Dwarf Fortress? I've never touched the Adventure mode, which is the actual roguelike, but it seems to have a damage system that doesn't use HP, but is much more realistic and remarkably gory. Apart from that, as far as roguelikes go, ADOM is pretty much the best I've played.
(Dwarf Fortress is only a sub title; the game has the full title "Slaves to Armok: God of Blood II" or something, which is, to be honest, a pretty dumb title, though it does have a pretty badass ring to it)