The Five Elements, Doshas, and the Sacred Work of Transitioning

Carol K. Ray
Originally written in 2022
Revised in 2026

Inspired by the Tibetan Book of the Dead, the teachings of Siddha-Veda, and reflections on accompanying those approaching death

Several years ago, while reading about the Tibetan Book of the Dead, I became fascinated by the traditional description of the elements dissolving during the dying process. I began to see a possible relationship between this progression and the three doshas.

To me, some of the changes appeared to move from the qualities of Kapha, through Pitta, and finally into Vata and Space.

This is not presented as a medical model or as a formal teaching of Siddha-Veda. It is a personal reflection arising from what I have learned, observed, and researched. Every person’s experience is unique, and dying does not always follow an orderly or predictable sequence.

Holding Sacred Space

As students of Siddha-Veda, we may sometimes be invited to help hold space for someone who is approaching death. Dr. Pankaj Naram spoke of death not simply as an ending, but as changing our clothes.

To hold space is not to control the experience or impose our beliefs. It is to be fully present, with as little fear and ego as possible. It is to bring love, steadiness, and acceptance into the room.

Before offering touch, prayer, music, Marmaa, meditation, or any other practice, ask what the person wants whenever they are able to respond.

What would bring you comfort?

Is there anything you would like me to do?

Is there anyone you want me to contact?

Would you like quiet, music, prayer, or simply someone to sit beside you?

Listen carefully. Repeat important requests to be certain you understand. If appropriate, write them down for the family or care team.

A Marmaa for clarity may also be offered if the person welcomes it. As I was taught, the tip of the right index finger is gently pressed six times while a frame is created above the right eye. This is a spiritual comfort practice, not medical treatment.

The Elements and the Doshas

In Tibetan Buddhist teachings, the dying process may be contemplated as a gradual dissolution of Earth into Water, Water into Fire, Fire into Air, and Air into Space.

Through the lens of Siddha-Veda, I began to recognize qualities that reminded me of Kapha, Pitta, and Vata.

Earth and Water: A Kapha-Like Phase

Earth represents structure, solidity, and physical form. Water represents fluidity, cohesion, and nourishment. Together, these elements are closely associated with Kapha.

As the body weakens, a person may become heavier, quieter, and less interested in activity. Movement often decreases. Sleep may increase, and the person may begin withdrawing from ordinary conversation and surroundings.

The hands, feet, and other extremities may become cool. Fluid balance may change, and swelling can sometimes appear. These signs can have many causes and should be interpreted by the medical or hospice team rather than assumed to indicate a particular organ is shutting down.

Some people report vivid dreams, meaningful memories, or a sense that deceased loved ones are near. Rather than correcting or dismissing these experiences, we can listen with openness. If the person wishes, their words may be written down and preserved for them or their family.

Fire: A Pitta-Like Phase

Fire is associated with heat, transformation, vision, and metabolism. These qualities suggest Pitta.

Near the end of life, body temperature and skin appearance may change. The skin can become warm, cool, pale, reddish, gray, or mottled. Some people become restless or agitated. Others experience a surprising period of clarity and energy sometimes called a rally.

A rally can be a precious opportunity for conversation and connection, but it does not necessarily mean the person is recovering.

A cool cloth on the forehead or neck may be comforting if the person welcomes it. Dry lips can be gently moistened using the method recommended by the care team.

Agitation, pain, breathing difficulty, or sudden distress should always be reported to hospice or the medical team. These symptoms may have treatable causes.

Air and Space: A Vata-Like Phase

Air represents movement, including the movement of breath. Space represents openness and the gradual release of contact with the physical world. These qualities suggest Vata and Ether, or Space.

Breathing may become shallow, irregular, or noisy, with longer pauses between breaths. Although these sounds can be distressing to those sitting nearby, they do not necessarily mean that the dying person is suffering. The hospice or nursing team can assess the person and recommend changes in position, medication, or other comfort measures.

Awareness of the outside world may gradually diminish. Even when a person no longer responds, a calm voice, familiar prayer, gentle music, or loving presence may still provide reassurance.

We do not need to fill every moment with words. Sometimes the greatest gift is simply to remain nearby, peaceful and unafraid.

Food, Fluids, and Mouth Comfort

As the body slows, interest in food and fluids commonly decreases. Swallowing may also become difficult. Food and drink should not be pushed upon someone who is no longer asking for them or cannot swallow safely.

Ice chips are not appropriate for everyone. They should be offered only when the person is alert, able to swallow, and the hospice or medical team considers them safe.

Frequent mouth care may provide more comfort than encouraging food or fluids. The lips and mouth can be gently moistened according to the care team’s instructions.

The goal is comfort, not meeting ordinary expectations for eating and drinking.

Comfort Guided by the Doshas

Doshas should never be used to stereotype a dying person or decide what they ought to want. They can, however, inspire gentle possibilities. Always follow the individual’s preferences.

Kapha-Inspired Comfort

A person expressing Kapha-like needs may appreciate steadiness, familiarity, and reassurance.

They may want to know that certain responsibilities, possessions, pets, or family matters will be cared for. Listen carefully, take notes, and repeat their wishes so they know they have been understood.

If welcomed, brushing their hair, caring for their hands, or sitting quietly nearby may feel nurturing. Familiar piano music, gentle rhythms, devotional music, or a beloved song may also bring comfort.

Pitta-Inspired Comfort

A person expressing Pitta-like needs may want clarity, respect, and some measure of choice.

Offer simple options without overwhelming them. Allow them to express concerns without arguing, correcting, or rushing to reassure them.

Music with meaningful words, a familiar prayer, guided imagery, or quiet meditation may be comforting. Aromas should be used only with permission and with the approval of the care team, since scents can worsen nausea or breathing discomfort.

Vata-Inspired Comfort

A person expressing Vata-like needs may appreciate grounding, warmth, and gentle reassurance.

Holding a hand, speaking softly, or placing a warm blanket over the body may help, but touch should always be invited rather than assumed. Avoid electric heating devices unless the medical team has approved their use.

Peaceful nature sounds, cello, harp, soft chanting, or a familiar voice singing may be soothing. Silence may be equally welcome.

One musical resource I have treasured is Graceful Passages by Gary Malkin and Michael Stillwater. “The End of Suffering” is one selection from this collection.

Many Traditions, Many Understandings

Religious traditions contain diverse beliefs, and no short summary can represent every community or individual. The following are offered only as small windows into the ways people have sought meaning in death.

Buddhism teaches impermanence and encourages preparation of the mind. Tibetan Buddhist traditions describe death as a profound transition in which the elements and ordinary forms of awareness gradually dissolve.

Cherokee spiritual beliefs and practices vary among families and communities. Many emphasize relationship, responsibility, ancestors, and the sacredness of the natural world. Guidance about ceremonies should come from the person, family, or an appropriate Cherokee spiritual leader.

Christianity offers hope in resurrection and eternal life. In John 11:25–26, Jesus speaks of himself as “the resurrection and the life.”

Sanatana Dharma teaches that the eternal Self is not destroyed when the physical body dies. Bhagavad Gita 2:22 compares leaving the body to setting aside worn clothing and taking up new garments. This is the image reflected in Dr. Naram’s gentle description of death as changing our clothes.

Islam teaches that earthly death is followed by continued existence and, ultimately, resurrection and the Day of Judgment. The timing of death rests with Allah.

Jainism teaches that the jiva, or soul, continues beyond the death of the body. Spiritual life seeks liberation from attachment, karma, and repeated rebirth.

Judaism holds every moment of life as precious. Jewish beliefs concerning the afterlife are diverse, but care for the dying, respect for the body, remembrance, and care for mourners hold deep importance.

Sikhism regards death as part of the natural order. The physical body dies, while the soul’s journey continues toward union with Waheguru.

Zoroastrianism gives special reverence to the purity of Earth, Water, Fire, and Air. Traditional practices surrounding death seek to avoid contaminating these sacred elements.

Across these differences, one truth appears again and again: death is a sacred threshold, and the person approaching it deserves dignity, tenderness, and respect.

The Gift of Presence

We may not know exactly what happens as someone leaves the body. We may not have the perfect prayer, remedy, or words.

We can still offer something profound.

We can listen.

We can honor the person’s wishes.

We can help create peace in the room.

We can sit beside another human being without trying to change, explain, or hurry the experience.

We can be fully present in love.

Important Note

This article offers personal, spiritual, and educational reflections. It does not provide medical advice or predict how death will occur. Changes in breathing, consciousness, temperature, swallowing, skin color, pain, or behavior should be discussed with the person’s hospice nurse or medical team. If someone is not expected to be dying and develops sudden or severe symptoms, seek emergency medical help.

Selected Resources

Kent Community Health NHS Foundation Trust, “Eating, Drinking and Swallowing at the End of Life”

Gateshead Health NHS Foundation Trust, “Understanding What Happens When Someone Is Dying”

The Tibetan Book of the Dead, also known as the Bardo Thodol

Bhagavad Gita, Chapter 2, Verse 22

The Holy Bible, John 11:25–26

Graceful Passages: A Companion for Living and Dying, created by Gary Malkin and Michael Stillwater

Carol K. Ray
carolkray@LearnSiddhaVeda.com