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Herx, Herxing

Jarisch-Herxheimer Reaction

Dr. Susan Marra explains the "herx" reaction here.


Always ensure your health by regularly visiting your doctor. Never assume that if you have any of the symptoms below that you are in a healing crisis. You may NOT be in a healing process, you may have a medical health problem.

Additional Information

Jarisch-Herxheimer reaction, or, Lucio's Phenomena
Also: A healing crisis, or, the "die-off".


An understanding of this pattern is essential to recovery from a severe chronic illness, especially those encouraged by heavy metal toxicity or other severe weakening of the immune system.

A sensitive balance must often be maintained between a sufficient and continual attack against and sufficient die off of cell and organ damaging factors, and, the emotional and physical strength of oneself. Too weak and inefficient a response will lead to death. Too strong a reaction may also presuppose fatality through physical and/or emotional fatigue and depression.

The limitation of destructive emotions of fear and uncertainty is best addressed with an awareness of what to expect and how to cope with and mediate those expressions. God will help, if you ask with humble sincerity and respond with resolute trust. Sometimes, it will be difficult to know by how you feel as to whether you are dying, or improving. Despair and depression will ensure death through inaction. Guard against them.

The Herxheimer reaction was first described by an Austrian dermatologist Jarisch Adolf Herxheimer working in Vienna and Innsbruck in 1895 and shortly after this, confirmed by his brother Karl Herxheimer also a dermatologist working in Frankfort.

It is a phenomena that results when there is an intensification of the disease symptoms and often an expansion of similar symptoms to other places all of a temporary nature, after which the patient is improved or well. Often it appears to some as if they have the flu. 

The symptoms of the Herxheimer Reaction can be most severe. Usually die off lasts only a few hours, though it can last several days, and may, in severe cases, be maintained for weeks. These symptoms can discourage not only the ill person, but also the doctor, therapist, or anyone who is in close relationship to the patient.

The brothers were involved in treating syphilitics. They observed that skin lesions they treated with very toxic heavy metals became larger and inflamed before lessening and healing. They also found that those cases that responded in this most violent manner healed the best and fastest. A patient could be quite ill for 2-3 days after which the syphilitic lesions resolved.

The Jarisch-Herxheimer reaction (referred to as "Herx" often) is believed to be a reaction caused by organisms (bacteria) dying off and releasing toxins into the body faster than the body may comfortably handle it. It was originally observed in patients with syphilis who received mercury treatment.

Some immune system compromised or distracted persons will have moderate to severe herxheimer effects from antibiotics that will usually have no effects on normal healthier individuals. 

It seems to occur when injured or dead bacteria release their products into blood and tissues, provoking a sudden and exaggerated inflammatory response - thus the response may be connected to a specific organism being killed off. Many non-antibiotic treatments (glutathione - whey products ) may also produce a herxheimer effect -- whether it is bacteria die off or simply toxin mobilization.

The most common ones include:

swollen glands,
constipation or diarrhea,
increased joint or muscle pain,
elevated heart rate,
chills, cold extremeties,
itching, scratching, nail biting,
unusual perspiration,
fever (usually low grade),
hypotension (low blood pressure),
Itching, hives and rash (sometimes assumed to be an allergic reaction)

Symptom intensifiers:

Two common sources: decreasing the blood flow, which allows the toxins to accumulate, or, increasing the die off of parasites.

anxiety and worry,
hormonal imbalances,
enzymes, bromelain, pancreatin, etc.,
clotting agents, heavy foods,
excessive exercise, tiredness,
fatigue, exhaustion,
cold temperatures,
air pollution,
chronic illnesses,
high doses of vitamins,
some forms of chelation treatments

Symptom reduction

Two common strategies: improving the blood flow to clear the toxins faster (see vascular constriction), or, neutralizing the toxins (or both).

relaxation techniques,
Enemas, Colemas, Colonics,
increase in blood thinning supplements,
Lemon/Olive Oil liver/gall bladder cleanse,
2 Tbsp Lemon Juice (Organic) or 1/2 lemon rind),
1 Tbsp cold pressed Extra Virgin Olive Oil,
flavanoids (widens blood vessels),
hydrogen peroxide intravenous,
aerobic oxygen supplementation,
lymphatic massage,
bentonite clay,
charcoal tablets,
diatomaceous earth,
pain medication,
muscle relaxers,
hot baths / hot tub,
steam bath or dry sauna,
infrared Hot House treatment,
a cleansing bath: add 1 cup salt, 1 cup soda, 1 cup epsom salts, 1 cup aloe vera, to a hot bath, remain in and keep hot for about 1-1/2 hours all the while consuming about 2 quarts of warm water.

Getting rid of mutated Candida and restoring the proper balance of healthy flora within oneís digestive system is no easy task. It takes a multifaceted approach to overcome the yeast, promote healthy microorganisms, and watching one's diet to prevent the yeast from feeding on excessive sugar.

The medium chain fatty acids in coconut oil provide nutritional support to overcome the yeast, but if this happens too quickly it can cause a die-off effect that is referred to as a Herxheimer reaction, which is the result of the rapid killing of microorganisms and absorption of large quantities of yeast toxins, cell particles, and antigens.

Mutated Candida produces 79 toxins according to Vitamin Research Products Inc journal (3/99Vol.13, #3). Sugar activates candida metabolism and some of its by-products are neurotoxins such as formaldehyde, alcohol and acetlyaldehyde. One's nervous system can become confused during candida infestation due to specific neurotoxins. 

Candida converts the element mercury to methyl mercury which is 100 times more toxic. Mercury chelation might deliver more mercury to the system temporarily allowing the candida-methyl mercury conversion. Mercury is an antibacterial, yet, in concentrations lower than fatal to humans, bacteria are often encouraged. Your symptoms may get worse before they improve.


Treating the Jarisch-Herxheimer(JH) Flare Reaction

Stuart L. Weg, M.D. is certified by the American Board of Anesthesiology with added qualifications in pain management.

The observed temporary worsening of clinical status in patients undergoing anti-infective treatment is called the Jarisch-Herxheimer (JH) reaction. It may be referred to by some of the terms listed below. This phenomenon, described in the cover article, is not just present in rheumatologic disease but is common to all forms of anti-infective therapies that I have used for most chronic painful states. This app arent common etiology of all chronic pain and arthritis is not within the scope of this discussion but will be covered in the future.

The JH reaction can take the mild form of sleepiness and fatigue to full blown anaphylactic shock. The timing vari es from almost immediately, as is the case of IV antibiotics, to up to a week or two later. This depends on the rate that toxins are produced and how fast they can be metabolized or eliminated. Drug levels are important, but often cannot explain the timin g of a reaction. 

In some cases an overwhelming, waterfall effect is present, while in other patients there is a slow, gradual building of symptoms. I have seen cases where adding another unrelated medication caused the antibiotic to become more bioavailable and that precipitated a JH. 

There are cases where simply changing a single 100 mg daily dose of minocycline to two 50 mg split doses has provoked a JH due to an absorption increase. Reducing, suspending or changing the offending medication is the most obvious treatment. Patients must understand that early signs of the JH reaction may not be present; even the most conscientious and observant physicians may not stop or lower the medication in time to avoid patient discomfort.

The classical discuss ions of a JH describe the presence of bacterial debris or toxins from anti-infective therapies that cause this reaction. This is certainly true, but another byproduct is also formed when cell wall deficient bacteria or L forms are attacked. 

I have noticed that some JH present as a flu syndrome. Other patients develop purulent drainage from the head and neck, urine and other areas. When I have cultured these patients, I have been able to isolate adult (non L-form) bacteria. Treatment with medications that favor the destruction of L-forms who are unwalled forms will also favor or select for the survival of adult or walled forms of bacteria.1 

Microbiologists call this change of the form of bacteria pleomorphism. The ind uction of walled forms of bacteria has been studied and should be kept in mind when considering treating a JH reaction.

Treatment of a JH should be aimed at eliminating toxins from the killed bacteria and destruction of newly induced adult bacteria. Consideration should also be given to the possibility of overgrowth of endemic yeast infections. Often there are symptoms that clinically indicate the presence of histamine. 

The physician's diagnostic skills and clinical judgment must be called into place to differentiate between a direct toxic reaction versus the appearance of an adult form organism or the more insidious development of yeast overgrowth.

For the ease of the reader, I am classifying the JH reaction into two categories:

1) Acute - life-threatening. These may also be called anaphilactoid.

2) Non-acute or non-life-threatening- not anaphilactoid.

Acute - Life Threatening

The severe acute reactions are probably related to a massive response of the immune system to toxins. There may be a large release of histamine as well. Such anaphilactoid reactions need immediate attention and should be considered life-threatening. The most severe problems involve swelling of the neck areas and closure of the airway. 

This must be treated at once with epinephrine followed by transportation to a hospital. 

The management of severe anaphilactoid emergencies is well known by healthcare personnel and beyond the ability of the patients to handle at home. A drop in blood pressure is also common along with skin changes due to dilation of the blood vessels. This can lead to cardiovascular collapse unless aggressively treated and also needs hospital management. 

Milder cases featuring asthma may respond to inhaled broncodialator medications, but this can sometimes delay the patient from seeking early medical attention and avoiding catastrophe. Skin rashes are not life threatening but often are quite distressing. A more detailed

1 Mattman, Lida Cell Wall Deficient Forms, Stealth Pathogens 1993 CRC Press

Anti-infective therapies or approaches that can feature the JH

Antibiotic/antifungal therapies < LI>Oxidative therapies
Ultraviolet Blood Irradiation
Hydrogen Peroxide therapy
High dose vitamin C therapy
Induced Hyperthermia
Sunlight exposure
Various herbal therapies
Bee sting reactions
Iodine reacti ons
Terms in Use for JH

Herxheimer Reaction
Die Off Reaction
Flare Reaction
Coming Out Reaction

Summary of Treatment Features of Life Threatening JH Reactions

Treatment of histaminic states
Acute life threatening histamine shock or airway swelling
Epinephrine with fluids for shock
Mild JH Reactions

Anti-histamine medication e.g.benadryl parenterally or by mouth
Supportive Care for Anaphylactic Type JH Reactions

Management of Bronchospasm (acute asthma) with Bronchodialators

discussion of these kinds of problems is presented in most textbooks of medicine and all manuals for emergency care.

Management of Non-life Threatening JH Reactions or Clinical Flares

The more typical JH reactions to anti-infective therapies are: worsening of symptoms, febrile states such as night sweats, flu-like picture, hot swollen joints, mental depression and fatigue. 

I recommend home therapies designed to clear the blood and make the patient more comfortable. My routine calls for baths in hydrogen peroxide and Epsom salts. These baths are very effective and have tremendous anti-infective effects. They may work for only a short time at first and may need to be repeated. 

The peroxide easily enters the body through the skin and rapidly detoxifies and sterilizes the blood. There will be a marked reduction in tight muscles that can be a part of a JH reaction. Unfortunately peroxide can have a JH reaction of its own, but this is more pronounced when it is used IV rather than in a bath. 

Magnesium in the Epsom salts also passes easily systematically; it has a local anesthetic, antispasmodic effect and an overall improvement in the performance of most systems. Oral peroxide is available but not discussed here. The IV route for both peroxide and magnesium is used to stop the JH reaction in office management. 

The same benefit of blood detoxification and general enhanced clearing of tissue toxins and bacteria can be claimed for high dose ascorbic acid (20-50 GMs IV). Vitamin C can be given in oral form too. Ascorbic acid powder equals about 5 grams per level teaspoon. This dose can be taken with water or juice as often as needed or until there is GI intolerance such as diarrhea. 

The clinical effects are similar to peroxide. In fact, the two can be given to a patient on the same day with excellent results. It must be remembered however; the vitamin C will also neutralize peroxide and thus should always be given after the bath. Mild JH reactions are also seen with vitamin C therapy again mainly when given IV. Such therapies as peroxide baths and vitamin C are easy to do at home and extremely effective at helping patients make a quick, safe recovery from a JH reaction.

Other oxidative office therapies can be alternated with these modalities or with antibiotics to hasten detoxification of bacterial toxins. Ultraviolet blood irradiation (UBI) involves removing a small portion of the circulating blood and cleaning it under UV light before returning it to the patient. 

The mechanism of action is not well known, but such treatment has been used for over fifty years mostly outside the United States for improvement in immunologic function. This treatment also ameliorates the JH phase of anti infective therapy. It is further noticed that direct exposure to sunlight has a similar effect to UBI in many patients. 

Therefore my patients are asked to get sun exposure if the climate allow s not using sunscreen up to the point of mild burning. I caution them that minocycline will cause them to be sensitive, but that they can go out with care and receive great benefit. And as I had expected, I do see stable patients develop mild JH re actions after such activities as fishing trips which cause a huge UV sun dose and large destruction of circulating bacteria.

Another approach to treating worsening of symptoms after oral antibiotic or other anti-infective therapy is the use of IV a ntibiotics. I have used IV doxycycline for quelling such problems. Other physicians have used IV minocycline, IV clindamycin and others for this purpose. In my practice the antibiotics are the drugs of last resort. The most preferred treatments involve the home remedies with peroxide and vitamin C.

I have tried to avoid the use of anti-inflammatory remedies for the JH reaction. The corticosteroids will control a rash, but I have noted a general deterioration of the patient's condition weeks later. Such topical steroids as are given in inhaled or skin medications are certainly absorbed. Their use will be a quick fix at a high cost due to the setback they cause. 

The nonsteroidal anti-inflammatories that are used orally have the effect of irritating the GI system and are implicated as one of the causes of the leaky gut syndrome also linked to many of the chronic pain states. Again they are drugs of a last resort. Topical soothing lotions such as aloe vera can do no harm and may make a rash feel better.

Yeast overgrowth must be considered when new symptoms develop after antibiotics are started. I put all chronic pain patients on continuous oral acidophilus supplements before starting any anti-infective therapy. We were noticing yeast emergence i n nearly 100% of the patients. With the addition of acidophilus, this problem is becoming a lot less common.


Worsening or flaring of symptoms after the commencement of anti-infective therapy should be expected and considered a JH reaction. The patient should be cautioned about the signs of a potentially life threatening anaphilactoid reaction and urged to seek medical attention at once. 

The more common clinical non-life threatening flares should not cause undo concern to the patient and may be treated by altering the medication dosage and with some of the suggested therapies above. Abandoning of the anti-infective approach to chronic pain and arthritic disease would be unfortunate simply because of these expected temporary setbacks.

For educational purposes only. Consult your physician before you make any changes in your treatment.


The Healing Crisis

AKA:  Jarisch-Herxheimer Reaction (JHR), Jarisch- Herxheimer (J-H) , The Herxheimer Reaction, The Herxheimer Effect, Lucio's Phenomena, The Healing Crisis, The "die-off”, Herx, The Cleansing Reaction, The Detox Reaction

“You have to get worse, before you get better”

Post remedial massage clients report periodic aggravation of their symptoms as an apparent direct response to their remedial massage treatment. In other words, these clients say that their treatment makes them feel much worse before they experience they feel better.

This phenomenon is known as the Jarisch-Herxheimer Reaction (JHR). JHR is believed to be caused when injured or dead bacteria release their endotoxins into blood and tissues faster than the body can comfortably handle it (1,2). This provokes a sudden and exaggerated inflammatory response and is associated with the systemic appearance of cytokines. Cytokines are a category of signalling proteins and glycoproteins, which, like hormones and neurotransmitters, are used extensively in cellular communication. 

While hormones are secreted from specific organs to the blood and neurotransmitters are related to neural activity, the cytokines are a more diverse class of compounds in terms of origin and purpose. They are produced by a wide variety of haematopoietic and non-haematopoietic cell types and can have effects on both nearby cells or throughout the organism, sometimes strongly dependent on the presence of other chemicals. 

The cytokine family consists mainly of smaller, water-soluble proteins and glycoproteins. “The JHR is an elegant model of the human cytokine cascade in events resembling sepsis…” (3).


JHR is your body's reaction to the release, mobilisation and over abundance of dead or dying bacteria, fungus, cell particles, antigens, yeast and viruses as a result of your treatment. 

This reaction is NOT COUNTERPRODUCTIVE or a COUNTER ACTION of the process. It is your body telling you to flush it more quickly.

The more toxic one's body is, the more severe the detoxification, or healing crisis. When the body tries to eliminate toxins at a faster rate than it actually can manage, you may actually feel worse and therefore conclude that the treatment is not working. 

It is characterized by a temporary increase in symptoms during the cleansing or detoxification process which may be mild or severe. But these reactions are instead signs that the treatment is working and that your body is going through the process of cleaning itself of impurities, toxins and imbalances.

Such reactions are temporary and can occur immediately or within several days of a remedial massage. Symptoms usually pass within one to three days but on very rare occasions can last several weeks. In any case, a cleansing & purifying process is underway, and stored wastes are in a free-flowing state. The healing crisis is the result of every body-system, in concert, working to eliminate waste products through all elimination channels and set the stage for regeneration.

JHR has shown an increase in inflammatory cytokines during the period of exacerbation, including tumour necrosis factor alpha, interleukin-6 and interleukin-8 (4,5)

Endotoxins, not to be confused with enterotoxin, are potentially toxic, natural compounds found inside pathogens such as bacteria. Classically, an "endotoxin" is a toxin, which unlike an "exotoxin", is not secreted in soluble form by live bacteria, but is a structural component in the bacteria which is released mainly when bacteria are lysed, which refers to the death of a cell by breaking of the cellular membrane.

The good news is that the JHR is thought to indicate that the treatment is indeed working and that following each worsening may bring about more improvement. However the lack of JHR should not cause anxiety if symptoms are improving. The more bacteria present and the stronger the symptoms and reaction.

Symptom intensifiers

Two common sources are a remedial massage following a period, possibly long term, of decreased the blood flow, which allows the toxins to accumulate and the other a period of increased the die off of parasites.

Other factors which may increase the probability of JHR are;

• Anxiety, fear and worry,
• Hormonal imbalances,
• Enzymes, pancreatin, bromelain, etc.,
• Clotting agents, heavy foods,
• Chronic illnesses,
• High doses of vitamins,
• Excessive exercise,
• Fatigue, tiredness, exhaustion,
• Exposure to cold temperatures,
• Air pollution,
• Anti-virals,
• Anti-bacterials,
• Anti-fungals,
• Anti-parasitics.


The healing crisis will usually bring about past conditions in whatever order the body is capable of handling at that time. People often forget the diseases or injuries they have had in the past, but are usually reminded during the crisis. 

There are a wide variety of reactions that may manifest during a healing crisis, the most common ones include:

• Fatigue or restlessness,
• Diarrhoea,
• Cramps,
• Arthritic flair up,
• Insomnia,
• Frequent urination and/or urinary tract discharges,
• Skin eruptions, including: boils, hives, and rashes.
• Headaches or migraines,
• Ringing in the ears,
• Mental dullness and disorientation,
• Cold or flu-like symptoms,
• Nausea,
• Swollen glands,
• Constipation, diarrhoea, or bloating,
• Myalgia increased joint or muscle pain,
• Elevated heart rate,
• Chills, cold extremities,
• Itching, scratching,
• Unusual perspiration,
• Fever (usually low grade) and/or chills,
• Hypotension (low blood pressure),
• Sinus congestion,
• Itching, hives and rash (sometimes assumed to be an allergic reaction),
• Emotions swings: anger, despair, sadness, fear, anxiety etc.,
• Suppressed memories arise.

Easing Your Way through the Healing Crisis:

Drink plenty of water, juices and herbal teas to flush the body of toxins. If you find water unpleasant then add favour to it, such as sliced lemons or cordial. Some professionals recommend distilled water as the best. Drink from 2 to 4 litres per day. This will help flush the toxins out of your system and speed along the detoxification.

If you are feeling fatigued, or sleepy, your body is talking to you and telling you to rest. Be kind to yourself and get the rest that you need and sleep.

Symptoms frequently disappear immediately after a good bowel movement.

Symptom reduction

Depending on your lifestyle and in which modalities you follow solutions vary. It is logical to conclude that improving the blood flow to clear the toxins faster and/or neutralizing the toxins will reduce symptoms;

Ask your doctor or pharmacist about;

Flavanoids (widens blood vessels),
Hydrogen peroxide,
Blood thinning supplements,
Pain medication,
Muscle relaxants,
Enemas, Colemas, Colonics.

Ask your Wellness Consultants about;

Enemas, Colemas, Colonics,
Aerobic oxygen supplementation,
Olive Oil Extract,
Charcoal tablets,
Hydrogen peroxide,
Diatomaceous earth,
Bentonite clay,
Liver/gall bladder cleanses,
Infrared Hot House treatment.

Common Sense;

Encourage perspiration and excretion by;
Drinking plenty of water, favoured if you dislike the taste,
Spit out any phlegm,
Blow your nose rather than sniffing,
Steam Baths,
Dry Saunas,
Hot Baths,
Hot Tubs,
Relaxation techniques, such as yoga and meditation,

The trusted advice of Russell McMillan, DDS, DPH, who wrote the Arthritis Trust of America in 1994 with his personal remedy for the JHR maybe the most pleasant of all treatments. 

"I take a saltz bath which consists of adding 1 cup salt, 1 cup soda, 1 cup Epsom salts, 1 cup aloe vera, to a hot bath which I remain in and keep hot for about 1½hours, all the while consuming about 2 quarts (4 litres) of warm water. Evidently the perspiration and osmotic pressure removes the causative toxins. I find it quite helpful".


Always ensure your health by regularly visiting your doctor. Never assume that if you have any of the above symptoms that you are in a healing crisis. You may not be in a healing process, indeed, you may have a medical health problem.

“You have to get worse, before you get better”