Knowing Skull
Knowing Skull is an Act 2 event featuring a sentient skull that will answer questions or grant wishes in exchange for HP. Each question or wish costs a percentage of your current HP (typically 6-13% per interaction). The skull can remove a card, provide gold, or grant a relic, all in exchange for HP. Multiple interactions are possible in a single visit.
Knowing Skull is particularly powerful if you have high HP and need specific services. Card removal in Act 2 is very valuable, and getting it for HP rather than gold preserves your gold for other purchases. The HP cost scales with your current HP, so wealthier-in-HP characters benefit more. Using the skull for card removal (the most consistent value option) and then leaving is usually the strongest approach, unless a relic or gold interaction would significantly improve the run.