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Given that everyone comes into RPGs wanting to use their imagination, the reasons why combat devolves to simple mechanics are somewhat mysterious to me. I think it may be because nothing is at stake. It's hard to conjure up the energy for vivid imagery when it doesn't really matter. Whatever the reason, running a role-playing game by the numbers is a crime akin to serving chips without salsa: Violators should be taken out and shot. Violence demands viscera!
Now, I am fortunate in that I have, through long practice, refined the art for conjuring up visceral violence nearly at will. You smash your iron-flanged mace into the orc's chin, the force of the blow smashing so hard that its teeth shatter into sharp shards that embed themselves in its bloody cheeks. The orc's axe carves your belly open, and your intestines leak out like wet, pulpy worms. See, it just flows out. For the less practiced, I've prepared a short list of rules of thumb to help you out.
Brutal Blows: Most games will feature results that represent especially brutal blows - a critical hit, max damage, death blows, and so on. If you narrate nothing else, narrate these. Aim for body horror - the graphic destruction of the body. I've found the most visceral reactions come from gruesome penetration of soft, pulpy body parts, or the shattering of bones that we all secretly fear breaking. Go for thrusts through the soft palate of the upper mouth or the loose skin of the neck; impacts on the fragile bones of the knee-cap or elbow; slashes through the tender skin of the belly. Carve off the breasts and leave them dangling, Crack open the cranium and have grey jelly spray outward, shatter the spine and let spinal fluid leak onto the floor.
Hits: Every good hit deserves a good description. However many RPGs, most especially those based on D&D, give creatures the ability to survive dozens of hits. If every successful attack is narrated as a brutal blow, the result can become silly, as no one could still be standing after that much trauma. When narrating a hit that's not a critical or a kill, focus on damage to the target's armor and shield, its state of pain or fatigue, and its position. "With a metallic crunch, your mace slams into his shield, leaving a dent. The knight swears in pain and recoils backward." Fortunately, the English language leaves us no shortage for words you can use to describe the backward movement after an attack: Fall back, lurch, stagger, recoil, withdraw, retreat, and limp are all words to remember.
Misses: Nothing is so frustrating for the player as to miss an attack that he has waited all round to roll for. Even worse is when his narration is "ok, you miss. Steve, you're up." You owe it to the player to explain why his adventurer missed. If he's a highly experienced fighter, it's because the opponent fell back, or put up a desperate defense: "Still reeling from your last slash, the orc retreats before your onslaught. You can't penetrate his defenses but you and he both know his time is coming soon." If it's because he's a novice, your narration will reflect that: "Your blood is pumping with the heat of combat, and you over-extend your sword blow."