gain a barrier that absorb 40/80/120 and lasts 10 seconds.
Major Signet of Amelioration Your heal rating is increased by 47/94/141
Minor Signet of Thrist When you critically heal a target they gain a 5/10/15% leech effect for 5 seconds (15 second cooldown)
Minor Signet of Equilibrium When you critically heal a target they gain a 5/10/15% damage increase for 5 seconds. 15 seconds cooldown
Minor Signet of Harmony Your healing effects are increased by 1/2/3%.
Minor Signet of Security Your barrier effects are increased by 1/2/3%.

For gadgets, I use two of them myself. The cooldown for them is separate but you cannot them at the same time. One of them is Advanced Kickback – Crit and the other is Advanced Stimulant – Heal. The description on the crit one is a bit wrong, it only provides you with 151 crit if you crit with a heal. None of them are essential but if you are looking to min/max might as well grab them.

The crit one takes 9 pure Lu runes and a Mark 2 Gadget kit.

The heal one take 7 Pure dusts with the following pattern in the Mark 2 Gadget kit.

Other The Secret World (TSW) Articles
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TSW Blood/Fist Healing Guide
TSW Fist Healing Endgame Guide
TSW Fist Healer Theorycrafting
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The Secret World Defeat Gatekeeper as Blood/AR Healer Guide
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