Rolling bearings are crucial parts of primary mine fans. In order to guarantee the safety of coal mine production, primary mine fans commonly work during regular operation and are immediately shut down for repair in case of failure. This causes the sample imbalance phenomenon in fault diagnosis (FD), i.e., there are many more normal state samples than faulty ones, seriously affecting the precision of FD. Therefore, the current study presents an FD approach for the rolling bearings of primary mine fans under sample imbalance conditions via symmetrized dot pattern (SDP) images, denoising diffusion probabilistic models (DDPMs), the image generation method, and a convolutional neural network (CNN). First, the 1D bearing vibration signal was transformed into an SDP image with significant characteristics, and the DDPM was employed to create a generated image with similar feature distributions to the real fault image of the minority class. Then, the generated images were supplemented into the imbalanced dataset for data augmentation to balance the minority class samples with the majority ones. Finally, a CNN was utilized as a fault diagnosis model to identify and detect the rolling bearings’ operating conditions. In order to assess the efficiency of the presented method, experiments were performed using the regular rolling bearing dataset and primary mine fan rolling bearing data under actual operating situations. The experimental results indicate that the presented method can more efficiently fit the real image samples’ feature distribution and generate image samples with higher similarity than other commonly used methods. Moreover, the diagnostic precision of the FD model can be effectively enhanced by gradually expanding and enhancing the unbalanced dataset.