Purpose/Significance To construct an ethical governance system of generative medical artificial intelligence (GMAI) that is adapted to the healthcare context in China, and to provide theoretical support and practical references for promoting the high-quality development of medical AI.Method/Process Based on the characteristics of the healthcare system, data ecosystem, and cultural context in China, the differences in GMAI governance scenarios between China and other countries are compared. A three-dimensional collaborative governance framework (technology, institution, and society) is established. Combined with a detailed analysis of the responsibilities of multiple stakeholders including patients, physicians, and technology platforms, key practical pathways such as federated learning, hierarchical supervision, and ethical sandboxes are elaborated. Result/Conclusion A three-dimensional collaborative governance scheme for GMAI clinical ethics is proposed:technological security guarantee, dynamic institutional regulation, multi-stakeholder social governance. This scheme effectively responds to the specific needs of GMAI governance in the Chinese context and provides replicable Chinese practices for global medical AI ethical governance.