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Personally disease checks only work on the 3rd day without sleeping. They just kick in close to the 72 hour mark. Sleeping however resets this. If you do not sleep the diseases work until you do again. Its as if they are being suppressed by sleep for 2-3 days. Like when you suppress them with a spell.
All in all without diseases the game changes drastically. They are so pivotal, especially early on. Without them the game just feels lacking. Best I've done is make a no disease build that plays in a way to always be capable of healing diseases. That way I could act like they did work but I healed them before they got me or ignore them by being a solo Dhampir. Still I couldn't reproduce the effect of them working when I failed to cure myself.
Things in this game break and get fixed but this issue has been broken for me for too long. I went and played BG3 and came back and it was still broken after all. If you ever figure it out feel free to say so.
Without things to push you into playing well, you may as well just be a tourist and lower the difficulty all the way down so even death doesn't matter. Like you can adjust the setting to stop death. Doesn't make the game more fun though.
Your stats effect the battles. If you go into every battle with full resources its so much easier than going in and having to make do with less spells or hit points or whatever. Diseases are a part of that. Curing them can take resources and they can lower your stats to make combat difficult or bring you into range of death via stat damage from things like poisons.
Diseases are NOT tedium because Tedious things don't matter and are just things you do because obviously you do. Diseases do not have to be cured. You can choose to leave it another day to use those spells other ways.
Tell me, what part of diseases is tedious? Do you just consider them a must cure and any resources spent on curing to be negligible or mandatory? Have you never played without being able to cure diseases except by passing checks and using unlikely to work or expensive skills? You know its possible to not have Ember or Daeran in your party right?
about difficulty, you can not relay on skill for difficulty alone, also i dont think pathfinder is a game where "skill" does matter a lot... it is more about ressources and knowledge, and diseases are just one part, what can make a session difficult, just one part of it... there are many, quite often it the tedious stuff that makes the game difficult, because you have to deal with it and you can not ignore it
also what was/is wrong with through the ashes? it is a good dlc to try different builds and i like it but i like the main campaign as well ( :
Through the ashes is also a lot of fun. No idea what this person is talking about.