Just come up with a super quick (and absolutely filthy) way of bringing vile damage into 4e.
For those of you that don't know, back in 3.0 / 3.5 Vile damage was harm so fundamentally evil, that it could not be simply removed by time or normal healing spells. To be cleansed of it, it required that the individual be healed within the bolstering embrace of various holy spells and protective inscriptions, meaning that characters often had to slog through an adventuring day bearing violated wounds, dripping with repugnant ichor and occasionally taking a bite at anyone nearby (it really was messed up :D ).
In 4e, I want to keep this concept - though as i don't use alignment at all, I can't really make it depend on rituals that remove "evil".
So, the rule I'm going to try are that Vile Damage is treated like an affliction. You can't heal it until you have been subjected to a Remove Affliction ritual cast by an individual of the appropriate level. It's simple, it makes it possible for the well balanced and prepared party to move on from it with the expenditure of a little time and cash, and it captures the same idea and feel as its earlier incarnation.
What do you think?