Plague Doctor Season 6 Guide: Poison Caster Build - Complete

Introduction
Levelling progression
How to transition into Surgical Blood Letting
Leveling progression details
Endgame progression
Surgical Blood Letting specialization trees
Best-in-slot items and gearing strategy
Poison Plague Doctor endgame guide
Setups, mercenaries, and early-mid game tips
Two alternative Surgical Blood Letting trees for faster farming
Poison caster endgame item sets (early H1-H3, then H5 farming)
Two-branch endgame DPS expectations and testing tips
Screenshots and visual references
FAQs

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Introduction

Welcome to my Plague Doctor guide! Youtube channel: https://www.youtube.com/@Proerd-iKappa Here you will find more in-depth explanations about how to progress with Plague Doctor in Season 6, hopefully it helps Quick backstory: This is my first time publishing a big build guide, if you have any questions or suggestions drop a comment on any of my videos and i shall answer it

I played season 5 Plague Doctor on Hardcore Odyssey mode, went through all the way to Hero Level 100 since i loved playing the class, and wanted to share my takes on it for everyone to experience it the best way possible, this sheet will be updated through season 6 since i'm playing the class again

Plague Doctor is a DLC class in Hero Siege, featuring options to play as a poison-themed spell caster or a knife throwing/stabber physical attacker

It was one of the best classes in Season 5, and will be one of the best in Season 6 as well, since the changes will only affect the early game Surgical Blood Letting build The patch notes changes to Devout Doctor will make it useless early game, but way better mid-late game, so on this guide we are levelling as a poison caster, and it is good enough to do a full level 0-100 run in 3 hours

Pros(physical build): Very tanky due to %life passives, toxic flask buff, and life steal, gets huge movement speed from booster shot and randy rider, very high single target damage, can scale damage through vitality stacking, above average clear speed endgame, inbuilt 100% bleed chance, inbuilt teleport, does not have many buttons to press

Cons(physical build): Levelling with Surgical Blood Letting is unoptimal, physical gear is expensive, can feel weak before skill augments are unlocked, the flask teleport does not ignore walls, randy rider is disabled after getting hit once, capping resistances is rough with physical classes, Surgical Blood Letting ricochet can feel bad against shielded mobs

On this sheet you will find the following contents: • Levelling progression • How to transition into Surgical Blood Letting • Scaling into the endgame • Best in Slot items • And also a small guide on how to scale Poison Plague Doctor Navigate trough them by changing the pages below

Class guide announcement video: https://youtu.be/G5da8gCxG7Q

Level 0 - 100 in 3 hours full run: https://youtu.be/377FRVoGZEI S6 Day 1-2 SSF build update: https://youtu.be/xor3YXApiWU?si=ZAvqlOUvowlCihIG

S6 My first uber boss showcase: https://www.youtube.com/watch?v=ddLuIF3t6Aw

Final S6 update - Wormhole 100 completed on day 3: https://youtu.be/3Kna-dpD8f4 Endgame Physical Plague Doctor showcase: https://youtu.be/mnAg9raufJ4 Endgame Poison Plague Doctor showcase: https://youtu.be/2LEqTOyPBoY

Levelling progression

The best way to level a Plague Doctor is by being a poison caster archetype, using skills on the Plague Caller side of the skill tree Your damage here will scale through mainly Skill levels, Intelligence, Flat poison skill damage, Poison/Magic skill damage%, and ignoring enemy poison resistance, search for items with those stats

First thing you do after creating your Plague Doctor is setting up your loot filter Use the "Normal" filter preset (until Nightmare and hell of course), and highlight those stats on all items: All Skills | Poison Skills | Flat Poison Skill Damage | Intelligence per level | Faster cast rate After highlighting on all items, add those modifiers on the Charm highlight: Intelligence | Life | Life% | Mana | Life/Mana after each kill | Arcane/Poison/Fire/Lightning/Cold/All resistance |

Faster cast rate | Magic Skill Damage | Cooldown Recovery

Find the filter highlight on the FAQ on previous page

The attribute points distribution is a personal choice, after my main skill gets to level 20 i like having at least 300 mana, so i put points into Energy until 300 mana, i put points into Intelligence until the weakest mobs die on a single cast, all other points go into Vitality

If you're playing on Hardcore, all points go in Vitality

Tip: When changing equipment, ALWAYS look at your damage tooltip (hover your mouse over your skill), be careful to not reduce your damage

Tip: Each 5 levels you gain a specialization point to use on your skills Here is how you level them before Level 60 Crematus: 5/5 Gas Cylinder Plague master: 5/5 Plague Domain -> 5/5 Toxology Plague of Rats: 5/5 Horde of Rats Jar of Leeches: 5/5 Leech Swarm -> 5/5 Power Sucktion

Tip: DON'T spend your gold improving the poison build, it is strong enough to progress through all Hell 1 with self found items, save the investments for the Surgical blood letting transition

Tip: If you find relics for the Surgical Blood Letting build, grab them (check FAQ)

Level 1 - 8: Put all your points into Crematus

Level 8 - 16: Here you start using two skill trees, one for zone clear and the other for act bosses and bloating mobs

Tree #1 - Zone clear

Tree #2 - Act bosses and bloatings

All points into Crematus

All points into Plague of Rats

Level 16 - 24: Tree #1 - Zone clear (Do a respec)

Tree #2 - Act bosses and bloatings

Max Plague Master (20 points) [Careful since it uses a lot of mana (get at least 300 mana)]

Max plague of Plague of Rats (20 points) 1 point on Toxic Flask | Oops | Life Blood aura | Crow Mask's Presence

4 points into Exploding Mice

Level 24 - 30: Tree #1 - Zone clear

Tree #2 - Act bosses and bloatings (Do a respec)

6 points into Chant of Weakness

Max Jar of Leeches (20 points)

10 points into Plague of Rats

Level 31 - 60: Tree #1 - Zone clear

Tree #2 - Act bosses and bloatings

Max Chant of Weakness (20 points)

1 point in Randy the Rancid Rat, unlock Expansive plague mind, so you can poison bosses and get Chant of Weakness boost

17 points into Toxic Flask

1 point in Life blood aura | Crow Mask's Presence

On level 35 unlock the Toxic Flask teleport specialization (Flask Flip)

Max Chant of Weakness (20 points)

17 points in Plague of Rats

Level 60:

Now you'll use only one tree for both bossing and zone clear, respec

Important: After reaching Hell 1 and getting level 100, change your filter highlights, start thinking about the Surgical Blood Letting transition

Then highlight those on charms: Life | Life% | Life/Mana stolen per hit | Arcane/Poison/Fire/Lightning/Cold/All resistance

Find the filter highlight on the FAQ on previous page

Crematus will be the main damage dealer, Toxic Flask will apply plague, poison break, and deal with enemies on tight dungeons, Rat is a movement speed buff

Screenshots of specialization trees on lv 60 below:

Level 100 build:

Get those hero level points

Hopefully at this point you're above level 100, progressing through Hell 1 with your poison plague doctor, using self found gear, make sure to change your filter highlight after reaching hell 1 like i said on previous page

Its time to invest into the Surgical Blood Letting transition, which is weak during leveling, but insanely strong after you get enough equipment Surgical Blood Letting is a completely different build archetype, which is a physical attacker, with built-in Vitality damage scaling through a specialization node Physical attacks can miss enemies, crit, steal HP and mana, proc deadly and crushing blow, so you gotta invest into some of those stats while also having a weapon with good base damage and attack speed Here is how a physical skill works, it all starts with the Base Damage: When you use a physical skill, the Base Damage is multiplied by the Skill damage: The skill damage dealt can be further increased by other multipliers: Deadly Blow, multiplies your damage dealt by 1.5x Critical Strike, multiplies your damage dealt according to your critical strike damage%, starts at 25% = 1.25x Armor Break, applied mainly through Crushing Blow, can be stack up to 5 times, each stack breaks enemy armor by 10%, for a total of 50%, multipling your damage dealt by 1.5x Additive elemental damage can increase your damage as well but without getting any multiplier bonus And finally the strongest affix in the game, Extra damage to bleeding/burning/poisoned, it multiplies the final damage dealt The final damage dealt formula is the following: Other very important stats are attack speed and hit chance (affected by attack rating and enemy defence), both being a direct multiplier that affects your final damage The passive Devout Doctor went through a big change in season 6, along with additive physical damage, so i'm taking a moment to explain how it works now

As i said before, Additive physical damage in Season 6 will be affected by all multipliers that are applied into weapon base damage, the only exception being Enhanced Damage% Devout Doctor is a passive that makes you gain additive physical damage based on your Life, but by looking at the newest numbers, it does not look like its worth giving it more than ~20 levels (with ward of blood or komodo's belt), so we are just using 2H weapons for now

On Endgame, after you start getting +all skills levels, leaving Devout Doctor on level ~25 can be worth it on some cases, the leftover points would go into either Malpractice (Damage) or Lifeblood aura (Health) What this means is that increasing your Life is now a decent way to increase your damage, keep that in mind when gearing, charms with flat or percentage life are a very good way to get life early on

I will make a list of good items that you can use to make the transition smooth, and some stat requirements you must meet within your gear set, i'm listing multiple items to avoid the market getting scuffed Tip: For runeword weapons, you must find a good base, that has either enhanced damage or attack speed Weapon: Aurora's Might runeword (2H Sword) | Ravager runeword (2H Sword) | Skysong runeword (2H Sword) | Malice runeword (2H Sword) | F4 - Tactical Rifle | Molten Hammer (Rendguard of carnage shield) | Wind's Force Armor: Fortress runeword | Heaven's Might | Gladiator's Demise | Cocoon of the Berserker Helmet: Chimera runeword | Flesh Ripper runeword | Tenebris' Greviance | Mask of the Beyond | Pit Lord's Vanquisher | Knight Captain's Helmet | Butcher's Hood | The Faceless Priest | The Colossal Avenger Gloves: Siege Breakers | Anubis' Mighty Hands | Razor Knuckles | Mythic Gloves (Enhanced damage / Str or Vit per level / Crit chance or damage) Boots: Sonicstep runeword | Hermes boots | Blood-Letter's Plated Boots | Battle Worn boots Belt: Brutes cord | Sun Wukong's Belt | Tribal Belt | Commander's Sash | Monkeyskin belt | Vagabond's Strap | Warbosses Trophy belt | Combat Duty Belt Amulet: Ravens Claw | Traveler's Compass | Elder's Heart Ring1: Demon eye ring Ring2: Ring of the cow raven | Elven's Grace | Dragonsteel ring | Satanic eye Charm: Anubis Ankh | Raider's Torch | Adventurer's Quiver | Doctor's Mask in a Jar (got buffed) | Traveler's Map Journal | Cap resistances with other slots Relics: Twin Blade | Razer Blade | Nunchunks | Amputation Kit Stat distribution: All points into Vitality Mercenary: In S6 Attack speed value will overall increase since the softcap is removed, and almost every attack speed source is lower, with that in mind we are using the Ranged mercenary found in act 3 during progression for the big attack speed buff, eventually you can swap for the Act 1 merc with the new MF gear if you want to (Death's Mirror, The Bucket, Leprechaun's Greed, Babylon's Fall) Early-Mid game Merc gear suggestions: Weapon (mandatory): Valkyrie as a 1-handed Throwing runeword (+All skills base if possible) | Used for fanaticism aura Shield: Gem Encrusted Tower | Makes your merc very tanky while giving 6 sockets to place runes such as Ist (Magic Find) Armor: Mystique Allure | Magic Find armor, untouched in patch notes Helmet: Delirium Tremens (+All skills base if possible) | Used to give a LOT of skill levels so you get more attack speed from the buff, also gives mana stolen per hit, sustaining the merc's mana

Before swapping out of Poison build, make sure your new equipment will meet those requirements: Stat checklist before swapping: Around 1200 attack rating

30% ignore defence (Eth runes or Clean cut jewel on free sockets) With those attack rating and ignore defence stats you will get 100% hit rate on most hell 3 monsters > 10% Crushing Blow

>a sum of > 50% of either Deadly Blow or Critical Strike chance

30% all resistances on H1 (optional) > 4% Life/Mana stolen per Hit Weapon base damage > 525

100% Enhanced damage on equipment (excluding weapons) > 100% increased attack speed

Look on the listed items whatever fits the best to meet those requirements, and you should be able to farm Hell 3+ Skill trees below: (only one for both clear and bossing while progressing to endgame) There is a argument about using Blood Thaumaturgist as a bossing augment, but you gotta hit all 4 shots to out-dps Surgeon Vortex, which is pretty hard to do on most boss fights where you have to keep a distance, so i prefer using Surgeon's Vortex for most bosses, even with the nerfs, the only exception might be Possessed Luna

On the next sheet page i posted two alternative Surgical Blood Letting sub skill trees that you can use to clear faster, just keep in mind that you're gonna lose some damage Surgical blood letting as the main damage dealer, Toxic Flask for teleport and a very strong buff, Defunct Surgeon for a attack speed buff, Randy the rancid rat for movement speed buff

Skill trees:

Hero level tree:

At this point you've successfully transitioned into Surgical Blood Letting, farming H1-H3 satanic zones, or even early H5 acts

Now you gotta start looking into endgame items to start progressing into H5 Ubers

Once again i will list some good items that can end up on a set capable of doing all content, while not being too crazy expensive, but now you gotta choose between three options to scale your character, all options are good, #1 and #2 might require higher investment to stand out

Armor augment (Angelic Keys):

• Damage options: Lethal Tempo / Rupturing Strike if using Shadowfury

• Zone clear option: Apparently Divine Piercing augment makes Surgon Vortex blade not disappear, greatly improving map clear, its a very good option as well for damage due to the armor break https://www.youtube.com/watch?v=e2nQMRA4AL8

#1 - Life Stacking (Very tanky, but lower damage) | Items here are used to raise your life, so you get more additive physical damage with Devout Doctor

Weapon: Sidewinder/Candy Shredder/Blood Moon Crescent/Any 1H-Angelic weapon with more than 700 base damage/Feral runeword (1.75 attack speed base with +60% attack speed)

Ring1: Emblem of the Daemon (need to guarantee burn on enemies through high additive fire damage -> Molten Paw weapon swap)

Potions: Protein Shake | Bottle of Sake | Empty bottle of Vodka | Caffeinated Coffe Container

#2 - Traditional Physical build (Highest damage potential, but expensive, needs crit charms) | Items here are used to support your high base weapon damage

attack speed base with +60% attack speed)/Blood Moon Crescent/Any 1H-Angelic weapon with more than 700 base damage (Rendguard of Carnage or Demon's Mirror shield) | Any 2HAngelic weapon with more than 1000 base damage Helmet: Legionnaire (crit damage/all skills base if possible) Armor: Executioner's Cocoon | +4/5 all skills Fortress | Sheep King's Hide Gloves: Brawler's Fightning Mitts | Siege Breakers | 2-mod Mythic/Rare Gloves (Extra damage to bleeding/burning | Str/Vit per level | Crit strike damage | Crit strike chance | Enhanced Damage) Boots: Crushfleet (crit damage base if possible) Belt: Belt of Skulls | 2-mod Mythic/Rare Belt (Str/Vit per level | Crit strike damage | Crit strike chance) | Girdle of Eternal War Amulet: Gryphon's Claw | 2-mod Mythic Amulet (+All skills (Plague) | Str/Vit per level | Enhanced Damage | Crit strike damage | Crit strike chance) | Steve's Amulet (with Steve's charm)

Ring1: Emblem of the Daemon (need to guarantee burn on enemies through high additive fire damage -> Molten Paw weapon swap)

Ring Charm: Torch of Shadows | Hello Its me Steve | Traveler's Map journal | Crit chance/damage and resistance charms | Tablet of Awakening if you need to cap deadly blow

Potions: Protein Shake | Bottle of Sake | Empty bottle of Vodka | Caffeinated Coffe Container

#3: Best in Slot Weapon: Damien's Corrupted Head (Extra damage to poisoned roll) Shield: Bubonic Plague's Pledge runeword (+5 all skills base) Armor: Grand Arch Wizard's Mantle Helmet: Sight of the Gods (Mobility) | High Roller's Deathcrown +777 or Gabriel's Dauntless Vision (Damage) Gloves: St Ahto's Diamond Hands Boots: Grimwalkers runeword (50% magic skill damage / +5 poison skills base if possible) Belt: El Patrón's Madness Amulet: Pendant of Eternity / 4-mod Mythic Amulet (+5 all skills Plague Doctor | Faster cast rate | Magic skill damage | +50 Intelligence) Rings: St Aaron's Eternal Rage Potions: Empty bottle of vodka | Ghostly Potion | Wizard Potion | Caffeinated Coffee Container (burn enemies by using Molten Paw's skill and letting your merc land autoattacks) Charms: 3x 3 slot charms (+5 All Skills (Plague Doctor)) | 8x 1 slot charms (flat poison skill damage) | Rotten Pumpkin | Chaos Gemstone (Extra damage to poisoned) | Torch of Shadows | Annihilator | Aimbot.exe (works for flask auto-aim, bad for teleport) | Sassy's Dislocated Foot

Skill trees:

Screenshots of specialization trees on lv 60 below:

Level 100 build:

Get those hero level points

Before swapping out of Poison build, make sure your new equipment will meet those requirements: Stat checklist before swapping: Around 1200 attack rating

30% ignore defence (Eth runes or Clean cut jewel on free sockets) With those attack rating and ignore defence stats you will get 100% hit rate on most hell 3 monsters > 10% Crushing Blow

a sum of > 50% of either Deadly Blow or Critical Strike chance

30% all resistances on H1 (optional) > 4% Life/Mana stolen per Hit

Weapon base damage > 525

100% Enhanced damage on equipment (excluding weapons) > 100% increased attack speed

Set #1: Wormhole push

Weapon: St. Soloyolo's Holy Bow (~2% more dps than Glock 22+Pit Ravager's, very small difference) Helmet: High roller's Deathcrown (+777) | Legionnaire (+5 all skills or 50% crit damage base) Armor: Tayrel's Chestplate Gloves: Rimskin Assassins Boots: Violence (+50% crit damage base) Belt: Girdle of Eternal War -> El Patrón's Madness Amulet: Steve's Necklace Rings: 1x Emblem of the Daemon (need to guarantee burn on enemies through high additive fire damage -> Molten Paw weapon swap)

1x Azazel's Despair (Anubis Soulgem)

Set #2: Speed farming

Weapon/Shield: Glock 22 + Pit Ravager's Cetratus Helmet: High roller's Deathcrown (+777) | Legionnaire (+5 all skills or 50% crit damage base) Armor: Tayrel's Chestplate Gloves: Rimskin Assassins Boots: Crushfleet due to higher movement speed with its passive (+50% crit damage base) Belt: +4 Liquor Holster Amulet: Steve's Necklace Rings: 1x Emblem of the Daemon (need to guarantee burn on enemies through high additive fire damage -> Molten Paw weapon swap)

1x Azazel's Despair (Anubis Soulgem)

Make sure to get 100% deadly blow with free sockets

Due to some requests, i'm including a quick guide on how to scale the poison caster Plague Doctor into the endgame, for those that will choose to not transition into the physical build, this build is also very strong, having few advantages over the physical build, especially for those who are playing trade, because poison caster items have a very low demand

Main stats to focus on your gear to increase damage: Skill levels, Flat poison skill damage, Intelligence, Magic/Poison skill damage%, Faster cast rate%, Ignore poison resistance%, Extra damage to poisoned enemies%

Ignore poison resistance% caps at 100%, it is very important to cap this stat Extra damage to poisoned enemies is the strongest stat, get as much as possible Life/Mana on kill are good sources of sustain while clearing zones Relics: Holy Bible | Magic Mushroom | Lost Wand | The Holy Grail for passive regen (flexible slot, if you need all resistances - Triforce, if you need health - Mayo's old sock) Augment: Spellslinger - Better for toxic flask (Single target dps), also increases your faster cast rate for teleport

Infinity - Better for crematus (Zone clear dps)

Listing below two different item list sets, one meant for H1 progression, and the other for H5 farming

#1: Early H1-H3

Armor: Toxicarcus runeword | Scourge Gladiator's Armor | Grandwizard's Robe | Lichbane | Exiled Pagan's Mantle

Boots: Hermes boots | Voodoo Stompers | Grand Wizard's Silk Shoes

Early -> Late game Act 1 Merc items suggestions (the idea here is mainly supporting resistances with Aurora's Might paired with MF items):

Weapon: Aurora's Might runeword (1H Mace/Sword) -> Death's Mirror Shield: Gem Encrusted Tower (6x Ist) -> Leprechaun's Greed Armor: Mystique Allure (2x Ist) -> Babylon's Fall runeword Helmet: Harlequinn's Crest (2x Ist) -> The Bucket

#2: H5 Farming

Weapon: Grief runeword (+5 all skills base if possible) | Doctor's Potion | Divinity Runeword (+5 all skills base if possible) | Steve's Wand of Fortune (with the complete Steve's set) | Serpent's Tooth

Shield: Bubonic Plague's Pledge runeword (+5 all skills base if possible)

Armor: Gem King's Garb (6x Pristine Emeralds) Helmet: Sight of the Gods Gloves: Plague Bringer's Touch Boots: Etherwalk runeword (50% magic skill damage / +5 poison skills base if possible) Belt: Tether of Anguish | Girdle of Eternal War (+3 Poison) Amulet: Philosopher's Stone | Amulet of Colosseum | Pendant of Eternity | Steve's Necklace (with Steve's Charm) Rings: Soulforged Ring | Signet of Corruption | Azazel's Despair (Damien gem) | Mythic ring (+Poison skills) Potions: Empty bottle of vodka | Ghostly Potion | Wizard Potion Charms: Doctor's Mask in a Jar | Hello its me Steve | Rotten Pumpkin | Torch of Shadows | Fulgurite | Tablet of Awakening | Apple of Evolution if you need -enemy res | Annihilator | Good mods for normal charms: Magic skill damage, resistances, life, flat poison skill damage, faster cast rate

#3: Best in Slot

Weapon: Damien's Corrupted Head (Extra damage to poisoned roll) Shield: Bubonic Plague's Pledge runeword (+5 all skills base) Armor: Grand Arch Wizard's Mantle Helmet: Sight of the Gods (Mobility) | High Roller's Deathcrown +777 or Gabriel's Dauntless Vision (Damage) Gloves: St Ahto's Diamond Hands Boots: Grimwalkers runeword (50% magic skill damage / +5 poison skills base if possible) Belt: El Patrón's Madness Amulet: Pendant of Eternity / 4-mod Mythic Amulet (+5 all skills Plague Doctor | Faster cast rate | Magic skill damage | +50 Intelligence) Rings: St Aaron's Eternal Rage Potions: Empty bottle of vodka | Ghostly Potion | Wizard Potion | Caffeinated Coffee Container (burn enemies by using Molten Paw's skill and letting your merc land autoattacks) Charms: 3x 3 slot charms (+5 All Skills (Plague Doctor)) | 8x 1 slot charms (flat poison skill damage) | Rotten Pumpkin | Chaos Gemstone (Extra damage to poisoned) | Torch of Shadows | Annihilator | Aimbot.exe (works for flask auto-aim, bad for teleport) | Sassy's Dislocated Foot

Skill trees:

Screenshots of specialization trees on lv 60 below:

Hero level tree:

[image blocks and references omitted for brevity; see source document for the full visual references]

Level 100 build:

Get those hero level points

Before swapping out of Poison build, make sure your new equipment will meet those requirements: Stat checklist before swapping: Around 1200 attack rating

30% ignore defence (Eth runes or Clean cut jewel on free sockets) With those attack rating and ignore defence stats you will get 100% hit rate on most hell 3 monsters > 10% Crushing Blow

a sum of > 50% of either Deadly Blow or Critical Strike chance

30% all resistances on H1 (optional) > 4% Life/Mana stolen per Hit

Weapon base damage > 525

100% Enhanced damage on equipment (excluding weapons) > 100% increased attack speed

Set #1: Wormhole push

1x Azazel's Despair (Anubis Soulgem)

Set #2: Speed farming

1x Azazel's Despair (Anubis Soulgem)

Make sure to get 100% deadly blow with free sockets

Endgame Poison Plague Doctor guide: This poison-caster endgame path emphasizes maximizing Skill levels, Flat poison damage, Intelligence, and magic/poison damage%, while leveraging Faster cast rate, Ignore poison resistance, and Extra damage to poisoned enemies. Relics such as Holy Bible, Magic Mushroom, Lost Wand, and The Holy Grail provide passive regen, with flexible slots like Triforce or Mayo's Old Sock for resistances or health respectively. Augment choices like Spellslinger and Infinity bolster toxic flask DPS and crematus zone-clearing performance respectively

Endgame poison caster progression (summary)

Early H1-H3: Gear and stat focus on poison damage, skill levels, and magic/poison damage modifiers.
H5 farming: Move to more specialized items with +All Skills, +Poison skills, and faster cast rate; push into Wormhole and high-damage augments.
Endgame: Transition into Surgical Blood Letting only after strong self-found gear; maximize life-based additive physical damage from Devout Doctor, while keeping Crematus as main damage dealer in poison tree.

Endgame progression

The endgame scaling centers on transitioning to Surgical Blood Letting for a physical damage-based archetype, while maintaining poison caster DPS in zones where it shines. The guide recommends two primary endgame paths:

Path A: Life stacking (tankier, lower raw damage, high survivability)
Path B: Traditional physical build (highest raw DPS, high gear cost)

Both paths require careful gear selection: weapon base damage, attack speed, crit, and +All Skills (Plague) are all crucial multipliers. You should also manage resistances, life/mana on hit, and source mods like Enhanced Damage and Attack Speed. Advanced gearing notes include ensuring 100% hit chance at Hell 3+, 10% Crushing Blow, and enough Deadly/Crirical Strike to sustain through endgame content

Important: After you reach Hell 1 and level ~100, finalize your filters to reflect Surgical Blood Letting transition, then focus on skills, intel, vitality, and gear that support your chosen endgame path

Surgical Blood Letting specialization trees

Screenshots of specialization trees for level 60 and level 100 builds are included in the document. Two main sub-trees are presented:

Sub-tree A (Zone farming emphasis)
Sub-tree B (Bossing and speed farming emphasis)

Notes:

Surgeries scale with Life and skill levels; benefits include built-in vitality scaling and HP/damage sustain
In endgame, a 4-shots-per-clip approach with surgeon-based DPS and Viabilities is used

Best-in-slot items and gearing strategy

This section lists multiple BIS sets across weapon, shield, armor, helmet, gloves, boots, belt, amulet, rings, and charms, plus relics for the Surgical Blood Letting transition. Emphasis on:

High base damage and attack speed for 2H weapon builds
Added life-based additive physical damage through Devout Doctor
High life, high resistances, and reliable lifesteal
Relics for passive regen and life sustain: Twin Blade, Razer Blade, Nunchunks, Amputation Kit, Triforce, Mayo's Old Sock, etc.

The guide also provides a detailed distribution plan for stat points and an optional mercenary path for early/mid game at S6 patch. It suggests using the Ranged mercenary from Act 3 for big attack-speed buffs, with later swap options to MF-optimized setups from Act 1 if desired

Poison Plague Doctor endgame guide

This subsection focuses on scaling your poison caster into the endgame without transitioning to surgical blood letting. It highlights main stat priorities: Skill levels, Flat poison skill damage, Intelligence, Magic/Poison skill damage%, Faster cast rate%, Ignore poison resistance%, and Extra damage to poisoned enemies. It notes that Ignore poison resistance% caps at 100% and emphasizes the importance of Life/Mana on kill for sustain. Relics are listed and augment options like Spellslinger and Infinity are discussed for DPS improvements

Two item-sets are outlined for H1-H3 progression and for H5 farming:

Early H1-H3 (Cobra Blood Vial, Skysong runeword, Toxicarcus, etc.) with Merc items guidance
H5 farming (Grief runeword, Divinity Runeword, Steve's Wand, Serpent's Tooth, etc.)

Setups, mercenaries, and early-mid game tips

Mercenary selection and gearing: Valkyrie for 1H throwing runeword, shield options for tankiness and MF, Mystique Allure for MF, and Delirium Tremens for skill levels to boost attack speed and mana sustain
Early/mid-game recommendations are oriented toward achieving 1200+ attack rating and 30% ignore defense with hits and a plan for 10% Crushing Blow and 50%+ Deadly/Crirical strike probability
The guide emphasizes that you should not over-invest in poisonous gear early; save gold for Surgical Blood Letting transition

Two alternative Surgical Blood Letting trees for faster farming

This section provides two additional specialization trees for faster zone farming: Wormhole push and Speed farming setups. Each tree emphasizes a different mix of nodes and skill synergies to optimize farming speed and map clearing efficiency. Both sets show skill point allocations and macro structures for quick reference

Poison caster endgame item sets (early H1-H3, then H5 farming)

Continuation of BIS item guides for poison caster endgame, including weapon, shield, armor, helmet, gloves, boots, belt, amulet, rings, potions, and charms. It emphasizes the best mods for poison-caster DPS and survivability, and discusses how to balance life/mana on hit with sustain and kill speed

Two-branch endgame DPS expectations and testing tips

This part outlines the expected DPS milestones, including a 1.7b DPS meter target on Astral Encampment dummies for AOE fights, with calculations illustrating hit rates, lifesteal, and survivability thresholds. It also provides testing tips for hitting the hardest bosses and ensuring proper resist cap and life pools before entering inferno mode

Screenshots and visual references

The document contains several image blocks showing specialization trees, hero level trees, and endgame visuals. See the image references in the source file for exact visuals:

Level 60 specialization trees (three variants)
Hero level tree image
Endgame display visuals (DPS tests and boss references)

FAQ

Relics? Physical - Twin Blade | Razer Blade | Nunchunks | Amputation Kit (flexible slot, if you need all resistances - Triforce, if you need health - Mayo's old sock) Physical (no crit) - Magic Mushroom | Mayo's Old Sock | Commander's Sword | Spirit Skull/Amputation Kit/Triforce Poison - Holy Bible | Magic Mushroom | Lost Wand | The Holy Grail for passive regen (flexible slot, if you need all resistances - Triforce, if you need health - Mayo's old sock) • Armor augment? (Angelic Keys) - Damage options: Lethal Tempo / Rupturing Strike if using Shadowfury

Zone clear option: Apparently Divine Piercing augment makes Surgon Vortex blade not disappear, greatly improving map clear, its a very good option as well for damage due to the armor break https://www.youtube.com/watch?v=e2nQMRA4AL8
What to do with hero levels? - Find hero level skill trees at Leveling progression page (Poison build) and Surgical Blood Letting transition page (physical build)
What to do with free sockets? - Depends on what you need:
Need deadly blow? (must get it to 100%)
Missing hits on enemies? Eth/Clean cut jewel
Need Life stolen%? Pristine skull
Need Mana stolen%? Vex rune
Need more damage? 1 angelic gem per item; Elemental gem (biggest damage boost) or Jah (balanced option for both survivability and damage) on other slots
On weapons you either use Enhanced damage (Old runes) or Attack speed (Moonstone), i personally prefer attack speed
Infinity - Better for crematus (Zone clear dps)

Here are some two more Surgical Blood Letting specialization trees for faster zone farming:

Set #1: Wormhole push
Set #2: Speed farming

Screenshots of level 60 trees and DPS graphs are included in the original file for reference.

Plague Doctor Season 6 Guide: Poison Caster Build - Complete

Introduction
Levelling progression
How to transition into Surgical Blood Letting
Leveling progression details
Endgame progression
Surgical Blood Letting specialization trees
Best-in-slot items and gearing strategy
Poison Plague Doctor endgame guide
Setups, mercenaries, and early-mid game tips
Two alternative Surgical Blood Letting trees for faster farming
Poison caster endgame item sets (early H1-H3, then H5 farming)
Two-branch endgame DPS expectations and testing tips
Screenshots and visual references
FAQs