Class imbalance poses a significant challenge in semi-supervised medical image segmentation (SSLMIS). Existing techniques face problems such as poor performance on tail classes, instability, and slow convergence speed. We propose a novel Gradient-Aware (GA) method, structured on a clear paradigm: identify extrinsic data-bias → analyze intrinsic gradient-bias → propose solutions, to address this issue. Through theoretical analysis, we identify the intrinsic gradient bias instigated by extrinsic data bias in class-imbalanced SSMIS. To combat this, we propose a GA loss, featuring GADice loss, which leverages a probability-aware gradient for absent classes, and GACE, designed to alleviate gradient bias through class equilibrium and dynamic weight equilibrium. Our proposed method is plug-and-play, simple yet very effective and robust, exhibiting a fast convergence speed. Comprehensive experiments on three public datasets (CT&MRI, 2D&3D) demonstrate our method's superior performance, significantly outperforming other SOTA of SSLMIS and class-imbalanced designs (e.g. + 17.90% with CPS on 20% labeled Synapse). Code is available at *.