Plague Doctor guide for Season 8
Table of Contents
- Overview
- What changed in Season 8
- FAQ and Loot filters
- Leveling progression
- Midgame progression
- Transitioning into the Physical build
- Endgame scaling
- Best in Slot items
- Best in Slot item sets
- Charm layout
---
Overview
Welcome to my comprehensive Season 8 Plague Doctor guide. This document covers the physical attacker archetype, with notes on the poison caster build for early-mid progression and the recommended transition to a pure physical build once you acquire a strong weapon and an angelic key armor augment. The guide is updated for Season 8 and reflects community insights from the #plague-doctor-discussion channel in Hero Siege's Discord.
The Plague Doctor is a DLC class in Hero Siege, offering two main playstyles: a poison-themed spell caster and a knife throwing/stabber-based physical attacker. The guide explains the advantages and drawbacks of both paths, and provides a structured plan to level efficiently, gear up, and transition to the endgame.
Physical build pros: Very tanky due to %life passives, toxic flask buff, and life steal; high movement speed from booster shot and Randy Rider; strong all-rounder with good single-target damage and clear speed; scales with vitality stacking; simple button usage with consistent damage output.
Physical build cons: Leveling with physical build can feel slow; requires investing in gear to swap; challenging capping resistances and higher-cost gear on trade.
Poison build pros: Strong season starter; effective after unlocking sub-skill augments; excellent boss killer; decent movement from Randy Rider; can use teleport gear; easier capping of resistances; tanky due to %life passives, toxic flask, and HP recovery from Jar of Leeches; poison gear tends to be cheaper on trade.
Poison build cons: More buttons to press than the physical build; mana potions needed against bosses; Crematus uptime is critical for maximum damage; damage can feel inconsistent due to reliance on poison break and poison debuffs.
Conclusion: If you prefer fewer buttons and smoother gameplay, use the physical build. If you want a strong boss killer and don't mind pressing more buttons, use the poison build.
The guide outlines content for the physical build:
- What changed in Season 8
- FAQ and Loot filters
- Leveling and mid-game progression as a Poison caster
- How to transition into the Physical build
- Scaling into the endgame
- Best in Slot item sets (soon)
Navigate through these sections using the document pages on the left side.
Helpful content below:
- S8 Poison Plague Doctor guide video: https://youtu.be/RwDDIslB3es
- S8 Physical Plague Doctor guide video: https://youtu.be/WY2ch7zlB-c
- Level 0 - 100 full run in Season 8 open beta: https://youtu.be/mfjJNooYjdw
- S7 guide video: https://www.youtube.com/watch?v=JRZbSDT_q0g
- S7 - Day 3 wormhole 100 completed https://youtu.be/hnOxJ4_WbdM
- S7 - Unlocking Inferno (H5 Amun Ra + Gabriel fights) https://youtu.be/6Yvccf-K9z4
- Level 0 - 100 full run in Season 6: https://youtu.be/h-l02BSbnHA
- S6 - H5 Uber Reaper with no SS tier items (Poison build): https://youtu.be/vXsWtS9xDjI
- S6 - H5 Gabriel with no SS tier items (Poison build): https://youtu.be/1PgVct_2dZc
- S6 guide video: https://youtu.be/G5da8gCxG7Q
- 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 (S6 footage): https://youtu.be/mnAg9raufJ4
What changed in Season 8?
(Only covering big changes related to character power that affects mainly Plague Doctor’s physical build)
A small buff to the physical build.
Molten Paw swap is only useful now for bossing, since only the merc’s basic attacks will be able to burn.
A relevant nerf to the physical build, this Surgical Blood Letting proc is going from 100% to 60% vitality conversion, by doing some quick testing I estimate that to be a ~15% damage nerf on a well built character (with over 600 vitality), spending points on strength becomes much more viable now.
Even though it is a relevant nerf, the physical build will definitely be still very strong, especially if you consider scaling more strength instead of vitality, my recommendation now will be spending the attribute points as a 3:1 ratio of vitality to strength (300 vitality, 100 strength)
FAQ and Loot filters
FAQ - Frequently asked questions | Loot filters (highlight only)
What relics to use?
Relics changed a lot in S8, feel free to experiment with them, here is my personal choice looking at them:
Setup 1 - Meant to use with a shadow weapon for maximum damage (recommended to start)
- Skull Axe (Demon Form proc) | Death's Scythe (Agility proc) | Shiv (Live by the Sword Proc) | Commander’s Sword
- After you get Legionnaire helmet, feel free to replace Shiv with Rock Belt
Setup 2 - Meant to use with any weapon for maximum clear speed
- The Amputation Kit | Rock Belt | Death’s Scythe | Shiv
- After you get Legionnaire helmet, feel free to replace Shiv with Monkey King Bar
Setup 3 - Meant to use with a non-shadow weapon for maximum damage
- Skull Axe | Nunchucks | Twin Blade | Razer Blade
Setup 4 - Defensive setup
- Cheese Burger | Mayo’s Old Sock | Cookies & Milk | Skull Axe
What armor augment to choose? (Angelic Key)
Save up 6 angelic keys and go for Divine Piercing, it makes Surgeon Vortex blades not disappear, greatly improving map clear, it is not worth going past level 1 though, I'm almost sure that the armor break coming from it is irrelevant due to already having crushing blow.
Video showcasing the augment: https://www.youtube.com/watch?v=e2nQMRA4AL8
What to do on the Hero Level skill tree?
Find hero level skill trees at the Leveling progression page for the Poison leveling build, and Transition to physical page for the physical build.
What to do with free sockets? (Physical build)
Step 1 - On weapons you ALWAYS place Moonstone gems
Step 2 - Check if you have 100% Deadly Blow, if not, place Xo runes
Step 3 - Check is if you have more than 0% Life/Mana stolen per hit, if not, place a Pristine Skull/Vex rune
Step 4 - Place an angelic gem on every item, only exception are rainbow sockets
Step 5 - Check if your resistances are capped (75%), if not, place Um runes
Step 6 - Personal choice, if you need damage: Pristine Diamond; if you need survivability: Jah
How to distribute attribute points?
Attribute points are a personal choice for the poison build, I personally like to get Energy until 200 mana, then Intelligence until I can one shot trash mobs, rest goes into Vitality.
For the physical build you put 300 points into Vitality and 100 into Strength (3:1 ratio).
What mercenaries to choose?
- For poison build use the Act 1 mercenary (skill tree in Leveling progression page)
- For physical build use the Act 3 mercenary (skill tree in Physical build transition page)
What loot filters to use?
Loot filters got updated in S8. I made for now just a leveling one from closed beta, hopefully it works when the season releases, i highly recommend you read the entire guide and make one based on what the character needs, but below i will keep posting the filters i use during the season:
Poison leveling filter (Normal):
If this link is bugged on season release:
Highlight those stats on all items: All Skills | Poison Skills | Flat Poison Skill Damage | Intelligence per level | Faster cast rate | Magic Skill Damage.
After highlighting on all items, highlight those Charm modifiers: Intelligence | Life | Life% | Mana | Life/Mana after each kill | Arcane/Poison/Fire/Lightning/Cold/All resistance.
[Huge block of encoded data omitted for brevity in this summary]
How to distribute attribute points? (Poison and Physical builds described above)
Mercenary (Act 3 for physical, Act 1 for poison) and loot filter notes continue with a long list of options, including a large, detailed montage of rewards and gear for the endgame phase.
Level progression and skill trees are described as follows:
- Core skill tree: Sanguine Physician and Plague Caller paths with point distributions
- Crematus, Toxic Flask, Jar of Leeches, Plague of Rats, and Randy the Rancid Rat are all part of the core mechanics
- Alternative specs for Crematus are shown via screenshots
- Mercenary skills tree with suggestions for early-mid game gear
Hero Level skill tree (Charm slots):
- After unlocking two charm slots, remaining points are personal choice; you can go for attribute boosts or glyphs.
Trick to abuse Extra Damage to Burning affix from Coffee Container:
- Use Molten Paw on weapon swap, cast fire enchant, then swap back. The mercenary basic attacks will burn, allowing the use of Coffee Container for big damage.
Leveling progression
Leveling progression as Plague Doctor
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%, ignoring enemy poison resistance, and faster cast rate, so search for items with those stats.
The first thing you do after creating your Plague Doctor is setting up your loot filter.
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.
Find the filter link on the FAQ on the previous page. (it might not work since i made it on S8 beta)
The attribute points distribution is a personal choice, after my main skill gets to level 20 i like having at least 200 mana, so i put points into Energy until 200 mana, then 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: Keep an eye on Runewords while leveling, here are a few good ones: Skysong weapon/shield (4 sockets) | Divine contemplation shield (3 sockets) | Divinity (4 sockets 1Handed Mace) | Scholar helmet (2 socket) | Ghost boots (2 socket) | Toxicarcus armor (3 socket)
Tip: Each 5 levels you gain a specialization point to use on your skills
Here is how you use them before Level 40
- Crematus: 3/3 Gas Cylinder -> 1/3 Potent Exhaling
- Plague master: 5/5 Plague Domain -> 2/5 Toxology
- Jar of Leeches: 5/5 Leech Swarm -> 2/5 Power Sucktion
Level 1 - 24: Put all your points into Crematus until maxed, then other points into Toxic Flask
Level 24-39: Here you start using two skill trees, #1 for zone clear and #2 for act bosses and bloating mobs.
Tree #1 - Zone Clear Tree #2 - Act bosses + Bloatings
- 20 points into Plague Master [Careful since it uses a lot of mana (get at least 200 mana)]
- Other points into Chant of Weakness
- On level 35 unlock the Toxic Flask teleport specialization (Flask Flip)
- 20 points into Jar of Leeches
- Other points into Plague of Rats
Level 40 respec:
Here you unlock the specialization big nodes, only a single skill tree will be used for both zone clear and bossing.
The playstyle will be keeping Crematus 100% uptime to clear all the trash mobs while debuffing the tanky mobs with poisoned and poison break, Jar of Leeches is used as a main damage dealer against bosses and tanky mobs, Randy the Rancid Rat is used for a movement speed buff, and Toxic Flask is used for a small health and damage reduction buff, it is also used as a teleport.
Plague of Rats is an optional skill choice for bosses, with the Rat Den node you can keep enemies with a 25% higher poison break compared to Crematus poison break, giving you a slight damage boost.
- 20 points into Crematus
- 1 point into Toxic Flask
- 1 point into Oops
- 1 point into Plague of Rats
- 1 point into Exploding Mice
- 15 points into Jar of Leeches
- 1 point into Randy the Rancid Rat
Pictures of the specialization trees below:
Level 40-100:
Based on the level 40 respec tree above, do the instructions below in order from top to bottom and you will be fine until level 100:
- Max Jar of Leeches
- Max Chant of Weakness
- Max Crow Mask’s Presence
- 1 point into Lifeblood Aura
- With the 14 points you have left, there are two options, pick whatever you prefer:
- Put 14 points into Toxic Flask for more Crematus damage
- Put 14 points into Lifeblood Aura for more Health
Specialization tree priorities:
Crematus:
- 5/5 Trifurcate Blow
- 3/5 Corrosive Embers
- 2/3 Spiraling Cremation (Level 70)
- 5/5 Corrosive Embers
- 3/3 Gas Cylinder
- 2/3 Potent Exhaling
- 3/3 Spiraling Cremation (Level 100)
Toxic Flask:
- 5/5 Agile Tosser
- 1/5 One with the Poison
- 2/3 Vial of Alchemy (Level 70)
- 5/5 One with the Poison
- 3/5 Flask flip
- 3/3 Vial of Alchemy (Level 100)
Plague of Rats:
- 5/5 Leptospirosis
- 3/5 Plague Carriers
- 2/3 Rat Den (Level 70)
- 5/5 Plague Carriers
- 5/5 Horde of Rats
- 3/3 Rat Den (Level 100)
Jar of Leeches:
- 5/5 Leech Swarm
- 1/5 Blood Sharing
- 2/3 Lasting Hunger (Level 70)
- 5/5 Power Sucktion
- 2/5 Bloody Surprise
- 3/3 Lasting Hunger (Level 100)
Randy the Rancid Rat:
- 2/3 Randy Rider (Level 70)
- 3/3 Randy Rider (Level 100)
Level 40-100: Alternative spec images and notes
Use the screenshots below as a reference to how the build should look like at level 100.
- Alternative spec skill tree for Crematus (better on zones that you aren’t instakilling stuff))
- Hero Level skill tree:
2nd step is going all the way up and grabbing those
3rd step is either grabbing those points or going for the charm slots, personal and situational choice
Mercenary skill tree (Act 1): Use magic find items on him if possible
Midgame progression
Midgame progression with the Poison build
Just like before, the plan is still to farm enough poison gear to make it viable to kill H5 Uber Reaper on season start, so we acquire its Shadow weapons, which are in my opinion mandatory weapons to use now early on in the physical build.
Important: If you are starting the season late, shadow weapons become much cheaper, so you can bypass the usual grind and swap to physical much earlier. Find more information on the physical build transition page.
This section of the guide will be focused on gearing progression and important mechanics to consider when choosing the items.
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
- Life/Mana on kill are good sources of sustain while clearing zones
Find more in depth information about how spell damage is calculated on this site: https://hero-siege-helper.vercel.app/damage
Just like the previous guide, to avoid market manipulation I'm listing multiple viable options to choose, ALL OF THEM ARE GOOD, they are listed randomly, there is no distinction if one is better than the other if they are on the same tier, try to find good opportunities to spend less gold if you’re playing trade.
Everything is updated according to how the items look like in S8 open beta, but feel free to contact me if i missed something.
I'm listing all the good items to use as a tier list from B to S.
- B tier: Good to progress through all Hell 1 levels and possibly defeat H3 Mevius
- A tier: Probably good enough to defeat H5 Uber Reaper
- S tier: Items to use if you need a further damage boost, items here might be expensive
Remark 1: I’m only considering the impact of those items for damage.
Remark 2: I’m not listing mythic/rare items, but all of them can range from A to S tier if they have good affixes, here is a small list of them with the respective maximum rolls:
+5 all skills | +30% extra damage to poisoned | +50% faster cast rate
+50% magic skill damage | +50 intelligence per level | +5 poison skills
Item type | B Tier | A tier | S tier
---|---|---|---
Weapon | Cobra Blood Vial | Skysong runeword (1 handed) | Wormclaw
Sands of Time | Voodoo Magician's Skull | Brilliance runeword | Clafaxier
Doomweed Vial | Divinity runeword | Dragon Knight's Flail
Deathquill | Thron of Helheim | Damien's Head | Gods Benevolence
Virulence runeword | Clafaxier's Legacy | Pagan God's Blasphemy | Beacon of Shadows
Clafaxier’s Legacy | Serpent's Tooth | Oculus of Ages | Steve's Wand of Fortune
Grief runeword | Pagan God’s Blasphemy | Damien's Corrupted Head | Doctor's Mask in a Jar
Shadow Buckler | Iron Giants Shield | Battle Mage’s Shield | Spellbinder’s Magebarrier
Suomi Finland Suatana | Suomi Finland Perkele | Aztec Ward | Armor
Toxicarcus runeword | Shroud of Enigma runeword | Mystify runeword | Magister’s Robe
Hazmat Suit | Arcane Robes of Authority | Scourge Gladiator’s Armor | Grandwizard’s Robe
Heaven’s Might | Grimbone's Ribcage | Isarius Ironthorn Breastplate | Mystique Allure
Stoneplate of Corruption | Traveler's Leather Jacket | Gem King’s Garb (Pristine emerald) | Noxious Hunter’s Reward
Sheep King’s Hide | Venomsteel Carapace | Wraith’s Cloak (Poison) | Dragon Knight's Vanguard
Exiled Pagan’s Mantle | Helmet Chimera runeword | Harlequinn’s Crest | Crown of Midnight
The Curator of Secrets | Harlequinn’s Veil | Boots Paradox runeword | Ghost runeword
Hermes boots | Mana-woven walkers | Arch Wizard’s Silk Boots | Ninja tabi runeword
Marchers of Hatred | Adamant Roamers | Pearl Escapade | Voodoo Stompers
Grand Charms: +25% critical strike damage or +5 to all skills (Plague Doctor) or +100% enhanced damage | |
Rings | Satanic Eye | Swiftsoul Band | Soulforged Ring
Signet of Corruption | The Absence of Constraint | Crow’s Feather | Traveller’s Map Journal
Charm layout
Endgame scaling
Endgame Scaling
At this point you unlocked Inferno with the non-crit build, which is easy to scale to this point since you have fewer stats to manage, but as gear improves, scaling critical strikes becomes more favorable. This section explains how to transition from a non-crit Shadow weapon build to an endgame crit-based physical Plague Doctor.
Relics to look for (maximum damage): Skull Axe | Nunchucks | Twin Blade | Razer Blade
Note: After swapping to a +3 Reaper’s Culling weapon you lose a x3 multiplier to base damage, so you should aim to increase critical strike chance and critical strike damage beforehand.
I again provide multiple viable options, all good, without preference among items on the same tier.
Item tiers:
- B Tier: Items that aren’t very impactful but are decent
- A tier: Very good items
- S tier: Best in Slot contenders
Remark 1: I’m only considering the impact of those items for damage.
Remark 2: I’m not listing mythic/rare items, but all of them can range from A to S tier if they have good affixes, here is a small list of them with the respective maximum rolls:
+50 vitality/strength per level | +5 all skills | +75% attack damage
+30% extra damage to bleeding | +150% enhanced damage
Table: Item type B Tier A tier S tier
Weapon | Sidewinder | Monsoon | Grimbone’s Scythe
Shaubs | Glowstick Estoc | AK-47 | Pit Fighter’s Skullcracker
... (table continues with the long legacy of items listed in the source text)
Best in Slot items
From my testing, these are the best items to achieve the highest possible damage with physical Plague Doctor.
- Weapon: Feral (1.75 base attack speed with +30% increased attack speed)
- Shield: St. Tomi’s Vibrant Aura
- Helmet: Lucifer’s Crown (this item is completely insane)
- Armor: Tayrel's Chestplate
- Gloves: Rimskin Assassins
- Boots: Chaoswalkers
- Belt: El Patrón's Madness
- Amulet: Steve’s Necklace
- Rings: 2x Azazel's Despair (Anubis Soulgem)
- Charm setup: Overloaded Dice (+1 to Surgical Blood Letting), Earth Melon, Hello its me, Steve!, Soul Collector, Annihilator, Fulgurite, Torch of Shadows (+3 Plague Doctor), Gladiator’s Dice, Chaos Gemstone (with high critical strike damage or extra damage to bleeding)
- 2x Grand Charms: +25% critical strike damage or +5 to all skills (Plague Doctor) or +100% enhanced damage
Potions: Protein Shake | Bottle of Sake | Empty bottle of Vodka | Caffeinated Coffee Container (make sure to use molten paw swap)
Relics (QoL/balanced): Skull Axe | Shiv | Death’s Scythe | Jefre’s Subscription | Razer Blade |
Charm layout
Best in Slot item sets
From my testing, this is what i believe are the best items you can use to achieve the highest possible damage with physical Plague Doctor
Weapon: Feral (1.75 base attack speed with +30% increased attack speed)
Shield: St. Tomi’s Vibrant Aura
Helmet: Lucifer’s Crown (this item is completely insane)
Armor: Tayrel's Chestplate
Gloves: Rimskin Assassins
Boots: Chaoswalkers
Belt: El Patrón's Madness
Amulet: Steve’s Necklace
Rings: 2x Azazel's Despair (Anubis Soulgem)
Charm setup: Overloaded Dice (+1 to Surgical Blood Letting), Earth Melon, Hello its me, Steve!, Soul Collector, Annihilator, Fulgurite, Torch of Shadows (+3 Plague Doctor), Gladiator’s Dice, Chaos Gemstone (with high critical strike damage or extra damage to bleeding)
2x Grand Charms: +25% critical strike damage or +5 to all skills (Plague Doctor) or +100% enhanced damage
Potions: Protein Shake | Bottle of Sake | Empty bottle of Vodka | Caffeinated Coffee Container
Relics (QoL/balanced): Skull Axe | Shiv | Death’s Scythe | Jefre’s Subscription | Razer Blade
Charm layout
Charm layout
- earth melon
- overloaded dice
- hello its me steve
- annihilator
- fulgurite
- torch of shadows (+3 plague doctor)
- gladiator's dice
- chaos gemstone
- 2x grand charms: +25% critical strike damage or +5 to all skills (Plague Doctor) or +100% enhanced damage
- POTS: Protein Shake | Bottle of Sake | Empty Bottle of Vodka | Caffeinated Coffee Container
What changed in Season 8? (summary)
(Only covering big changes related to character power that affects mainly Plague Doctor’s physical build)
A small buff to the physical build. Molten Paw swap is only useful now for bossing, since only the merc’s basic attacks will be able to burn.
A relevant nerf to the physical build, this Surgical Blood Letting proc is going from 100% to 60% vitality conversion, by doing some quick testing I estimate that to be a ~15% damage nerf on a well built character (with over 600 vitality), spending points on strength becomes much more viable now.
Even though it is a relevant nerf, the physical build will definitely be still very strong, especially if you consider scaling more strength instead of vitality, my recommendation now will be spending the attribute points as a 3:1 ratio of vitality to strength (300 vitality, 100 strength)
1) FAQ and Loot filters
FAQ - Frequently asked questions | Loot filters (highlight only)
What relics to use?
Relics changed a lot in S8, feel free to experiment with them, here is my personal choice looking at them:
- Setup 1 - Meant to use with a shadow weapon for maximum damage (recommended to start)
Skull Axe (Demon Form proc) | Death's Scythe (Agility proc) | Shiv (Live by the Sword Proc) | Commander’s Sword
After you get Legionnaire helmet, feel free to replace Shiv with Rock Belt
- Setup 2 - Meant to use with any weapon for maximum clear speed
The Amputation Kit | Rock Belt | Death’s Scythe | Shiv
After you get Legionnaire helmet, feel free to replace Shiv with Monkey King Bar
- Setup 3 - Meant to use with a non-shadow weapon for maximum damage
Skull Axe | Nunchucks | Twin Blade | Razer Blade
- Setup 4 - Defensive setup
Cheese Burger | Mayo’s Old Sock | Cookies & Milk | Skull Axe
What armor augment to choose? (Angelic Key)
Save up 6 angelic keys and go for Divine Piercing, it makes Surgeon Vortex blades not disappear, greatly improving map clear, it is not worth going past level 1 though, I'm almost sure that the armor break coming from it is irrelevant due to already having crushing blow.
Video showcasing the augment: https://www.youtube.com/watch?v=e2nQMRA4AL8
What to do on the Hero Level skill tree?
Find hero level skill trees at the Leveling progression page for the Poison leveling build, and Transition to physical page for the physical build.
What to do with free sockets? (Physical build)
Step 1 - On weapons you ALWAYS place Moonstone gems
Step 2 - Check if you have 100% Deadly Blow, if not, place Xo runes
Step 3 - Check is if you have more than 0% Life/Mana stolen per hit, if not, place a Pristine Skull/Vex rune
Step 4 - Place an angelic gem on every item, only exception are rainbow sockets
Step 5 - Check if your resistances are capped (75%), if not, place Um runes
Step 6 - Personal choice, if you need damage: Pristine Diamond; if you need survivability: Jah
How to distribute attribute points?
Attribute points are a personal choice for the poison build, I personally like to get Energy until 200 mana, then Intelligence until I can one shot trash mobs, rest goes into Vitality.
For the physical build you put 300 points into Vitality and 100 into Strength (3:1 ratio).
What mercenaries to choose?
- Poison build: Act 1 mercenary (skill tree in Leveling progression page)
- Physical build: Act 3 mercenary (skill tree in Physical build transition page)
What loot filters to use?
Loot filters got updated in Season 8. I prepared a leveling filter from closed beta; read guide for customizing filters for your needs. The section includes encoded filter data blocks and instructions.
Leveling progression
Leveling progression as Plague Doctor
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%, ignoring enemy poison resistance, and faster cast rate, so search for items with those stats.
The first thing you do after creating your Plague Doctor is setting up your loot filter.
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.
Find the filter link on the FAQ on the previous page. (it might not work since i made it on S8 beta)
The attribute points distribution is a personal choice, after my main skill gets to level 20 i like having at least 200 mana, so i put points into Energy until 200 mana, then 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: Keep an eye on Runewords while leveling, here are a few good ones: Skysong weapon/shield (4 sockets) | Divine contemplation shield (3 sockets) | Divinity (4 sockets 1Handed Mace) | Scholar helmet (2 socket) | Ghost boots (2 socket) | Toxicarcus armor (3 socket)
Tip: Each 5 levels you gain a specialization point to use on your skills
Here is how you use them before Level 40
- Crematus: 3/3 Gas Cylinder -> 1/3 Potent Exhaling
- Plague master: 5/5 Plague Domain -> 2/5 Toxology
- Jar of Leeches: 5/5 Leech Swarm -> 2/5 Power Sucktion
Level 1 - 24: Put all your points into Crematus until maxed, then other points into Toxic Flask
Level 24-39: Here you start using two skill trees, #1 for zone clear and #2 for act bosses and bloating mobs.
Tree #1 - Zone Clear Tree #2 - Act bosses + Bloatings
- 20 points into Plague Master [Careful since it uses a lot of mana (get at least 200 mana)]
- Other points into Chant of Weakness
- On level 35 unlock the Toxic Flask teleport specialization (Flask Flip)
- 20 points into Jar of Leeches
- Other points into Plague of Rats
Level 40 respec:
Here you unlock the specialization big nodes, only a single skill tree will be used for both zone clear and bossing.
The playstyle will be keeping Crematus 100% uptime to clear all the trash mobs while debuffing the tanky mobs with poisoned and poison break, Jar of Leeches is used as a main damage dealer against bosses and tanky mobs, Randy the Rancid Rat is used for a movement speed buff, and Toxic Flask is used for a small health and damage reduction buff, it is also used as a teleport.
Plague of Rats is an optional skill choice for bosses, with the Rat Den node you can keep enemies with a 25% higher poison break compared to Crematus poison break, giving you a slight damage boost.
- 20 points into Crematus
- 1 point into Toxic Flask
- 1 point into Oops
- 1 point into Plague of Rats
- 1 point into Exploding Mice
- 15 points into Jar of Leeches
- 1 point into Randy the Rancid Rat
Pictures of the specialization trees below:
Level 40-100:
Based on the level 40 respec tree above, do the instructions below in order from top to bottom and you will be fine until level 100:
- Max Jar of Leeches
- Max Chant of Weakness
- Max Crow Mask’s Presence
- 1 point into Lifeblood Aura
- With the 14 points you have left, there are two options, pick whatever you prefer:
- Put 14 points into Toxic Flask for more Crematus damage
- Put 14 points into Lifeblood Aura for more Health
Specialization tree priorities:
Crematus:
- 5/5 Trifurcate Blow
- 3/5 Corrosive Embers
- 2/3 Spiraling Cremation (Level 70)
- 5/5 Corrosive Embers
- 3/3 Gas Cylinder
- 2/3 Potent Exhaling
- 3/3 Spiraling Cremation (Level 100)
Toxic Flask:
- 5/5 Agile Tosser
- 1/5 One with the Poison
- 2/3 Vial of Alchemy (Level 70)
- 5/5 One with the Poison
- 3/5 Flask flip
- 3/3 Vial of Alchemy (Level 100)
Plague of Rats:
- 5/5 Leptospirosis
- 3/5 Plague Carriers
- 2/3 Rat Den (Level 70)
- 5/5 Plague Carriers
- 5/5 Horde of Rats
- 3/3 Rat Den (Level 100)
Jar of Leeches:
- 5/5 Leech Swarm
- 1/5 Blood Sharing
- 2/3 Lasting Hunger (Level 70)
- 5/5 Power Sucktion
- 2/5 Bloody Surprise
- 3/3 Lasting Hunger (Level 100)
Randy the Rancid Rat:
- 2/3 Randy Rider (Level 70)
- 3/3 Randy Rider (Level 100)
Use the screenshots below as a reference to how the build should look like at level 100:
- Alternative spec skill tree for Crematus (better on zones that you aren’t instakilling stuff))
- Hero Level skill tree:
1st step is grabbing those
2nd step is going all the way up and grabbing those
3rd step is either grabbing those points or going for the charm slots, personal and situational
Mercenary skill tree (Act 1): Use magic find items on him if possible
Endgame Scaling
Endgame Scaling
At this point you unlocked Inferno with the non-crit build, which is very easy to scale to this point since you have less stats to care about, but as you start getting better gear, scaling critical strikes becomes the better option for damage, so this section of the guide will give more details on how to transition from a non-crit Shadow weapon build to a endgame crit-based physical Plague Doctor.
Relics to look for (maximum damage): Skull Axe | Nunchucks | Twin Blade | Razer Blade
Keep in mind after swapping out of a +3 Reaper’s Culling weapon, you will lose a x3 multiplier to your base damage, so i highly recommend to get more critical strike chance and critical strike multiplier than the table below before swapping to a critical strike build:
Critical strike chance and damage %
that are the equivalent to a +3 Reaper’s Culling weapon
- 95% -> 200%
- 90% -> 211%
- 80% -> 223%
- 70% -> 271%
- 60% -> 316%
- 50% -> 380%
- 40% -> 475%
- 30% -> 633%
Once again, to avoid market manipulation I'm listing multiple viable options to choose, ALL OF THEM ARE GOOD, they are listed randomly, there is no distinction if one is better than the other if they are on the same tier, try to find good opportunities to spend less gold if you’re playing trade.
Everything is updated according to how the items look like in S8 open beta, but feel free to contact me if i missed something.
I'm listing all the good items to use as a tier list from B to S.
- B tier: Items that aren’t very impactful but are decent
- A tier: Very good items
- S tier: Best in Slot contenders
Remark 1: I’m only considering the impact of those items for damage.
Remark 2: I’m not listing mythic/rare items, but all of them can range from A to S tier if they have good affixes, here is a small list of them with the respective maximum rolls:
+50 vitality/strength per level | +5 all skills | +75% attack damage
+30% extra damage to bleeding | +150% enhanced damage
Item type | B Tier | A tier | S tier
---|---|---|---
Weapon | Sidewinder | Monsoon | Grimbone’s Scythe
Glowstick Estoc | AK-47 | Pit Fighter’s Skullcracker | Stormslayer
The Hope Ender | Glock 22 | St. Amitiel’s Truth | St. Soloyolo’s Holy Bow
Feral runeword (+%attack speed) | Candy Shredder | Headsman’s Bloodthirster | Luci’s Day
Gurag's Stone Crusher | The Light of Dawn | St. Gabriel’s Retribution | St. Mika’s Zweihander
St. Draxis Longsaw | St. Draxis Pigstick | St. Rexis Sundering Axe | Aurelion Fury
Dracula's Demise | Deathquill | Vorpal Sharktooth | Rakhul’s Legion Crusher
Eden’s Harvester | base with 1.75 attacks per second | Eternity | Shield Tombstone
Defender’s Justice | Gladius’ Wall | Rendguard of Carnage | Demon’s Mirror
St. Hallgar’s Bloodforged Aegis | Pit Ravager’s Cetratus | St. Tomi’s Vibrant Aura | Armor
Chimera runeword | Legionnaire runeword | Harlequinn’s Veil | Harlequinn’s Veil
Nikita’s KJ-33 Helmet | Eternal Death | The Colossal Avenger | Helm of the Beyond
Boots Sonicstep runeword | Hermes boots | Blood-Letter’s Plated boots | Whisper Walker's Feiyue
Crushfleet runeword | Steampowered Flamewalkers | Violence runeword | Brute Roamers
Gloves Lifeward Gauntlets | Anubis’ Mighty Hands | Scuttle Crab Gauntlets | Razor Knuckles
Siege Breakers | Pit Fighter’s Bone Crushers | Brawler’s Fighting Mitts | Rimskin Assassins
St. Ahto’s Diamond Hands | St. Ahto’s Diamond Hands | St. Ahto’s Diamond Hands |
Belt Traveler’s Double Belt | Tundra Warrior’s Girdle | Cingulum of Shifting Destiny | Combat Duty Belt
Gladiator King’s Belt | Girdle of Eternal War | El Patrón’s Madness | Liquor Holster
Amulet Gambler’s Demise | Shining Pearl | Light Bringer’s Mark | All Seeing Eye
Compass of Wealth | Gurag's Pebble | High Demon’s Necklace | Traveler’s Compass
Pyramid Pendant | Rift Warrior's Skull | Eagle’s Claw | Philosopher’s Stone
Tarethiel’s Fall | Steve’s Necklace | Raven’s Claw | Steve’s Necklace
Rings Colossus circle of Vitality | Satanic Eye | Elven Grace | Soulforged Ring
Quickening Zephyr (Plague Doctor) | Soulforged Ring | All Seeing Eye | Soulforged Ring
Rift Warrior's Skull | Circle of Nature | Khodo’s Wedding Band | Iron Ring of Prometheus
Mark of Ferocity | Ring of Tallus | Stone of Premonition | Giant’s Band of Strength
Girdle of Eternal War | Ring of Tallus | |
Giant’s Band of Strength | | |
Azazel’s Despair (Anubis) | Destroyer’s End | Fury of Tarethiel |
Charm layout | | |
Best in Slot items sets: From my testing, these are the best items you can use to maximize damage with physical Plague Doctor. The page lists a final recommended equipment set including Weapon, Shield, Helmet, Armor, Gloves, Boots, Belt, Amulet, Rings, and a final Charm layout. A practical guide for players chasing high DPS, with a Molten Paw swap used to maximize Burning affix synergy with Coffee Container.
Charm layout:
- earth melon
- overloaded dice
- hello its me steve
- annihilator
- fulgure
- torch of shadows (+3 plague doctor)
- gladiator’s dice
- chaos gemstone
- grand charms: +25% critical strike damage or +5 to all skills or +100% enhanced damage
- two Grand Charms of choice
- potions: Protein Shake | Bottle of Sake | Empty Bottle of Vodka | Caffeinated Coffee Container
Best in Slot item sets (visual references)
- Weapon: Feral
- Shield: St. Tomi’s Vibrant Aura
- Helmet: Lucifer’s Crown
- Armor: Tayrel's Chestplate
- Gloves: Rimskin Assassins
- Boots: Chaoswalkers
- Belt: El Patrón's Madness
- Amulet: Steve’s Necklace
- Rings: 2x Azazel's Despair
- Charm setup: Overloaded Dice, Earth Melon, Hello Its Me Steve, Soul Collector, Annihilator, Fulgurite, Torch of Shadows, Gladiator's Dice, Chaos Gemstone, Grand Charms
- Potions: Protein Shake, Bottle of Sake, Empty Bottle of Vodka, Caffeinated Coffee Container
Best in Slot gear and items are highly expensive and require careful farming, trading, and luck. The guide notes that these recommendations are subject to S8 changes and market availability.
Charm layout (final)
- 1st column: earth melon, overloaded dice, hello its me steve, annihilator
- 2nd column: fulgure, torch of shadows, gladiator's dice
- 3rd column: chaos gem, soul collector
- Grand Charms: two slots; one for +25% crit damage or +5 to all skills; one for +100% enhanced damage
- Additional items: protein shake, bottle of sake, etc.
Transitioning into the Physical build
Time to swap into a completely different Plague Doctor build.
Core mechanics explained:
- The skills used here are the following:
- Surgical Blood Letting as the main damage dealer
- Toxic Flask used to teleport and buff our health and damage by a massive amount
- Defunct Surgeon used to give a small attack speed buff
- Randy the Rancid Rat used to give a movement speed buff
- The main skill of this build is Surgical Blood Letting, a physical attack with built-in Vitality damage scaling through a specialization node.
- Physical attack rate is based off your weapon’s base attack speed, and it can be increased by raising your %increased attack speed: It is important to know that the %increased attack speed affix on weapons increases the weapon’s base attack speed, while the same affix on other items increase the global increased attack speed, so a %increased attack speed affix will always have much more value on weapons compared to other items.
- The bottom stat is the global increased attack speed, which is multiplied by 0,75 before being added into the attacks per second stat
- Physical attacks can miss enemies, and what determines if you hit an enemy is their defence compared to your attack rating, enemies defence scale exponentially based on zone level, that is one of the reasons we are using Shadow weapons at the beginning of the transition, to not care about that stat since they give 100% hit chance.
- Physical attacks can steal HP and mana, determined by those stats: Make sure those aren’t 0% or else you can’t sustain health and mana properly.
- Physical attacks can proc deadly and crushing blow, deadly blow multiplies your physical damage dealt by 1.5x, so it is very important to keep deadly blow’s % close to 100%, while crushing blow gives your attacks a chance to break the enemyArmor, stacking up to 5 times (50% armor break), so another multiplier of 1.5x, but this time to your total damage, since we hit multiple times per second, a crushing blow’s 5%+ is good enough.
- Physical attacks can land critical strikes, which are a chance to multiply your damage by the critical strike damage%, it is very hard to find sources to scale critical strikes; in the endgame this is usually done by non-unique charms, which are pretty rare, and also getting nerfed in S7, that is another reason why i suggest going for Shadow weapons.
This is how Base damage is calculated: When you use a physical skill, the Base Damage is multiplied by the Skill damage: Since S7, it is possible to see the Skill damage dealt on the tooltip, so just hover your mouse over Surgical Blood Letting and you will check its Skill damage dealt. The skill damage dealt is multiplied by other multipliers: Deadly blow, critical strike damage and armor break were explained beforehand, extra damage to X modifier is the strongest affix in the game, since it is the last multiplier before the damage is done to the enemy.
- Equipment/Gear: I highly recommend to only transition into the physical build after you acquire either Shadowfury or Shadow Carver. Those weapons have a special ability called Reaper’s Culling. It multiplies Base Damage by x2, x2.5 or x3, depending on the Reaper’s Culling level. It also makes your hits never miss. Getting a +3 Reaper’s Culling is very important, but using a +1 to begin the physical swap is fine as well. The downside is not being able to land critical hits. Conclusion: With those you will be able to not care about critical strike chance/damage, attack rating, and ignore target defence%, which are usually rough stats to get when progressing a physical build.
I’d also highly recommend getting a Divine Piercing armor augment, it makes Surgeon Vortex blades not disappear when hitting enemies, greatly improving map clear, it is not worth going past level 1 though. In my opinion this is not mandatory to start like a Shadow weapon, but is a huge QOL, getting it on any of the A tier armors listed below is worth it.
Once again, to avoid market manipulation I'm listing multiple viable options to choose, ALL OF THEM ARE GOOD, they are listed randomly, there is no distinction if one is better than the other if they are on the same tier, try to find good opportunities to spend less gold if you’re playing trade.
I'm listing all the good items to use as a tier list from B to S.
- B tier: Good enough to start the transition (don’t use angelic keys on the armors of this tier though)
- A tier: Potentially good for H5 Amun Ra
- S tier: Items to use if you need a further damage boost, items here might be very expensive
Remark 1: I’m only considering the impact of those items for damage.
Remark 2: I’m not listing mythic/rare items, but all of them can range from A to S tier if they have good affixes, here is a small list of them with the respective maximum rolls:
+50 vitality/strength per level | +5 all skills | +75% attack damage
+30% extra damage to bleeding | +150% enhanced damage
Item type | B Tier | A tier | S tier
---|---|---|---
Weapon +1 Reaper’s Culling | Shadow Weapon | +3 Reaper’s Culling | Shadow Weapon More info on Scaling into the endgame page
Shield | N.A. | N.A. | More info on Scaling into the endgame page
Armor | Shroud of Enigma runeword | Force runeword | Cuirass of Blood
... (continues with many armor and accessory options)
Best in Slot items sets continue with a curated list of items for optimal DPS, including a final recommended charm layout and potion set. The charm layout and layout visuals are provided in the referenced screenshots.
Endnotes on the Transition
- It is recommended to transition into the physical build after you acquire either Shadowfury or Shadow Carver.
- Shadow weapons provide guaranteed hit and drastically reduce the complexity of attack rating and defense calculations during transition.
- Divine Piercing armor augment is highly recommended but not mandatory at the start.
Transitioning into Endgame and Distant Targets
Level 40-100 progression continues with a refined node setup and a focus on maximizing critical strike damage and base damage multipliers. The guide provides step-by-step adjustments, including the best skills to take, the order of leveling, and the best ways to manage mana and survivability during scale-up. It also includes a heavily annotated set of screenshots illustrating the recommended skill trees and layout for reference at level 100.
Hero Level skill tree:
- Step 1: grab the essential nodes on both Sanguine Physician and Plague Caller paths
- Step 2: progress upward to obtain high impact nodes
- Step 3: finish with charm slots as desired
Mercenary (Act 3) tips
- Act 3 merc is preferred for attack speed buffs in early- to mid-game physical builds.
- If you want more magic find later, switch to Act 1 merc with Death's Mirror, The Bucket, Leprechaun's Greed, and Babylon's Fall.
- Early-mid game merc gear recommendations emphasize tankiness and sustain to keep up DPS.
Charm layout and screens
The final charm layout is shown in the provided screens with a highlighted arrangement. The layout is intended to maximize DPS while preserving survivability. The text references images that show a recommended arrangement of charms on equipment and inventory.
Leveling progression - final notes
- Leveling progression with poison build emphasizes the importance of maintaining Crematus uptime, prioritizing Jar of Leeches as a primary damage dealer during boss fights, and using Toxic Flask for mobility and survivability.
- The guide emphasizes that the leveling process is the same for poison and physical paths until the transition occurs, after which the physical build takes a more aggressive DPS stance.
Hero Level tree and Glyphs
- The hero level tree is used to unlock charm slots and glyph enhancements for farming efficiency. The two charm slots are a core part of the endgame damage potential.
Act 3 mercenary progression
- The act 3 mercenary provides an attack speed boost that significantly increases overall DPS for physical builds.
- Early-mid game gear suggestions include a Valkyrie as 1-handed throwing runeword weapon, a Gem Encrusted Tower shield, Runemaster's Mantle armor, a Delirium Tremens helmet, Treasure Hunter's Boots, Midas' Hands gloves, and Belt of Infinite Wealth.
Endgame: Realistic expectations and notes
- Endgame scaling focuses on converting more of the build into crit-based DPS.
- Shadow weapons are still recommended during transition to ensure hits land consistently as you scale.
- It is important to track your DPS and adjust equipment to ensure Crematus uptime and poison uptime.
Reading time and resources
- The guide includes a significant number of external resources and video references for deeper understanding and validation of the build options. It is recommended to view the linked videos for S8 open beta builds and S7/S6 guides for historical context and practical demonstrations.
Closing notes
This guide is intended as a bedrock resource for Season 8 Plague Doctor players. It contains sections with step-by-step leveling, transitioning into the physical build, midgame and endgame strategies, and a detailed tiered item recommendation matrix. As Season 8 evolves, the guide will be updated with new data and community insights.
Charm layout visuals and practice images
The following images illustrate the final charm layout and the pathing for the Crematus, Toxic Flask, Jar of Leeches, and Randy the Rancid Rat nodes. The images include the progression for the recommended skill trees and layout, including the hero level tree and mercenary skill tree.
- Screen 1: Crematus tree (level 100 reference)
- Screen 2: Toxic Flask tree (level 100 reference)
- Screen 3: Jar of Leeches tree (level 100 reference)
- Screen 4: Randy the Rancid Rat tree (level 100 reference)
- Screen 5: Level 100 hero tree with two charm slots
- Screen 6: Mercenary Skill Tree (Act 1) with life/skill/resource stats
Final notes on the S8 season and community feedback
This guide reflects Season 8 changes and community experiences, and will be updated as new data emerges. The author thanks the #plague-doctor-discussion channel for their input and ideas that shaped this benchmark guide for the season.
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