Despite there being as many countless Pure Lands as there are Buddhas, the historical Buddha most famously taught us about one in the West (Amituofo; Amitabha Buddha’s) and another in the East (Medicine Buddha’s) of our world system. This can be seen as a skilful means to urge us to seek birth in either Pure Land. If the Buddha taught about more Pure Lands in equal detail, we might become confused as to which to aspire birth in. Even the speak of these two Pure Lands alone might cause ambivalence to those new to Buddhism.
Also, there is no practical need for the Buddha to speak at length about too many other Pure Lands – as they are all basically of the same nature (in physical magnificence) and purpose (i.e. for training beings for enlightenment). However, as Amituofo’s Pure Land is the easiest to reach, ALL Buddhas will recommend it to beings of their worlds.
As a theory, some propose that the eastern direction has the psychological feel of giving life (as the sun rises in the East, signifying birth of a new day). This relates to Medicine Buddha’s vows to heal the ailing in this life… while the western direction has the psychological feel of refuge and return (as the sun sets in the West, signifying the time to go home) at the end of this life. They relate this to Amitabha Buddha’s vows to guide beings to return ‘home’ to their Buddha-nature.
However, that said, all Buddhas, having the same perfect compassion and wisdom, will most gladly and skilfully help all beings in whatever ways possible – as according to their karmic conditions. E.g. Mindfulness of Amitabha Buddha can have healing effects too, while mindfulness of Medicine Buddha can lead to birth in Amitabha Buddha’s Pure Land too (as we shall see later). Note that Amitabha Buddha is also known as ‘The Unsurpassable Great King Of Healers’ (无上大医王). Due to impending death, there is also a limit to healing in Samsara, while complete and permanent healing is by reaching Pure Land.
If we study the ‘Sutra Of The Meritorious Virtues Of The Fundamental Vows Of Medicine Master Vaidurya [Lapis Lazuli] Light Tathagata’ (药师琉璃光如来本愿功德经) or simply ‘Medicine Master Sutra’ (药师经), as taught by Sakyamuni Buddha (some time after teaching Amitabha Sutra), we will realise that there is mention of Amitabha Buddha and his Pure Land (Of Ultimate Bliss) in it. The central importance of Amitabha Buddha’s Pure Land is thus emphasised by being ‘cross-marketed or publicised’ – even in this relatively short sutra, which focuses mainly on Medicine Buddha’s Pure Land. Let us look at such excerpts from the sutra.)
Excerpt: ‘Moreover, Manjusri [Bodhisattva], that World-Honoured One, the Medicine Master Vaidurya Light Tathagata [Medicine Buddha], when practising the Bodhisattva path, of [his] great vows given rise to, and that Buddha land’s adornment of meritorious virtues, I [Sakyamuni Buddha], if for one kalpa, or more than one kalpa, am not able to exhaustively speak of them. Nevertheless, that Buddha Land [Medicine Buddha’s Pure Land], is always pure, without women [i.e. without gender differences, tension or sexism], also without evil destinies [of the three lower realms], and sounds of suffering. With vaidurya as ground, and golden cords lining its paths, the cities, towers, palaces, pavilions, studios, windows, and nets, are all with the seven treasures composed. Also like the Western Land Of Ultimate Bliss [of Amitabha Buddha’s Pure Land], its adornments of meritorious virtues, are equal and without differences .’
Comments: The Buddha listed some physical attributes of Medicine Buddha’s Pure Land, which parallel that of Amitabha Buddha’s Pure Land. He emphasises that both Pure Lands are essentially pure and identical (other than possibly some minor characteristics, as according to particular causal ‘architectural’ visions). This is so as all Pure Lands coexist ‘collectively’ on the same ‘plane’ or ‘dimension’, based upon the same equanimous state of mind and perfect meritorious virtues and wisdom. In other words, all Pure Lands are equally pure as they are shaped by the same fully enlightened state of mind.
It is worth noting that Manjusri Bodhisattva, who personifies perfect wisdom, was also present in the assemblies which the Buddha taught the three main Pure Land Sutras (Amitabha Sutra, Immeasurable Life Sutra and Contemplation Sutra), hinting that knowledge of the Pure Land teachings is required for great wisdom (or for perfecting wisdom), and that it takes great wisdom (or is greatly wise) to pay attention to the profoundly skilful Pure Land teachings. As such, the Pure Land teachings are not just based upon faith and compassion, or merely for those lacking in wisdom or intelligence. They are suitable for those of all mental capacities, from the lowest to the highest.
Excerpt: ‘Moreover, Manjusri, if there are the fourfold assembly, of bhiksus [monks], bhiksunis [nuns], Upasakas [laymen], Upasikas [laywomen], the remaining purely faithful good men and good women and others, who are able to receive and uphold the Eight-Part Fasting Precepts, if passing one year, or repeatedly for three months receive and uphold, learn and live with them, with these good roots, aspire to be born in the Western Land Of Ultimate Bliss, where the Immeasurable Life Buddha [i.e. Amitabha Buddha] is to hear the right Dharma, those yet uncertain [i.e. undecided],
if hearing the name of the World-Honoured One, Medicine Master Vaidurya Light Tathagata [Yaoshi Liuliguang Rulai; Medicine Buddha], when approaching the end of life, there will be eight great Bodhisattvas, with their names called:  Namo [i.e. homage to and refuge for life in] Manjusri Bodhisattva,  Namo Contemplator Of The World’s Sounds Bodhisattva [Guanyin Bodhisattva],  Namo Attainment Of Great Strength Bodhisattva [Dashizhi Bodhisattva],  Namo Inexhaustible Intention Bodhisattva,  Namo Treasure Sandalwood Flower Bodhisattva,  Namo Medicine King Bodhisattva,  Namo Medicine Superior Bodhisattva, [and]  Namo Maitreya Bodhisattva [Mile Bodhisattva]. These eight great Bodhisattvas, riding upon space will come, to show them the path, to immediately in that [Pure] Land [of Amitabha Buddha], within that world’s all kinds of varicoloured treasure [lotus] flowers, spontaneously manifest birth.’
Comments: If those who aspire to be reborn in Amitabha Buddha’s Pure Land are lacking in strong resolution on the deathbed, even mindfulness of the (name of) Medicine Buddha (by sound, or thought; which is a mental sound) will aid successful birth there – even though it is not Amitabha Buddha’s name that is heard! The assistance is possible as there are great Bodhisattvas (e.g. Guanyin and Dashizhi: Amitabha Buddha’s chief assistant Bodhisattvas et al.) who are mindful of those who are mindful of either Amitabha or Medicine Buddha, who will safely redirect them to Amitabha Buddha’s Pure Land. This speaks of the great priority of aiding birth in Amitabha Buddha’s Pure Land – due to its excellence. It can be seen here that the Buddhas and Bodhisattvas compassionately, skilfully and selflessly cooperate with one another to guide beings to be reborn in the Pure Lands they wish to go, even if with some hesitation.
Of course, if one is mindful of Medicine Buddha to be reborn in his Pure Land, there should not be redirection elsewhere. However, it is worth noting that the sutra does NOT mention Medicine Buddha or the above Bodhisattvas personally receiving aspirants to reach his Pure Land, while the sutras associated with Amitabha Sutra DOES state Amitabha Buddha, and/or his chief assistant Bodhisattvas, along with more Bodhisattvas coming forth to receive and guide aspirants to reach his Pure Land. This is a reason why it is interpreted that it is harder to reach Medicine Buddha’s Pure Land. Reaching Amitabha Buddha’s Pure Land allows ease of accessing all other Pure Lands, including Medicine Buddha’s Pure Land, as stated in the Amitabha Sutra (阿弥陀经) –
Excerpt: ‘The beings of that [Pure] Land [Of Ultimate Bliss, of Amitabha Buddha] often, early in the morning, each with the hem of their clothes, fill many wonderful flowers, to make offerings to a hundred thousand kotis [1 koti: 10 million] of Buddhas in other directions. Promptly by mealtime, they return to the original land, to eat and practise walking meditation.’
Comments: This is possible because, as mentioned, all Pure Lands coexist on the same spiritual ‘plane’ or ‘dimension’, while Buddhas can compassionately empower to enable their Pure Lands’ inhabitants to reach one another and meet more Buddhas. This inter-accessibility via Amitabha Buddha’s Pure Land is explicitly clear.
The above passages on how Medicine Buddha connects us to Amitabha Buddha also reminds that, as mentioned in the Amitabha Sutra, the teachings related to Amitabha Buddha are universally protected and kept in mind (i.e. being mindful of, for teaching) by all Buddhas of all directions, including Medicine Buddha, even though he resides to the East of our world system, which is even farther East from Amitabha Buddha’s Western Pure Land!