How do you tell the difference between die off and just worsening of symptoms

For me, it's just some of my symptoms that worsen. And, it is difficult sometimes for me to tell if it's a herx or a flare because my symptoms change throughout the day....

But, no, not all symptoms need to ramp up for it to be a herx...my very first herx was last July, started doxycycline...and on day 4, I had back pain...like I've never had before...and it lasted 12 days, until Trav suggested that I back off on the dose and see what happens. It worked. So, that confirmed for me it was a herx.

If the bacteria dies on its own, like at the end of its life cycle or whatever, does it still release Toxins? I'm wondering if it's possible to her while not on meds...?

A herx could easily make your glands swollen - that would be a sign that things are trying to be eliminated.

Hives, nerve pain, exhaustion, pain in your right side and many other things can occur because of drug side effects though.

I do not think huge herxes are necessary. Conversely, I think the stress it puts on the body can slow recovery.