However, in the Tendai Sect (Tendai Esoteric Buddhism) which traditionally had close ties with the Emperor's family, it was sometimes linked with the Emperor, a king of the eastern country, because it was the founder of a religious sect in Toho joruri sekai.
しかし伝統的に天皇家と結びつきが強かった天台宗（天台密教）では、薬師如来が東方浄瑠璃世界の教主であることから、東の国の王たる天皇と結び付けられもした。