Returning to my concern about the HP ratio of large creatures to humans, I worked through your small Akho vs human example in Gardasiyal using the QP system. (This reminded me how much I dislike the stock combat rules in that game: too many cascading table-to-table resolutions, which is why I wrote a homebrew version.)
Small Akho: HBS 150, damage table E, 4 critical hits, -7 QP defensive wound severity modifier due to -4 armor rating, +2 offensive wound severity modifier due to HBS.
Average human with long sword: HBS 100, damage table D (10 skill levels), 1 critical hit, -4 QP defensive wound severity modifier due to medium armor, +2 offensive wound severity modifier due to weapon skill.
Due to their HBS scores, the Akho has a 50% chance to hit, while the human has a 30% chance.
(Apologies for the lack of formatting for the tables)
Human: Damage table D against -5 wound severity modifier
Wound type Chances out of 20 Damage Avg damage
No effect 7 0 0
Minor 4 0.25 0.05
Serious 8 0.5 0.2
Critical 0 1 0
Kill 1 2 0.1
20 Avg: 0.35
Akho: Damage table E against -2 wound severity modifier
Wound type Chances out of 20 Damage Avg damage
No effect 3 0 0
Minor 5 0.25 0.0625
Serious 6 0.5 0.15
Critical 5 1 0.25
Kill 1 2 0.1
20 Avg: 0.5625
Human: Damage table E against -5 wound severity modifier
Wound type Chances out of 20 Damage Avg damage
No effect 6 0 0
Minor 5 0.25 0.0625
Serious 6 0.5 0.15
Critical 2 1 0.1
Kill 1 2 0.1
20 Avg: 0.4125
We see that the human will, on average, be killed by about two hits from the Akho, the same as in Bethorm, requiring four attacks, implying that the Akho could kill up five such people per round if it could bring all its tentacles to bear and they were within melee range. To kill the Akho using damage table D will take 4 critical wounds / (0.35 critical wounds per hit * 30% chance to hit), or about 11 hits over 38 attacks.
If the human has a weapon that hits on damage table E, like a pole arm, this becomes 10 hits over 32 attacks, a modest increase. On the other hand, if we give the human a long sword in Bethorm, then their average damage goes up from 5 to 6, doing twice as much damage to the Akho on a hit, and thus the human then requires only 10 hits to slay the Akho. The armor-penetrating damage goes up even more with a bastard sword or other larger weapons.
In summary: You've deflated attack damage and hits in Bethorm substantially compared to Gardasiyal, more so for the larger creatures, which is what looked wrong to me. You compensated by changing the armor ratios in favor of the powerful creatures: many of them have 4 points of armor vs physical attacks, better than even steel plate at 3 points, whereas in Gardasiyal, steel plate in the HP system has a -6 armor modifier, as good as nearly any creature's armor. (Bethorm's attack damage ratios between characters and creatures appear to be about the same as Gardasiyal's, on the other hand.) However, this relative increase in creatures' armor is more than offset by a relatively wider range of weapon damages in Bethorm vs Gardasiyal. Thus, creatures will not be able to take as many hits from large weapons in Bethorm as in Gardasiyal.
As for the multiple attack rules, my point was that they only sound meaningful for two-armed humanoids. I don't know if they apply to other creatures. (I don't even know if the idea of an "off hand" applies to a Pe Choi, let alone an Akho.) It would seem a lot easier to me to just list the number of attacks for the relatively few many-limbed creatures.
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