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Damage upgrades to kill the noise fast ofc helps alot, try to gain any means of healing alot (pill dupe / card mimic, something). I got super lucky and got Guppy's Paw at womb1 so could finish it with that. Bombing your way out of nonsense rooms (hands from ceiling in particular) helps a ton.
https://bindingofisaacrebirth.gamepedia.com/The_Guardian
Always hold on cards that restore your hp
wiggle your spear for best damage
Don't take size down pills. You need bigger character hitbox to block enemy tears
DON'T TAKE DEVIL DEALS. You need hp more than damage
This is one of challenges, where you have to accept you're going to take damage (no matter how good you're in this game).