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Plak tow was a Vulcan phrase literally meaning "blood fever". It was characterized by irrational and instinct driven behavior, a combative nature and a high fever, especially during the final stages of pon farr. Normally a Vulcan in this state was unable to speak or think clearly and the desire to mate was very strong and irresistible. The "blood fever" was initiated by a telepathic mating bond between two Vulcans, but instances of Vulcans mating with members of other races did exist. (VOY: " Blood Fever")
Even a brief moment of bonding was enough to initiate the blood fever. After the plak tow was initiated, it had to be brought to its natural conclusion, or the chemical imbalance that had resulted would lead to death. The "fever" could be broken through either successful mating or through koon-ut-kal-if-fee: the ritual challenge to fight to win ones mate. Once either of these rituals had been implemented, the blood fever was purged and one would recover from the symptoms. Often the ritual combat was to the death, but could also be resolved without death. (VOY: "Blood Fever"; TOS: "Amok Time")
In 2267, T'Pau expressed surprise when Spock, while suffering from pon farr, protested T'Pring's choice of Kirk as her champion in the koon-ut-kal-if-fee. Neither Kirk nor Spock wanted to kill the other, so to avoid the situation, Chief Medical Officer McCoy drugged Kirk with a neural paralyzer under the pretext of injecting him with a tri-ox compound so he could breathe better in the dry, hot Vulcan air. As McCoy intended, Kirk seemed to have been killed by Spock during the ritual battle. (TOS: "Amok Time")
In 2373, Ensign Vorik, experiencing pon farr himself, unintentionally initiated the telepathic mating bond with Lieutenant B'Elanna Torres. Even though Torres turned down Vorik's proposal for marriage, she began experiencing the blood fever herself. This not only resulted in her engaging in some irrational and extremely emotionally driven behavior, but also brought out her more aggressive Klingon mating instincts. With her baser instincts driving her, she tried to unsuccessfully seduce Lieutenant Tom Paris on an away mission. Trying to resolve the blood fever which was driving him near insanity, Vorik declared the koon-ut-kal-if-fee and challenged Paris to a fight. Deciding to take on the challenge herself, Torres fought Vorik and by winning the ritual battle, the blood fever was purged. (VOY: "Blood Fever")