Medical reports with substantial information can be naturally complementary to medical images for computer vision tasks, and the modality gap between vision and language can be solved by vision-language matching (VLM). However, current vision-language models distort the intra-model relation and mainly include class information in prompt learning that is insufficient for segmentation task. In this paper, we introduce a Bi-level class-severity-aware Vision-Language Graph Matching (Bi-VLGM) for text guided medical image segmentation, composed of a word-level VLGM module and a sentence-level VLGM module, to exploit the class-severity-aware relation among visual-textual features. In word-level VLGM, to mitigate the distorted intra-modal relation during VLM, we reformulate VLM as graph matching problem and introduce a vision-language graph matching (VLGM) to exploit the high-order relation among visual-textual features. Then, we perform VLGM between the local features for each class region and class-aware prompts to bridge their gap. In sentence-level VLGM, to provide disease severity information for segmentation task, we introduce a severity-aware prompting to quantify the severity level of retinal lesion, and perform VLGM between the global features and the severity-aware prompts. By exploiting the relation between the local (global) and class (severity) features, the segmentation model can selectively learn the class-aware and severity-aware information to promote performance. Extensive experiments prove the effectiveness of our method and its superiority to existing methods. Source code is to be released.