In recent years, there have been significant advancements in deep learning for medical image analysis, especially with convolutional neural networks (CNNs) and transformer models. However, CNNs face limitations in capturing long-range dependencies while transformers suffer high computational complexities. To address this, we propose RWKV-UNet, a novel model that integrates the RWKV (Receptance Weighted Key Value) structure into the U-Net architecture. This integration enhances the model's ability to capture long-range dependencies and improve contextual understanding, which is crucial for accurate medical image segmentation. We build a strong encoder with developed inverted residual RWKV (IR-RWKV) blocks combining CNNs and RWKVs. We also propose a Cross-Channel Mix (CCM) module to improve skip connections with multi-scale feature fusion, achieving global channel information integration. Experiments on benchmark datasets, including Synapse, ACDC, BUSI, CVC-ClinicDB, CVC-ColonDB, Kvasir-SEG, ISIC 2017 and GLAS show that RWKV-UNet achieves state-of-the-art performance on various types of medical image segmentation. Additionally, smaller variants, RWKV-UNet-S and RWKV-UNet-T, balance accuracy and computational efficiency, making them suitable for broader clinical applications.