Deep learning has made significant advancements and breakthroughs in medical image recognition. However, the clinical reality is complex and multifaceted, with patients often suffering from multiple intertwined diseases, not all of which are equally common, leading to medical datasets that are frequently characterized by multi-labels and a long-tailed distribution. In this paper, we propose a method involving label decoupling and reconstruction (LDRNet) to address these two specific challenges. The label decoupling utilizes the fusion of semantic information from both categories and images to capture the class-aware features across different labels. This process not only integrates semantic information from labels and images to improve the model's ability to recognize diseases, but also captures comprehensive features across various labels to facilitate a deeper understanding of disease characteristics within the dataset. Following this, our label reconstruction method uses the class-aware features to reconstruct the label distribution. This step generates a diverse array of virtual features for tail categories, promoting unbiased learning for the classifier and significantly enhancing the model's generalization ability and robustness. Extensive experiments conducted on three multi-label long-tailed medical image datasets, including the Axial Spondyloarthritis Dataset, NIH Chest X-ray 14 Dataset, and ODIR-5K Dataset, have demonstrated that our approach achieves state-of-the-art performance, showcasing its effectiveness in handling the complexities associated with multi-label and long-tailed distributions in medical image recognition.