Aligning Large Language Models (LLMs) with human preferences is critical, yet traditional fine-tuning methods are computationally expensive and inflexible. While test-time alignment offers a promising alternative, existing approaches often rely on distorted trajectory-level signals or inefficient sampling, fundamentally capping performance and failing to preserve the generative diversity of the base model. This paper introduces LLMdoctor, a novel framework for efficient test-time alignment that operates via a patient-doctor paradigm. It integrates token-level reward acquisition with token-level flow-guided preference optimization (TFPO) to steer a large, frozen $\textit{patient}$ LLM with a smaller, specialized $\textit{doctor}$ model. Unlike conventional methods that rely on trajectory-level rewards, LLMdoctor first extracts fine-grained, token-level preference signals from the patient model's behavioral variations. These signals then guide the training of the doctor model via TFPO, which establishes flow consistency across all subtrajectories, enabling precise token-by-token alignment while inherently preserving generation diversity. Extensive experiments demonstrate that LLMdoctor significantly outperforms existing test-time alignment methods and even surpasses the performance of full fine-tuning approaches like DPO.