Dolomite bodies in the Middle Permian of the central Sichuan Basin have been reported as favorable natural gas reservoirs. The Middle Permian dolomite consists of three types of recrystallized dolomite (Rd1, Rd2, and Rd3) and one type of dolomite cement (Sd). Rd1 might be formed as the primary mineral along the calcite in the original sea-water. Its δ13C value and 87Sr/86Sr ratio, consistent with those of marine limestone and Permian seawater, support that the dolomitizing fluid for Rd1 was Permian seawater preserved in the strata. Rd2 consists of fine to medium (50 μm to 250 μm) and planar to curved crystals. Geochemical indicators (slightly high 87Sr/86Sr ratio, similar rare earth element patterns, negative δ18O, slightly high salinity) confirm that the dolomitizing fluid of Rd2 was mainly Permian seawater during shallow burial, with a small number of hydrothermal fluids. Rd3 and Sd are featured by very large (>250 μm), curved crystals, and high-temperature, high-salinity, and obviously positive Eu anomalies, suggesting that their diagenetic fluids were mainly hydrothermal fluids from deep. Additionally, inherited carbon sources and the 87Sr/86Sr ratios of some samples fall within the range of Permian seawater distribution, confirming the contribution of Permian seawater. ELIP activity caused the formation of this dolomite through the mixing of seawater and hydrothermal fluids. The main fluid circulation channels were activated basement faults, epigenetic karst pores, and shallowly buried high-permeability strata. During the peak period of ELIP activity, the continuous upwelling of deep hydrothermal fluids led to the continuous formation of Rd2, Rd3, and Sd. The dolomitization fluid of Rd2 was mainly composed of seawater and featured a certain lateral extension, which was away from faults. Rd3 and Sd are mainly distributed along the fault system, and excessive dolomitization caused by the hydrothermal activity, to some extent, inhibited the lateral movement of hydrothermal fluids. This study provides a good example for exploring the genetic mechanism and distribution pattern of structurally controlled dolomites under a volcanic activity background.