This paper elaborated on the dilemmas and key issues in the construction of the medical?prevention coordination of county medical alliances in China. By using the analysis framework of the symbiosis theory， the authors analyzed the symbiosis elements of medical?prevention coordination in county medical alliances from the aspects of symbiosis unit， symbiosis matrix， symbiosis environment and symbiosis mode. In addition， strategies and optimal paths were explored to establish the efficient operation of medical?prevention coordination in China’s county medical alliances， such as ensuring the coordinated development of symbiotic units， laying a solid foundation for symbiotic matrix， improving the symbiotic environment of policies and system， and creating a mutually beneficial and symmetrical symbiotic mode.