The Bhaishajyaguru Sutra that supplies this mantra survives independently in Sanskrit fragments, in Chinese translation from as early as the fourth to seventh centuries CE, and in Tibetan translation compiled later still, so three distinct canonical transmission lines carry the Medicine Buddha material into three different Buddhist worlds, East Asian Mahayana practice built on the Chinese textual line and Tibetan Vajrayana practice built on the Tibetan line, with some cross influence but genuinely separate manuscript histories behind each. The mantra recited today in Tibetan Buddhist contexts, and given in this atlas, follows Tibetan pronunciation conventions for the underlying Sanskrit, which is why bekandze looks so different from what a Sanskrit dictionary would predict for the word it renders, generally reconstructed as related to bhaishajya, medicine, run through Tibetan phonetic adaptation.
Translators disagree about how much of the mantra is meaningful Sanskrit vocabulary and how much is formulaic repetition without separable grammatical content, a question that recurs across many longer tantric mantras and is not unique to this one. The repeated bekandze, escalating to maha bekandze, great bekandze, is read by some commentators as an intensifying address to the Medicine Buddha under different aspects of his healing power, while others treat the repetition as primarily rhythmic and devotional rather than as carrying three grammatically distinct meanings, similar to disputes elsewhere in Vajrayana mantra scholarship about how far seed syllable style repetition should be parsed as ordinary sentence grammar at all.