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Polylactic acid (PLA) fabrics exhibit significant sunlight reflectivity and high emissivity within the atmospheric window, making them suitable as the foundational material for this study. This research involves the modification of one side of the fabric with hydrophilic agents and titanium dioxide (TiO2), while the opposite side is treated with MXene and subsequently coated with polydimethylsiloxane (PDMS) to inhibit oxidation of the MXene. Through these surface modifications, a thermal management fabric based on PLA was successfully developed, capable of passively regulating temperature in response to environmental conditions and user requirements. The study discusses the optimal concentrations of TiO2 and MXene for the fabric, and characterizes and evaluates the functional surface of the PLA. Surface morphology analyses and tests indicate that the resulting functional PLA fabrics possess excellent ultraviolet (UV) resistance, favorable air permeability, high sunlight reflectivity on the TiO2-treated side, and superior photothermal conversion capabilities on the MXene-treated side. Furthermore, photothermal effect tests conducted under a light intensity of 1000 W/m2 reveal that the MXene-treated fabric exhibits a heating effect of approximately 25 °C, while the TiO2-treated side demonstrates a cooling effect exceeding 5 °C. This study developed PLA functional fabrics with heating and cooling capabilities.